Recurrent meningitis

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By John E Greenlee MD

This article also discusses Posttraumatic bacterial meningitis and Recurrent bacterial meningitis. -ed.

The term “recurrent meningitis” encompasses a variety of conditions, some of which are life-threatening, some spontaneously remitting, and some representing exacerbations of chronic infections. Recurrent meningitis may, thus, represent repeated episodes of bacterial meningitis, recurrent episodes of viral meningitis, chemical meningitis due to rupture of dermoid or parasitic cysts, or meningitis in response to nonsteroidal or other agents. In some instances, as in protracted cases of meningitis due to Cryptococcus neoformans, what appears to be recurrent meningitis may actually represent periodic exacerbations of a chronic, ongoing infectious process. In this clinical article, Dr. John Greenlee, Professor of Neurology at University of Utah School of Medicine and staff neurologist at the George E Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah, reviews the pathogenesis, clinical features, diagnosis, and treatment of this group of disorders.

Key Points

  • Episodes of recurrent meningitis fall into 2 groups: recurrent bacterial meningitis and recurrent episodes of nonpurulent meningitis.
  • Recurrent bacterial meningitis is most frequently associated with defects in the skull base or spinal cord or with genetic defects in the complement system.
  • Nonbacterial recurrent meningitis has a much wider differential diagnosis and may include viral, fungal, protozoal, or non-infectious processes, as well as conditions such as sarcoid or meningeal reaction to nonsteroidal or other pharmacological agents.