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Chronic meningitis caused by a penicillin-sensitive microorganism?
Abstract:
21 patients studied had persistent or progressive chronic meningitis not associated with a demonstrable infectious or other disease, except Streptococcus milleri antigen in the cerebrospinal fluid of 1 patient. The cerebrospinal-fluid (CSF) abnormalities consisted of a moderate, predominantly mononuclear, pleocytosis, a sharp rise in CSF protein (mean 2.3 g/l), intrathecal synthesis of considerable quantities of oligoclonal immunoglobulin G, and, in half the patients, a fall in the CSF-glucose/blood-glucose ratio. In all patients symptoms began during summer or autumn. In 4 patients the onset was preceded by localised cutaneous lesion, described as erythema chronicum migrans. 4 more patients had been bitten by ticks in the weeks before onset of symptoms. The patients had profound fatigue, malaise, and weight-loss. Half had fever, usually moderate. The neurological abnormalities included aseptic meningitis, cranial neuropathy (mostly facial-nerve paralysis), motor and sensory peripheral radiculoneuropathy, and myelitis. The patients improved or recovered, sometimes dramatically, during a 2-week course of intravenous penicillin G.
Insights
Chronic meningitis in 21 patients, potentially linked to tick-borne illness, showed significant cerebrospinal fluid abnormalities. Intravenous penicillin G led to dramatic recovery, suggesting an infectious etiology.
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.