Herpesvirus-Associated Central Nervous System Diseases after Allogeneic Hematopoietic Stem Cell TransplantationReport as inadecuate




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Herpesvirus infections of the central nervous system CNS are associated with encephalitis-myelitis and lymphoproliferative diseases in immunocompromised individuals. As of now, data of herpesvirus-associated CNS diseases in transplant recipients is limited. Hence, in this prospective study, we investigated the incidence of herpesvirus-associated CNS diseases and explored the diagnosis of these diseases in 281 allogeneic hematopoietic stem cell transplantation allo-HSCT recipients. Herpesvirus-DNA and cerebrospinal fluid CSF cells were sampled from 58 recipients with herpesvirus-associated diseases or with unexplainable CNS manifestations. Results showed that 23 patients were diagnosed as herpesvirus-associated CNS diseases, including 15 Epstein-Barr virus EBV-associated diseases 4 encephalitis and 11 lymphoproliferative diseases, 5 herpes simplex virus type 1 encephalitis, 2 cytomegalovirus encephalitis-myelitis and 1 varicella zoster virus encephalitis. The median time of diseases onset was 65 range 22-542 days post-transplantation. The 3-year cumulative incidence of herpesvirus-associated encephalitis-myelitis and post-transplant lymphoproliferative disorder PTLD was 6.3% ±1.9% and 4.1% ±1.2%, respectively. Of the evaluable cases, CSF cells mainly consisted of CD19+CD20+ B cells 7-11 and had clonal rearrangement of immunoglobulin genes 3-11 in patients with CNS-PTLD. On the contrary, in patients with encephalitis-myelitis, CSF cells were comprised of different cell populations and none of the gene rearrangement was detected. Herpesvirus-associated CNS diseases are common in the early stages of allo-HSCT, wherein EBV is the most frequent causative virus. The immunophenotypic and clonal analysis of CSF cells might be helpful in the differential diagnosis between encephalitis and lymphoproliferative diseases.



Author: Meiqing Wu, Fen Huang, Xinmiao Jiang, Zhiping Fan, Hongsheng Zhou, Can Liu, Qianli Jiang, Yu Zhang, Ke Zhao, Li Xuan, Xiao Zhai,

Source: http://plos.srce.hr/



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