What ’s Next (Generation) for the Diagnosis of Chronic Meningitis?

Chronic meningitis is a syndrome defined by the presence of clinical signs and symptoms of meningitis or meningoencephalitis with a persisting cerebral spinal fluid (CSF) pleocytosis that are present for at least 4 weeks. The differential diagnosis is broad, with categories including neoplastic, paraneoplastic, autoimmune, and noninfectious inflammatory disorders and central nervous system (CNS) infections. The exact frequency of the different etiologies often varies tremendously across reports; however, among most institutions, common infectious causes of chronic meningitis includeMycobacterium tuberculosis and fungal meningitis (eg,Cryptococcus,Coccidioides, andHistoplasma species) and noninfectious causes include neoplastic meningitis, sarcoidosis, and primary and systemic vasculitis. However, these causes just scratch the surface of the many possible and reported etiologies, and the diagnostic potentials are multiplied enormously among individuals with HIV infection or other immunocompromising conditions. The diagnostic process typically begins with a substantial and expensive battery of tests on serum and spinal fluid and comprehensive imaging of the neuraxis and often of other organs. Not surprisingly, there are many opportunities for errors of omission (eg, failure to test for a cause that should have been considered) or commission (unnecessary testing). Even when conventional diagnostic algorithms are pursued, an answer may not be apparent, and patients then typically...
Source: JAMA Neurology - Category: Neurology Source Type: research