Central nervous system infections following bone marrow transplantation: An autopsy report of 27 cases

The authors retrospectively assess the autopsy findings of central nervous system (CNS) infections in marrow transplant recipients. From July 1987 to June 1998, 845 patients at our institution were submitted to bone marrow tr ansplantation (BMT). The CNS of 180 patients was studied through autopsy an d these patients had their medical records reviewed. Twenty-seven (15%) pat ients presented brain parenchyma infection. Fungi were isolated in approxim ately 60% of the cases. Mean survival time was 153 days (0-1,264 days) and the majority of the patients died during the first 3 months after BMT (18 c ases; 67%). Aspergillus sp. were the most prevalent fungi (similar to 30%), followed by Candida sp. infection (similar to 18%). There was one case of Fusarium sp. infection and two cases of unidentified fungus. All patients w ith fungal infections had documented involvement at widespread sites. Toxop lasma gondii encephalitis was demonstrated in 8 patents (similar to 30%). B acterial abscesses were responsible for approximately 11% of the findings. Eleven (41%) of the 27 patients died secondary to cerebral causes. These re sults show that infectious compromise of the CNS following BMT is a highly fatal event, caused mainly by fungi and T. gondii. Furthermore, they provid e a likely guide to the possible causes of brain abscesses following BMT.