![]() ![]() M tuberculosis, the source of tuberculosis (TB), can cause tuberculous meningitis (TBM). 3 In all cases of chronic meningitis, an HIV test should be performed, since many of the infectious causes are more common in HIV-infected individuals and the treatment course may vary in HIV-positive patients. 1 Infectious Causesīacterial: Neisseria meningitides and Streptococcus pneumoniae account for 37% to 93% of acute bacterial meningitis cases, whereas the most common cause of chronic meningitis is Mycobacterium tuberculosis (40%-60%). Symptom treatment and supportive therapy should be implemented, and the presence of complications, such as seizures or hydrocephalus, warrants appropriate therapy. If a patient is stable and there is no presumptive cause, specific treatment should wait until initial test results are known. Empiric therapy for a presumed cause should be initiated if a patient appears ill or is deteriorating. Treatment of chronic meningitis requires a comprehensive workup. 6 In a small number of patients, meningeal biopsies are helpful for diagnosing chronic meningitis. 9,10ĬT and MRI can exclude conditions such as abscesses, tumors, and nonmeningeal infections. 3 Typical CSF findings in patients with and without meningitis are given in TABLE 1. CSF neutrophils are elevated in 90% of acute meningitis cases, and lymphocytes are elevated in only about 10% of cases. Culture results are helpful, but usually are not available in a timely manner. Glucose levels may be normal or decreased. Lymphocyte counts are elevated in more than 90% of cases elevated neutrophil counts occur in fewer than 10% of cases. Lumbar puncture is important in the diagnosis of chronic meningitis, although CSF findings are nonspecific. 1,6,7 The duration of symptoms in chronic meningitis generally ranges from 17 months to 43 months. 3 Patients with acute meningitis typically present abruptly with severe symptoms, whereas patients with chronic meningitis typically present more gradually with symptoms that may fluctuate, worsen, or remain static. The classic triad of fever, headache, and neck stiffness occurs in about 85% of patients diagnosed with acute bacterial meningitis, but in only about 10% of patients with chronic meningitis. 1 Symptoms are nonspecific and may include headache, fever, neck pain, ataxia, lethargy, nausea, and alterations of alertness and cognitive function. The approach to diagnosis includes many factors, such as symptoms medical, medication, and exposure history physical examination CSF profile and other tests (e.g., blood testing, cultures, neuroimaging, chest radiograph). 1,6,7 In up to one-third of patients with chronic meningitis, no cause is found. Noninfectious causes include, but are not limited to, sarcoidosis, Behçet's disease (BD), Wegener's granulomatosis (WG), systemic lupus erythematosus (SLE), medications, and neoplasms. Infectious causes are bacteria, mycobacteria, fungi, viruses, and parasites. There are numerous causes of chronic meningitis, including infectious, inflammatory, neoplastic, and toxic exposures. ![]() 5 This article will concentrate on the causes and treatment of chronic meningitis. Chronic meningitis may not be well known to pharmacists, although published cases date to the early 1970s. 3 Some individuals with chronic meningitis seek medical attention before the symptoms or signs have been present for 4 weeks, so it is important to differentiate these patients from those who are recovering from acute or recurrent meningitis. 1,3,4 Chronic meningitis affects about 10% of patients diagnosed with meningitis. ![]() 2 Recurrent meningitis involves the occurrence of multiple acute episodes, each of which is less than 4 weeks in duration. 1 Chronic meningitis is defined as meningeal inflammation that persists for more than 4 weeks, whereas acute meningitis lasts for less than 4 weeks. Meningitis, which is an inflammation of the brain and spinal-cord membranes (meninges), is generally caused by microorganisms or other irritants in the cerebrospinal fluid (CSF). ![]()
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