Purpose of Review

This article reviews current epidemiologic trends, clinical presentations, and diagnostic strategies for central nervous system (CNS) infections in human immunodeficiency virus-negative (HIV) patients immunocompromised by their underlying disease or by receipt of immunosuppressive or immunomodulating therapies. Three patient groups are considered: (1) cancer patients; (2) hematopoietic or solid organ transplantation recipients; and (3) patients with autoimmune or inflammatory conditions requiring therapies that alter the host immune response.

Recent Findings

Clinical presentations, associated neuroimaging, and cerebrospinal fluid (CSF) abnormalities differ between immunocompromised and immunocompetent patients. Infections can trigger the emergence of neurotropic antibodies or inflammatory conditions due to treatment with cancer immunotherapies. Unbiased metagenomic assays to identify obscure pathogens help clinicians navigate the increasing range of conditions affecting the growing population of patients with altered immunity.

Summary

Awareness of clinical presentations and disease and drug-specific risks is important for early diagnosis and intervention in these often life-threatening infections and their noninfectious mimes.

中文翻译：

---

免疫功能低下患者的中枢神经系统感染

审查目的

本文回顾了因自身基础疾病或接受免疫抑制或免疫调节疗法而免疫力低下的人类免疫缺陷病毒阴性（HIV）患者的中枢神经系统（CNS）感染的当前流行病学趋势，临床表现和诊断策略。考虑了三个患者组：（1）癌症患者；（2）造血或实体器官移植受者；（3）患有自身免疫或炎性疾病的患者，需要通过改变宿主免疫反应的疗法进行治疗。

最近的发现

免疫功能低下和免疫能力强的患者之间的临床表现，相关的神经影像学检查和脑脊液（CSF）异常有所不同。由于癌症免疫疗法的治疗，感染可触发神经营养性抗体或炎症性疾病的出现。用于鉴定模糊病原体的无偏宏基因组测定法可帮助临床医生应对越来越多的疾病，影响越来越多的免疫力改变的患者。

概括

对于这些经常威胁生命的感染及其非感染性哑剧的早期诊断和干预，对临床表现以及疾病和特定药物风险的意识非常重要。