Recurrent meningitis: Difference between revisions
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*Infections |
*Infections |
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**Viral: [[HSV-2]] (Mollaret's disease; most common cause); [[HSV-1]]; [[EBV]] |
**Viral: [[HSV-2]] (Mollaret's disease; most common cause); [[HSV-1]]; [[EBV]] |
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**Bacterial: [[Streptococcus pneumoniae]], [[Haemophilus influenzae]], [[Neisseria meningitidis]], [[Staphylococcus aureus]], [[Escherichia coli]] |
**Bacterial: [[Streptococcus pneumoniae]], [[Haemophilus influenzae]], [[Neisseria meningitidis]], [[Staphylococcus aureus]], and [[Escherichia coli]] (particularly in children with lumbosacral malformations) |
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**Fungal: [[Cryptococcus neoformans]], [[Candida]], [[Histoplasma capsulatum]], [[Coccidioides immitis]], [[Blastomyces dermatitidis]] |
**Fungal: [[Cryptococcus neoformans]], [[Candida]], [[Histoplasma capsulatum]], [[Coccidioides immitis]], [[Blastomyces dermatitidis]] |
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**Parasitic: [[Echinococcus]], [[Strongyloides stercoralis]], [[Toxoplasma gondii]] |
**Parasitic: [[Echinococcus]], [[Strongyloides stercoralis]], [[Toxoplasma gondii]] |
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**Immunosuppression: [[methotraxate]], [[azathioprine]], [[TNF-alpha inhibitors]] ([[adalimumab]], [[infliximab]], [[etanercept]]) |
**Immunosuppression: [[methotraxate]], [[azathioprine]], [[TNF-alpha inhibitors]] ([[adalimumab]], [[infliximab]], [[etanercept]]) |
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**Other: [[IVIg]] |
**Other: [[IVIg]] |
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**[[Asplenia]] |
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**[[Hypogammaglobulinemia]] |
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*Inflammatory/autoimmune |
*Inflammatory/autoimmune |
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**[[SLE]] |
**[[SLE]] |
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**[[Granulomatosis with polyangiitis]] |
**[[Granulomatosis with polyangiitis]] |
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**[[Rheumatoid arthritis]] |
**[[Rheumatoid arthritis]] |
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== Risk Factors == |
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** Congenital: [[dermal sinus tract]], [[Neural tube defect|neural tube defects]] (including [[spina bifida]], [[encephalocele]]), [[Mondini dysplasia]] |
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** Acquired: skull base surgery, head injury |
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* Immunodeficiency |
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** [[IgG subclass deficiency]] |
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*** Terminal complement deficiency (C5-C9) specifically increases risk of [[meningococcus]] |
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*** C2-C6 deficiencies are associated with [[pneumococcus]] and [[meningococcus]] |
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** [[Agammaglobulinemia]] |
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** [[Common variable immunodeficiency]] (CVID) |
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** [[HIV]] |
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** [[Asplenia]]/[[hyposplenia]]: [[sickle cell disease]], [[splenectomy]], trauma |
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**Immunosuppression following transplant |
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*Chronic parameningeal infections, including [[sinusitis]], [[mastoiditis]], [[otitis media]], and [[osteomyelitis]] |
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==Specific Patients== |
==Specific Patients== |
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Revision as of 15:47, 18 September 2025
Etiologies
- Infections
- Viral: HSV-2 (Mollaret's disease; most common cause); HSV-1; EBV
- Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, and Escherichia coli (particularly in children with lumbosacral malformations)
- 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
- Inflammatory/autoimmune
Risk Factors
- Anatomic defects
- Congenital: dermal sinus tract, neural tube defects (including spina bifida, encephalocele), Mondini dysplasia
- Acquired: skull base surgery, head injury
- Immunodeficiency
- IgG subclass deficiency
- Complement deficiency, including properdin deficiency, terminal complement deficiency, and use of eculizumab
- Terminal complement deficiency (C5-C9) specifically increases risk of meningococcus
- C2-C6 deficiencies are associated with pneumococcus and meningococcus
- Agammaglobulinemia
- Common variable immunodeficiency (CVID)
- HIV
- Asplenia/hyposplenia: sickle cell disease, splenectomy, trauma
- Immunosuppression following transplant
- Chronic parameningeal infections, including sinusitis, mastoiditis, otitis media, and osteomyelitis
Specific Patients
Terminal Complement Deficiency
- Prone to recurrent neisserial infections
Hypogammaglobulinemia
- Can develop chronic meningoencephalitis, primarily cause by:
Further Reading
- Recurrent Meningitis. Curr Pain Headache Rep. 2017;21(33). doi: 10.1007/s11916-017-0635-7
