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Meningitis, Encephalitis Rare After Heart Transplants

But diagnosis is difficult due to lack of classic symptoms

THURSDAY, Oct. 11 (HealthDay News) -- Patients who have undergone heart transplant face a rare but potentially devastating risk of central nervous system infections that are difficult to diagnose, according to a report published online Oct. 8 in the Archives of Neurology.

Diederik van de Beek, M.D., Ph.D., of the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues conducted a study of 315 heart transplant patients who underwent their transplant surgery between 1988 and 2006. Of these, eight (3 percent) developed infections of the central nervous system.

All eight infections were diagnosed within four years of transplantation, with acute or subacute confusion and headache the most common symptoms, noted in 88 percent of cases. The classic symptoms of central nervous system infections such as fever and neck stiffness were often absent, and cerebrospinal fluid examinations usually did not reveal the infection.

Three patients were diagnosed with cryptococcal meningitis, two with progressive multifocal leukoencephalopathy, two with varicella-zoster virus encephalitis and one with Aspergillus fumigatus infection.

"Our study emphasizes a shift in infectious causes of central nervous system infections during the last two decades," the authors write. "Because the mortality and morbidity rates are high, aggressive diagnosis and intervention are warranted in heart transplant recipients with suspected central nervous system infection."

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