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Chronic meningitis

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Abstract

Chronic meningitis may be caused by a large number of infectious agents, including spirochetes (Treponema pallidum, Borrelia burgdorferi), Mycobacterium tuberculosis, and fungi (primarily Cryptococcus neoformans). The incidence of these specific causes of chronic meningitis has been impacted since the advent of HIV infection, and new information is also available on how this epidemic has affected populations in developing countries of the world. In the area of diagnostics, the development of polymerase chain reaction has been a major advance that has increased our capabilities for identifying etiologic agents (such as M. tuberculosis) that are difficult to culture. Finally, the management of patients with chronic meningitis has evolved, and the availability of new antifungal agents and adjunctive strategies has changed the approach to the patient with cryptococcal meningitis.

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References and Recommended Reading

  1. Katz DA, Berger JR: Neurosyphilis in acquired immunodeficiency syndrome. Arch Neurol 1989, 46:895–898.

    PubMed  CAS  Google Scholar 

  2. Flood JM, Weinstock HS, Guroy ME, et al.: Neurosyphilis during the AIDS epidemic, San Francisco, 1985–1992. J Infect Dis 1998, 177:931–940. This article reviewed cases of neurosyphilis in a population with a high rate of coexisting HIV infection, and demonstrated that symptomatic neurosyphilis was an infrequent event in this patient population.

    PubMed  CAS  Google Scholar 

  3. Hart G: Syphilis tests in diagnostic and therapeutic decision making. Ann Intern Med 1986, 104:368–376.

    PubMed  CAS  Google Scholar 

  4. Steere AC: Lyme disease. N Engl J Med 1989, 321:586–596.

    Article  PubMed  CAS  Google Scholar 

  5. American College of Physicians: Guidelines for laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med 1997, 127:1106–1108.

    Google Scholar 

  6. Tugwell P, Dennis DT, Weinstein A, et al.: Laboratory evaluaton in the diagnosis of Lyme disease. Ann Intern Med 1997, 127:1109–1123. This article is a review of the laboratory diagnosis of Lyme disease, but also reviews 64 reports on the CSF ELISA for the diagnosis of Lyme neuroborreliosis. The results demonstrated that few patients with Lyme disease had positive results on serologic testing of CSF without positive results on serum serologic testing.

    PubMed  CAS  Google Scholar 

  7. Leonard JM, Des Prez RM: Tuberculous meningitis. Infect Dis Clin North Am 1990, 4:769–787.

    PubMed  CAS  Google Scholar 

  8. Kent SJ, Crowe SM, Yung A, et al.: Tuberculous meningitis: a 30-year review. Clin Infect Dis 1993, 17:987–994.

    PubMed  CAS  Google Scholar 

  9. Bonington A, Strang JIG, Klapper PE, et al.: Use of Roche AMPLICOR Mycobacterium tuberculosis PCR in early diagnosis of tuberculous meningitis. J Clin Microbiol 1998, 36:1251–1254. The sensitivity and specificity of this PCR test for the diagnosis of tuberculous meningitis were 60% and 100%, respectively.

    PubMed  CAS  Google Scholar 

  10. Munsiff SS, Walani SR, Driver CR: Outcome of patients with drug-resistant tuberculous meningitis in New York City (NYC), 1992–1996 (abstract 376). Clin Infect Dis 1998, 27:991. This abstract presented preliminary data that HIV-infected patients with multidrug-or rifampin-resistant tuberculous meningitis were more likely to die in the 60 days after collection of CSF than HIVinfected patients with fully susceptible or other resistant isolates.

    Google Scholar 

  11. Schoeman JF, Van Zyl LE, Laubscher JA, et al.: Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 1997, 99:226–231.

    Article  PubMed  CAS  Google Scholar 

  12. Palur R, Rajshekhar V, Chandy MJ, et al.: Shunt surgery for hydrocephalus in tuberculous meningitis: a long term follow up study. J Neurosurg 1991, 74:64–69.

    Article  PubMed  CAS  Google Scholar 

  13. Mathew JM, Rajshekhar V, Chandy MJ: Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome. J Neurol Neurosurg Psych 1998, 65:115–118.

    Article  CAS  Google Scholar 

  14. Powderly WG: Cryptococcal meningitis and AIDS. Clin Infect Dis 1993, 17:837–842.

    PubMed  CAS  Google Scholar 

  15. Moosa MYS, Coovadia YM: Cryptococcal meningitis in Durban, South Africa: a comparison of clinical features, laboratory findings, and outcome for human immunodeficiency virus (HIV)-positive and HIV-negative patients. Clin Infect Dis 1997, 24:131–134.

    PubMed  CAS  Google Scholar 

  16. Heyderman RS, Gangaidzo IT, Hakim JG, et al.: Cryptococcal meningitis in human immunodeficiency virus-infected patients in Harare, Zimbabwe. Clin Infect Dis 1998, 26:284–289.

    Article  PubMed  CAS  Google Scholar 

  17. Bennett JE, Dismukes WE, Duma RJ, et al.: A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. N Engl J Med 1979, 301:126–131.

    Article  PubMed  CAS  Google Scholar 

  18. Dismukes WE, Cloud G, Gallis HA, et al.: Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. N Engl J Med 1987, 317:334–341.

    Article  PubMed  CAS  Google Scholar 

  19. Larsen RA, Leal MAE, Chan LS: Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS: a randomized trial. Ann Intern Med 1990, 113:183–187.

    PubMed  CAS  Google Scholar 

  20. Saag MS, Powderly WG, Cloud GA, et al.: Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. N Engl J Med 1992, 326:83–89.

    Article  PubMed  CAS  Google Scholar 

  21. Van der Horst CM, Saag MS, Cloud GA, et al.: Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med 1997, 337:15–21. In this double-blind multicenter trial, AIDS patients with a first episode of acute cryptococcal meningitis were randomly assigned to treatment with amphotericin B with or without flucytosine for 2 weeks, followed by either fluconazole or itraconazole for 8 weeks. Clinical responses were similar in both groups at 2 and 8 weeks. In a multivariate analysis, the addition of flucytosine during the initial 2 weeks and treatment with fluconazole for the next 8 weeks were independently associated with CSF sterilization.

    Article  PubMed  Google Scholar 

  22. Wong-Beringer A, Jacobs RA, Guglielmo BJ: Lipid formulations of amphotericin B: clinical efficacy and toxicities. Clin Infect Dis 1998, 27:603–618.

    Article  PubMed  CAS  Google Scholar 

  23. Leenders ACAP, Reiss P, Portegies P, et al.: Liposomal amphotericin B (AmBisome) compared with amphotericin B both followed by oral fluconazole in the treatment of AIDS-associated cryptococcal meningitis. AIDS 1997, 11:1463–1471. In a prospective trial comparing liposomal amphotericin B to amphotericin B for the therapy of AIDS-associated cryptococcal meningitis, the median time to CSF sterilization was shorter in the patients treated with liposomal amphotericin B; the time to clinical response and the clinical failure rate did not differ between groups.

    Article  PubMed  CAS  Google Scholar 

  24. Yamaguchi H, Ikemoto H, Watanabe K, et al.: Fluconazole monotherapy for cryptococcosis in non-AIDS patients. Eur J Clin Microbiol Infect Dis. 1996, 15:787–792.

    Article  PubMed  CAS  Google Scholar 

  25. Anthony SJ, Patel A, Leonard J: Use of fluconazole in the treatment of non-AIDS cryptococcal meningitis. J Natl Med Assoc 1997, 89:694–695.

    Google Scholar 

  26. Pappas PG, Perfect J, Larsen RA, et al.: Cryptococcosis in HIVnegative patients: analysis of 306 cases (abstract 101). Clin Infect Dis 1998, 27:939.

    Google Scholar 

  27. Hospenthal DR, Bennett JE: Flucytosine monotherapy for cryptococcosis. Clin Infect Dis 1998, 27:260–264.

    Article  PubMed  CAS  Google Scholar 

  28. Bach MC, Tally PW, Godofsky EW: Use of cerebrospinal fluid shunts in patients having acquired immunodeficiency syndrome with cryptococcal meningitis and uncontrollable intracranial hypertension. Neurosurgery 1997, 41:1280–1283.

    Article  PubMed  CAS  Google Scholar 

  29. Fessler RD, Sobel J, Guyot L, et al.: Management of elevated intracranial pressure in patients with cryptococcal meningitis. J Acquir Immune Defic Syndr 1998, 17:137–142. In this report of 10 HIV-infected patients with cryptococcal meningitis and elevated intracranial pressure, drainage of CSF to maintain normal intracranial pressure ameliorated the neurologic sequelae and all patients returned to their premorbid level of consciousness.

    CAS  Google Scholar 

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  1. Department of Medicine, MCP Hahnemann University, 3300 Henry Avenue, 19129, Philadelphia, PA, USA

    Allan R. Tunkel MD, PhD

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  1. Allan R. Tunkel MD, PhD
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Tunkel, A.R. Chronic meningitis. Curr Infect Dis Rep 1, 160–165 (1999). https://doi.org/10.1007/s11908-996-0024-6

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  • DOI: https://doi.org/10.1007/s11908-996-0024-6

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