Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched...Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.展开更多
BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a ...BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.展开更多
文摘Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.
文摘BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.
