Meningitis, Recurrent

[Curr Pain Headache Rep 2017;21:33]

- Etiology of recurrent meningitis:

• infections
• malignancy
• benign tumours
• medications
• autoimmune diseases, e.g. Behcet’s, SLE, Sjogren’s, sarcoidosis

- Recurrent meningitis requires evaluation of underlying cause:

• congenital anatomical defect (epidermoid/dermoid cysts, neural tube defects, asplenia)
• acquired anatomical defect (head injuries, basal skull fracture, malignancy)
• congenital immunodeficiencies (complement deficiency, agammaglobulinemia, IgG subclass deficiency, IRAK 4 deficiency)
• acquired immunodeficiencies - HIV
• chronic parameningeal infections (sinusitis, otitis media, mastoiditis)

NB:

• Anatomical defects most commonly cause recurrent S. pneumoniae or H. influenzae meningitis.
• Complement deficiency is associated with recurrent N. meningitidis meningitis. Vaccination for S. pneumoniae, N. meningitidis, H. influenzae recommended for asplenia or complement deficiency.

- For chronic meningitis, recommend syphilis and Lyme serology. Consider TB.

Viral – typically self-limiting:

Enterovirus

Herpes simplex virus 2 (HSV2) (Mollaret's syndrome)

Varicella zoster virus (VZV)

Epstein-Barr virus (EBV)

S. pneumoniae
N. meningitidis
H. influenzae
S. aureus
Enterobacterales
Listeria monocytogenes
Treponema pallidum
Borrelia spp

M. tuberculosis

Fungal:

Cryptococcus neoformans

Cryptococcus gattii

Candida spp

Histoplasma capsulatum

Blastomyces dermatitidis

Coccidioides immitis

Parasitic (rare):

Echinococcus spp

Strongyloides stercoralis

Toxoplasma gondii