Evaluation of the epidemiologic, clinical, radiologic, and treatment methods of patients with subacute and chronic meningitis

Abstract

Background Meningitis is known as a meningeal inflammation accompanied by pleocytosis in the cerebrospinal fluid (CSF), and can be classified into acute, subacute, and chronic meningitis based on symptoms duration of ≤ 5 days, ≥ 5 days and ≥ 4 weeks, respectively. Subacute and chronic meningitis are caused mainly by indolent infectious agents and noninfectious causes such as autoimmune, and neoplastic. In this study, we investigated the characteristics, diagnosis, and treatment of subacute and chronic meningitis. Methods We extracted the medical records of patients with chronic and subacute meningitis who were referred to three tertiary centers from Jun 2011 to Jun 2021. Initially, 2050 cases of meningitis were screened, and then 79 patients were included in the study. Results Headache (87.3%), nausea and vomiting (74.7%), fever (56.4%), and visual impairments (55.7%) were the most prevalent symptoms. The most common signs were nuchal rigidity (45.3%), altered mental status (26.9%), and papillary edema (37.5%). Brain computed tomography (CT) was normal in 68.6% of the patients while 22.9% of the cases had hydrocephalus. Brain magnetic resonance imaging (MRI) was normal in 60.0% of the patients. The most common abnormal MRI findings were leptomeningeal enhancement (16.0%) and hydrocephalus (16.0%). We had a 44.3% definite diagnosis with bacterial (n:25, 31.6%) and neoplastic (n:8, 10.1%) being the most prevalent etiologies. Mycobacterium tuberculosis (60%) and Brucella spp. (12%) were the most prevalent bacterial pathogens. Conclusions The most common etiologies include infectious, neoplastic, and immunologic. Due to insidious presentation and uncommon etiologies, establishing a proper diagnosis, and providing timely targeted treatment for patients with subacute and chronic meningitis remains a challenge for clinicians.

Clinical and mycological implications of cryptococcal meningitis in Iran

“…Moreover, testosterone can increase capsule production and decrease macrophage efficiency [ 25 ]. CM presents with insidious, progressive, subacute-to-chronic meningitis, a pattern that is also noted in the current investigation [ 11 ]. All the patients had mild symptoms, such as headaches, which were either ignored or not properly managed as neurological symptoms.…”

“…We performed a cross-sectional multicenter study across 15 Iranian hospitals in Alborz, East Azerbaijan, Fars, Gilan, Gorgan, Isfahan, Khuzestan, Lorestan, Mazandaran, and Tehran provinces from March 2021 to November 2022. Suspected patients were presented with either chronic (defined as presenting symptoms for a duration of at least 4 weeks) or subacute (defined as presenting symptoms for a duration of at least 5 days) meningitis symptoms, including fever, headache, meningismus, and altered mental status [ 10 , 11 ]. The CM cases were diagnosed by screening clinical manifestations, laboratory tests, and the hospital medical record information systems.…”

Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland

“…Our results presented 30.8% and 5.0% specificity with MRI and CT, respectively, on identifying meningitis-related findings in imaging. Previous study indicated MRI being more specific but with a lower specificity of 16% [ 34 ].…”

Case report: Chronic Candida albicans meningitis: a rare entity diagnosed by metagenomic next-generation sequencing

“…For example, in one retrospective study of 79 patients with chronic meningitis, only 44.3% received a definitive diagnosis, 31.6% were bacterial (mostly Mycobacterium tuberculosis and Brucella spp.) and 10.1% were neoplastic (Bineshfar et al, 2022). Even with invasive diagnostic methods, i.e.…”