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Recurrent Meningitis

by John E. Greenlee, MD

Recurrent meningitis is usually caused by bacteria, viruses, or noninfectious conditions.

Recurrent viral meningitis is most often due to

  • Herpes simplex virus type 2 (HSV-2; called Mollaret meningitis)

Typically when HSV-2 is the cause, patients have ≥ 3 episodes of fever, nuchal rigidity, and CSF lymphocytic pleocytosis; each episode lasts from 2 to 5 days, then resolves spontaneously. Patients can also have other neurologic deficits (eg, altered sensorium, seizures, cranial nerve palsies).

Acute bacterial meningitis may recur if it is acquired via a congenital or acquired defect at the skull base or in the spine and that defect is not corrected. If the cause is an injury, meningitis may not develop until many years later. If patients have recurrent bacterial meningitis, clinicians should thoroughly check for such defects. High-resolution CT can usually show defects in the skull. Clinicians should check the patient's lower back for a dimple or tuft of hair, which may indicate a defect in the spine (eg, spina bifida).

Rarely, recurrent bacterial meningitis (usually due to Streptococcus. pneumoniae) results from a deficiency in the complement system.

Acute meningitis secondary to NSAIDs or other drugs may recur when the causative drug is used again.

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