Recurrent meningitis: Difference between revisions

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Etiologies

Infections
- Viral: HSV-2 (Mollaret's disease; most common cause); HSV-1; EBV
- Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Escherichia coli
- Fungal: Cryptococcus neoformans, Candida, Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis
- Parasitic: Echinococcus, Strongyloides stercoralis, Toxoplasma gondii
Malignancy: leptomeningeal metastaisis from solid malignancy, leukemic meningitis, lymphomatous meningitis
Benign tumours: epidermoid cyst, dermoid cyst, craniopharyngioma
Medications
- NSAIDs: ibuprofen (most common), diclofenac, naproxen, sulindac
- Antibiotics: cotrimoxazole, cephalosporins, amoxicillin, ciprofloxacin
- Antiepileptics: lamotrigine, carbamazepine
- Chemotherapy: cetuximab, intrathecal chemotherapy
- Immunosuppression: methotraxate, azathioprine, TNF-alpha inhibitors (adalimumab, infliximab, etanercept)
- Other: IVIg
Immune defects
- Asplenia
- Hypogammaglobulinemia
- Complement deficiencies, including properdin deficiency, terminal complement deficiency, and use of eculizumab
Inflammatory/autoimmune

Specific Patients

Terminal Complement Deficiency

Prone to recurrent neisserial infections

Hypogammaglobulinemia

Can develop chronic meningoencephalitis, primarily cause by:
- Enterovirus
- Mycoplasma

@@ Line 1: / Line 1: @@
+==Etiologies==
-==Differential Diagnosis==
+*Infections
+**Viral: [[HSV-2]] (Mollaret's disease; most common cause); [[HSV-1]]; [[EBV]]
+**Bacterial: [[Streptococcus pneumoniae]], [[Haemophilus influenzae]], [[Neisseria meningitidis]], [[Staphylococcus aureus]], [[Escherichia coli]]
+**Fungal: [[Cryptococcus neoformans]], [[Candida]], [[Histoplasma capsulatum]], [[Coccidioides immitis]], [[Blastomyces dermatitidis]]
+**Parasitic: [[Echinococcus]], [[Strongyloides stercoralis]], [[Toxoplasma gondii]]
+*Malignancy: leptomeningeal metastaisis from solid malignancy, leukemic meningitis, lymphomatous meningitis
+*Benign tumours: epidermoid cyst, dermoid cyst, craniopharyngioma
+*Medications
+**NSAIDs: [[ibuprofen]] (most common), [[diclofenac]], [[naproxen]], [[sulindac]]
+**Antibiotics: [[cotrimoxazole]], [[cephalosporins]], [[amoxicillin]], [[ciprofloxacin]]
+**Antiepileptics: [[lamotrigine]], [[carbamazepine]]
+**Chemotherapy: [[cetuximab]], intrathecal chemotherapy
+**Immunosuppression: [[methotraxate]], [[azathioprine]], [[TNF-alpha inhibitors]] ([[adalimumab]], [[infliximab]], [[etanercept]])
+**Other: [[IVIg]]
 *Immune defects
 **[[Asplenia]]
 **[[Hypogammaglobulinemia]]
 **[[Complement deficiencies]], including [[properdin deficiency]], [[terminal complement deficiency]], and use of [[eculizumab]]
+*Inflammatory/autoimmune
-*Parameningeal focus of infection
-*Structural abnormalities
-**Post-neurosurgery
-**[[CSF leak]] or [[CSF fistula]]
-**[[Dermal sinus]]
-**[[Epidermoid cyst]]
-**[[Craniopharyngioma]]
-*Drugs
-**[[TMP-SMX]]
-**[[NSAIDs]]
-**[[IVIg]]
-**OKT3
-**[[Phenytoin]]
-*Infections
-**[[HSV-2]] (Mollaret's disease)
-*Inflammatory
 **[[SLE]]
 **[[Behçet disease]]
+**[[Sarcoidosis]]
+**[[Sjögren syndrome]]
+**[[Vogt-Koyanagi-Harada syndrome]]
+**[[Granulomatosis with polyangiitis]]
+**[[Rheumatoid arthritis]]
 ==Specific Patients==
@@ Line 35: / Line 39: @@
 **[[Enterovirus]]
 **[[Mycoplasma]]
+== Further Reading ==
+* Recurrent Meningitis. ''Curr Pain Headache Rep''. 2017;21(33). doi: [https://doi.org/10.1007/s11916-017-0635-7 10.1007/s11916-017-0635-7]
 [[Category:CNS infections]]