Chronic meningitis caused by a penicillin-sensitive microorganism?

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Persistent or progressive chronic meningitis can present diagnostic challenges.
• Cerebrospinal fluid (CSF) analysis is crucial for diagnosing central nervous system infections and inflammatory conditions.
• Identifying the underlying cause of chronic meningitis is essential for effective treatment.

Purpose of the Study:

• To investigate the clinical characteristics and outcomes of patients with chronic meningitis.
• To explore potential etiological factors, including tick-borne diseases.
• To evaluate the efficacy of penicillin G treatment in this patient cohort.

Main Methods:

• Retrospective analysis of 21 patients with chronic meningitis.
• Detailed cerebrospinal fluid (CSF) analysis, including protein, cell counts, and immunoglobulin profiling.
• Clinical assessment of neurological symptoms and patient history, including tick exposure and skin lesions.
• Treatment with intravenous penicillin G and monitoring of patient response.

Main Results:

• Patients presented with chronic meningitis, fatigue, malaise, and weight loss, with symptom onset during summer/autumn.
• CSF analysis revealed moderate mononuclear pleocytosis, elevated protein, oligoclonal IgG synthesis, and decreased glucose/blood glucose ratio in some.
• Neurological manifestations included aseptic meningitis, cranial neuropathies, radiculoneuropathy, and myelitis.
• Four patients had preceding erythema chronicum migrans, and four reported tick bites.
• All patients showed improvement or recovery after a 2-week course of intravenous penicillin G.

Conclusions:

• The clinical presentation and response to penicillin G suggest a possible tick-borne etiology for this form of chronic meningitis.
• Early diagnosis and treatment with penicillin G can lead to significant recovery in affected patients.
• Further research is warranted to confirm the causative agent and optimize management strategies.