Table 2.

Common central nervous system infections postrenal transplantation

Disease	Organism		Diagnosis	Treatment
Meningitis: headache, fever, altered mental sensorium, cranial nerve palsy, neck rigidity	Bacterial	Listeria monocytogenes, Haemophilus influenza, Neisseria meningitides, and Streptococcus pneumonia	Pleocytosis of CSF, increased protein, and reduced glucose	Antibiotics based on culture and sensitivity
			Gram stain positive
			Rapid antigen latex agglutination test
			PCR for N. meningitides and S. pneumoniae
		Mycobacterium tuberculosis	CSF positive for acid-fast bacilli	Antitubercular therapy
			Raised adenosine deaminase
			Raises total leukocyte with lymphocyte predominance, low glucose, increased protein
	Fungal	CSF shows lymphocytic or monocytic pleocytosis, elevated protein, and low glucose
		Cryptococcus neoformans	Test CSF for cryptococcal antigen, stain with India ink	I.V. amphotericin B and fluconazole
		Aspergillus spp.	Galactomannan assay	Voriconazole, amphotericin B
			(1,3)-β-d-glucan assay
			DNA PCR assay in serum or BAL samples
			Branching, septate hyphae
		Candida spp.	Pseudohyphae and budding yeast	Fluconazole, echinocandin, or amphotericin B
Encephalitis: headache, seizures, focal neurologic deficit, altered mental status, cranial nerve palsy		Cytomegalovirus	PCR-positive CSF	Ganciclovir
			MRI scan showing enhancing ventriculoencephalitis
		Varicella zoster virus	MRI scan showing mixed lesions (ischemic or hemorrhagic infarcts)	Acyclovir, ganciclovir
			Demyelinatinag lesions at gray-white matter junction
			PCR-positive CSF
		Human herpes virus 6	PCR-positive CSF	Ganciclovir or foscarnet
			Focal or diffuse encephalitis
Focal brain infections: headaches, seizures, and focal neurologic deficits	Parasite	Toxoplasma gondii	MRI scan showing multiple ring-enhancing lesions, predilection to basal ganglia, thalami, and corticomedullary junction	Pyrimethamine and folinic acid
	Bacterial	Nocardia asteroides	Gram-positive, weakly acid-fast, branching rod-shaped bacteria	Trimethoprim/sulfamethoxazole and neurosurgical intervention
			MRI scan showing single or multiple lesions with contrast enhancement and little mass effect
	Fungal	Mucormycosis, aspergillosis, Candida, Cryptococcosis	Begin with paranasal sinuses, producing periorbital edema and may invade the intracavernous carotid artery, cerebral artery emboli, mycotic aneurysm, and stroke	Antifungals

CSF, cerebrospinal fluid; I.V., intravenous; BAL, bronchoalveolar lavage; MRI, magnetic resonance imaging.