Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis

Abstract

SUMMARY Recurrent bacterial meningitis is a rare phenomenon and generally poses a considerable diagnostic challenge to the clinician. Ultimately, a structured approach and early diagnosis of any underlying pathology are crucial to prevent further episodes and improve the overall outcome for the affected individual. In this article, we are reviewing the existing literature on this topic over the last two decades, encompassing 363 cases of recurrent bacterial meningitis described in 144 publications. Of these cases, 214 (59%) were related to anatomical problems, 132 (36%) were related to immunodeficiencies, and 17 (5%) were related to parameningeal infections. The review includes a detailed discussion of the underlying pathologies and microbiological aspects as well as recommendations for appropriate diagnostic pathways for investigating this unusual entity.

Craniopharyngeal duct: a cause of recurrent meningitis

“…These include anatomical abnormalities, immunodeficiency disorders and chronic parameningeal infections. 1 Anatomical defects may be acquired or congenital. Acquired causes may be as a result of head injury causing CSF fistulae or secondary to neoplasms causing erosion of the skull base.…”

“…1 Although uncommon, a persistent craniopharyngeal duct may serve as a conduit for infective organisms to transcend intracranially. We describe a patient who presented with recurrent meningitis and was subsequently investigated to identify any underlying cause.…”

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

“…When we look at the general causes of recurrent bacterial meningitis, S. pneumoniae was also the leading agent in 72% of the patients in the same study. [3] In another study from our country conducted on fourteen pediatric RBM patients, eight out of the eleven patients (72.7%) with bacterial growth had S. pneumoniae in the culture. In the same study, S. pneumoniae growth was also observed in three patients in whom RBM had developed due to a trauma.…”

“…However, this review did not distinguish between pediatric and adult patients. [3] The majority of the articles on RBM are either case reports or studies conducted on a limited number of patients. The patients are evaluated as a general study group including both pediatric and adult patients.…”

“…[19] In an extensive review, all of the CSF leaks detected through MRI have been surgically verified. [3] In our study, CT cisternography was used to show CSF leaks, which were detected at a high rate.…”