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Chronic meningitis: diagnostic and therapeutic challenges
Matthew Smyth1, Monica Diaz2, Deanna Saylor1,2
1University Teaching Hospital, Lusaka, Zambia.
Purpose Of Review:
We review recent advances in diagnosis and treatment of chronic meningitis, focusing on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent chronic meningitis. Noninfectious causes and unique challenges faced in resource-limited settings are also considered.
Recent Findings:
Novel biomarkers are being identified that may be useful for the diagnosis of TBM [i.e. monokine induced by interferon-γ (MIG), plasminogen binding proteins] and syphilitic meningitis (i.e. CXCL13, neurofilament light protein, etc.) but require more validation. Much progress has been made regarding diagnosis and treatment of CM, with a new semiquantitative lateral flow assay showing high diagnostic and prognostic utility and clinical trials demonstrating that regimens of oral lipid nanocrystal formulation and a single dose of liposomal formulation of amphotericin B maintain clinical efficacy with improved side effect profiles. An ongoing clinical trial of ceftriaxone for treatment of syphilitic meningitis and early stage studies of linezolid for TBM treatment may also lead to changes in recommended treatment regimens for these conditions in the near future.
Summary:
Diagnosis and management of chronic meningitis remains a significant challenge, and further research is needed to improve our diagnostic and therapeutic armamentariums. However, emergence of potential new biomarkers for diagnosis and disease course is cause for optimism.
Insights
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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