Chronic, by definition lasting longer than 4 weeks. With some infections lasting many months
Causes
Microorganisms (bacteria and fungi), viruses, and non-infectious causes including cancer, medications, autoimmune disease or inflammatory conditions
Risk factors
HIV infection, diabetes, immunosuppression
Diagnostic method
Culture of microorganism from the cerebrospinal fluid (CSF), biopsy of tissue or CSF sample with staining of organism, molecular methods such as immunoassay (antigen or antibody assays), nucleic acid amplification, magnetic resonance imaging (MRI) of the brain
Prevention
Vaccination, BCG vaccine in tuberculosis meningitis[1]
Medication
Antibiotics, antifungals, antivirals in infectious causes
Prognosis
Poor
Chronic meningitis is a long-lasting inflammation of the membranes lining the brain and spinal cord (known as the meninges). By definition, the duration of signs, symptoms and inflammation in chronic meningitis last longer than 4 weeks.[2] Infectious causes (due to bacteria, fungi and viruses) are a leading cause and the infectious organisms responsible for chronic meningitis are different than the organisms that cause acute infectious meningitis. Tuberculosis and the fungi cryptococcus are leading causes worldwide. Chronic meningitis due to infectious causes are more common in those who are immunosuppressed, including those with HIV infection or in children who are malnourished. Chronic meningitis sometimes has a more indolent course than acute meningitis with symptoms developing more insidiously and slowly. Also, some of the infectious agents that cause chronic infectious meningitis such as mycobacterium tuberculosis, many fungal species and viruses are difficult to isolate from the cerebrospinal fluid (the fluid surrounding the brain and spinal cord) making diagnosis challenging. No cause is identified during initial evaluation in one third of cases.[3] Magnetic resonance imaging (MRI) of the brain is more sensitive than computed tomography (CT scan) and may show radiological signs that suggest chronic meningitis, however no radiological signs are considered pathognomonic or characteristic. MRI is also normal in many cases further limiting its diagnostic utility.
Worldwide, tuberculosis meningitis is a leading cause of disability and death, with central nervous system tuberculosis (with tuberculosis meningitis being the most common type) occurring in 5-10% of all cases of extrapulmonary tuberculosis and 1% of all cases of tuberculosis overall.[4] Cryptococcal meningitis is also a major cause of death and disability worldwide, especially in areas where HIV and AIDS are more common, accounting for more than 100,000 yearly deaths in Sub-Saharan Africa.[3] The treatment for chronic infectious meningitis is directed at the underlying infectious agent.
^Kumar, R (1 November 2005). "Tuberculous meningitis in BCG vaccinated and unvaccinated children". Journal of Neurology, Neurosurgery & Psychiatry. 76 (11): 1550–1554. doi:10.1136/jnnp.2005.065201. PMC 1739405. PMID 16227549.
^Aksamit, Allen J. (2 September 2021). "Chronic Meningitis". New England Journal of Medicine. 385 (10): 930–936. doi:10.1056/NEJMra2032996. PMID 34469648. S2CID 237391707.
^ abThakur, Kiran T.; Wilson, Michael R. (October 2018). "Chronic Meningitis". CONTINUUM: Lifelong Learning in Neurology. 24 (5): 1298–1326. doi:10.1212/CON.0000000000000664. PMC 6812559. PMID 30273241.
^Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (April 2008). "Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects". Clinical Microbiology Reviews. 21 (2): 243–261. doi:10.1128/CMR.00042-07. PMC 2292571. PMID 18400795.
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