Central nervous system infections in cancer patients
INTRODUCTION Central nervous system (CNS) infections remain a source of significant morbidity and mortality among cancer patients, despite the evolution of effective prophylactic regimens and better antimicrobials for active infection. With the past decade’s introduction of more intensive immunosuppressive regimens and novel biologic response modifiers, as well as refinement of hematopoietic growth factor support of chemotherapy, longer survival has been achieved along with a change in the spectrum of infections in increasing types of vulnerable populations. For example, since the 1980s, the numbers of patients at risk for CNS infection after nontransplant hematologic malignancy treatment have almost reached levels encountered in recipients of hematopoietic stem cell transplantation (HSCT) and nosocomial invasive fungal disease has doubled, while better control of bacteria and viruses has reduced the incidence of infections from these organisms (1). Rapid diagnosis is essential if patients are to experience meaningful survival without serious neurologic sequelae, a problem in at least one third of long-term pediatric cancer survivors of CNS infections (2).