Chronic and Subacute Meningitis

Abstract

Meningitis is defined as inflammation involving the meninges of the brain and spinal cord. Meningitis can be categorized as acute, subacute, or chronic based on duration of inflammation. This article focuses on the most common causes of subacute and chronic meningitis. Chronic meningitis is commonly defined as inflammation evolving during weeks to months without resolution of CSF abnormalities. Determining the time course of meningitis is important for creating a differential diagnosis. Most organisms causing acute meningitis rarely persist more than a few weeks. Although numerous etiologies of subacute and chronic meningitis have been identified, this article focuses on the most common etiologies: (1) infectious, (2) autoimmune, and (3) neoplastic.

A case of tuberculous meningitis

“…5 As seen in our case, clinical signs then progress to include meningeal stiffness, focal deficits, cranial nerve palsies (most commonly the sixth cranial nerve) and eventually increased intracranial pressure leading to alterations in A case of tuberculous meningitis I level of consciousness and mental state. [6][7][8] SIADH is a common but non-specific finding.…”

Clinical Reasoning: A 57-year-old man with unilateral anosmia, papilledema, and meningismus

“…Fungal cultures, acid-fast bacillus smear, and mycobacterial cultures are valuable, but may take weeks to confirm a diagnosis. 5 Histoplasmosis and blastomycosis antigen detection in the urine and CSF is highly sensitive and specific. 5 Coccidiodes may produce peripheral or CSF eosinophilia, which is relatively unusual in other fungal meningitides, and serology and antigen testing may confirm the diagnosis.…”

“…5 Histoplasmosis and blastomycosis antigen detection in the urine and CSF is highly sensitive and specific. 5 Coccidiodes may produce peripheral or CSF eosinophilia, which is relatively unusual in other fungal meningitides, and serology and antigen testing may confirm the diagnosis. 5 India ink staining is inexpensive, but has largely been replaced by cryptococcal antigen testing of CSF, which is highly sensitive and specific.…”

The challenge of treating central nervous system infections

“…Gram staining of CSF has good specificity in bacterial meningitis (up to 97%), but can be negative in 40-75% depending on the concentration of microorganisms [14]. In TBM, sensitivity of Ziehl-Nielsen staining for acid-fast bacilli is only 5-30% [17].…”