14 CHRONIC MENINGITIS General Discussion Meningitis can be divided based on time course, associated CSF profile, and underlying cause. Chronic meningitis is arbitrarily defined as meningitis that persists for 4 or more weeks. It is important to document that patients are not in a slow recovery phase as this distinguishes them from resolving acute meningitis cases. Chronic meningitis is uncommon and accounts for less than 10% of all meningitis cases. It has the widest spectrum of causes and occurs in both immunocompetent and immunocompromised individuals. Chronic meningitis may be caused by many different pathogens as well as by noninfectious causes. The major infectious causes are tuberculous meningitis and cryptococcal meningitis. The major noninfectious causes are neoplastic disease, neurosarcoidosis, and vasculitis. The CSF examination is helpful in differentiating the patient with chronic meningitis from the patient with acute meningitis, encephalitis, or recurrent meningitis. A mildly decreased glucose in the setting of mononuclear pleocytosis should raise the possibility of chronic meningitis. Causes of Chronic Meningitis Bacterial • Mycobacterial (M. tuberculosis, M. avium) • Spirochetal (Borrelia burgdorferi, Leptospira interrogans, Treponema pallidum) • Agents causing sinus tracts (Actinomycetes, Arachnia, Nocardia) • Brucella • Tropheryma whippelii • L. monocytogenes • N. meningitides • Francisella tularensis Fungal • Cryptococcus neoformans • Coccidioides immitis • Histoplasma capsulatum • Candida sp. • Other mycoses (Aspergillus, Blastomyces, Dematiaceous sp, Paracoccidioides, Pseudallescheria, Sporothrix, Trichosporon beigelii, Zygomycetes) Parasitic • Taenia solium (cysticercosis) • Acanthamoeba • Angiostrongylus • Toxoplasma gondii • Coenurus cerebralis • Schistosoma sp. Viral • Retroviruses (HIV-1, HTLV-1) • Enteroviruses • Herpesvirus Noninfectious • Neoplastic • Neurosarcoidosis • Vasculitis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on CHRONIC MENINGITIS Full access? Get Clinical Tree
14 CHRONIC MENINGITIS General Discussion Meningitis can be divided based on time course, associated CSF profile, and underlying cause. Chronic meningitis is arbitrarily defined as meningitis that persists for 4 or more weeks. It is important to document that patients are not in a slow recovery phase as this distinguishes them from resolving acute meningitis cases. Chronic meningitis is uncommon and accounts for less than 10% of all meningitis cases. It has the widest spectrum of causes and occurs in both immunocompetent and immunocompromised individuals. Chronic meningitis may be caused by many different pathogens as well as by noninfectious causes. The major infectious causes are tuberculous meningitis and cryptococcal meningitis. The major noninfectious causes are neoplastic disease, neurosarcoidosis, and vasculitis. The CSF examination is helpful in differentiating the patient with chronic meningitis from the patient with acute meningitis, encephalitis, or recurrent meningitis. A mildly decreased glucose in the setting of mononuclear pleocytosis should raise the possibility of chronic meningitis. Causes of Chronic Meningitis Bacterial • Mycobacterial (M. tuberculosis, M. avium) • Spirochetal (Borrelia burgdorferi, Leptospira interrogans, Treponema pallidum) • Agents causing sinus tracts (Actinomycetes, Arachnia, Nocardia) • Brucella • Tropheryma whippelii • L. monocytogenes • N. meningitides • Francisella tularensis Fungal • Cryptococcus neoformans • Coccidioides immitis • Histoplasma capsulatum • Candida sp. • Other mycoses (Aspergillus, Blastomyces, Dematiaceous sp, Paracoccidioides, Pseudallescheria, Sporothrix, Trichosporon beigelii, Zygomycetes) Parasitic • Taenia solium (cysticercosis) • Acanthamoeba • Angiostrongylus • Toxoplasma gondii • Coenurus cerebralis • Schistosoma sp. Viral • Retroviruses (HIV-1, HTLV-1) • Enteroviruses • Herpesvirus Noninfectious • Neoplastic • Neurosarcoidosis • Vasculitis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on CHRONIC MENINGITIS Full access? Get Clinical Tree
