Fungal encephalitis following bone marrow transplantation: Clinical findings and prognosis

Background: Central nervous system fungal infections (FI) are important complications and a cause of mortality in patients who receive hematopoietic stem cell transplantation (HSCT).
Aims: To study the clinical aspects of fungal encephalitis (FE).
Settings and Design: The study was carried out at the HSCT Center of the Hospital de Clνnicas, Federal University of Paranα, Curitiba, Brazil.
Materials and Methods: Clinical records and autopsy reports from patients submitted to HSCT with a diagnosis of FE.
Results: Twelve patients were diagnosed with FE presenting with lowered level of consciousness, hemiparesis and seizures. We were able to identify two subgroups regarding susceptibility to FE: (1) patients with early onset FI and severe leucopoenia, and (2) patients with later onset FI with graft-versus-host disease using immunosuppressive drugs. Eleven of the patients died directly due to the neurological complication, all had post-mortem confirmation of the diagnosis of FI.
Conclusions: These clinical, paraclinical and temporal patterns may provide the opportunity for earlier diagnosis and interventions.

Keywords
Allogeneic hematopoietic stem cell transplantation, A spergillus sp, central nervous system infection, fungal encephalitis, mucormycosis