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Chronic meningitis: diagnostic and therapeutic challenges.
Matthew Smyth1, Monica Diaz2, Deanna Saylor1,2
1University Teaching Hospital, Lusaka, Zambia.
Current Opinion in Infectious Diseases
|April 4, 2025
Summary
Advances in diagnosing and treating chronic meningitis, including tuberculous meningitis (TBM) and cryptococcal meningitis (CM), show promise. New biomarkers and improved therapies offer optimism for managing these challenging infections.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Medicine
Background:
- Chronic meningitis presents diagnostic and therapeutic challenges.
- Key forms include tuberculous meningitis (TBM), cryptococcal meningitis (CM), and syphilitic meningitis.
- Resource-limited settings face unique hurdles in managing these conditions.
Purpose of the Study:
- To review recent advancements in the diagnosis and treatment of chronic meningitis.
- Focus on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent forms.
- Consider noninfectious etiologies and challenges in resource-limited environments.
Main Methods:
- Literature review of recent scientific advances.
- Analysis of novel diagnostic biomarkers.
- Evaluation of updated therapeutic regimens and ongoing clinical trials.
Main Results:
- Novel biomarkers (e.g., MIG, CXCL13) show potential for TBM and syphilitic meningitis diagnosis, requiring validation.
- Progress in CM diagnosis with a new lateral flow assay.
- Improved CM treatment regimens (oral lipid nanocrystal amphotericin B) demonstrate efficacy and better tolerability.
- Ongoing trials for syphilitic meningitis (ceftriaxone) and TBM (linezolid) may alter future treatment guidelines.
Conclusions:
- Diagnosis and management of chronic meningitis remain challenging.
- Emerging biomarkers offer hope for improved diagnostic accuracy and disease monitoring.
- Further research is essential to enhance diagnostic and therapeutic capabilities.
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