Noninfectious cause of Chronic meningitis is associated with Drug hypersensitivity of
(B) Ibuprofen # Noninfectious Causes of Chronic Meningitis: Drug hypersensitivity: Exposure to NSAIDS (ibuprofen), sulfonamides, isoniazid, tolmetin, ciprofloxacin, Penicillin; Carbamazaepine; Lamotrigine; IV Immunoglobulin; OKT3 antibodies; phenazopyridine; improvement after discontir uation of drug; recurrent episodes with recurrent exposure. CSF formula: Shows PMNs; occasionally mononuclear cells or eosinophilsHelpful diagnostic tests: CBC (Esinophilia)INFECTIOUS CAUSES OF CHRONIC MENINGITISCausative AgentRisk Factors and Systemic ManifestationsCommon Bacterial Causes Partially treated suppurative meningitisHistory consistent with acute bacterial meningitis and incomplete treatmentParameningeal infectionOtitis media, pleuropulmonary infection, right-to-left cardiopulmonary shunt for brain abscess; focal neurologic signs; neck, back, ear, or sinus tendernessMycobacterium tuberculosisExposure history; previous tuberculous illness; immunosuppressed or AIDS; young children; fever, meningismus, night sweats, miliary TB on x-ray or liver biopsy; stroke due to arteritisLyme disease (Bannwarth's syndrome) Borrelia burgdorferiHistory of tick bite or appropriate exposure history; erythema chronicum migrans skin rash; arthritis, radiculopathy, Bell's palsy, meningoencephalitis-multiple sclerosis-like syndromeSyphilis (secondary, tertiary) Treponema pallidumAppropriate exposure history; HIV- seropositive individuals at increased risk of aggressive infection; "dementia"; cerebral infarction due to endarteritisUncommon Bacterial Causes ActinomycesParameningeal abscess or sinus tract (oral or dental focus); pneumonitisNocard iaAssociated brain abscess may be presentBrucellaIntake of unpasteurized dairy products; exposure to goats, sheep, cows; fever, arthralgia, myalgia, vertebral osteomyelitisWhipple's disease Tropheryma whippeliiDiarrhea, weight loss, arthralgias, fever; dementia, ataxia, paresis, ophthalmoplegia, oculomasticatory myoclonusRare Bacterial CausesLeptospirosis (occasionally if left untreated may last 3-4 weeks)Fungal CausesCryptococcus neoformansAIDS and immune suppression; pigeon exposure; skin and other organ involvement due to disseminated infectionCoccidioides immitisExposure history--southwestern US; increased virulence in dark-skinned racesCandida sp.IV drug abuse; post surgery; prolonged intravenous therapy; disseminated candidiasisHistoplasma capsulatumExposure history--Ohio and central Mississippi River Valley; AIDS; mucosal lesionsAspergillus sp.Sinusitis; granulocytopenia or immunosuppressionSporothrix schenckiiTraumatic inoculation; IV drug use; ulcerated skin lesionRare Fungal CausesXylohypha (formerly Cladosporium) trichoides and other dark-walled (demateaceous) fungi such as Curvularia, Drechslera; Mucor, and, after water aspiration, Pseudoallescheria boydiiProtozoal CausesToxoplasma gondiiUsually with intracerebral abscesses; common in HIV-seropositive patientsTrypanosomiasis Trypanosoma gambiense, T. rhodesienseEndemic in Africa; chancre, lymphadenopathy; prominent sleep disorderRare Protozoal CausesAcanthamoeba sp. causing granulomatous amebic encephalitis and meningoencephalitis in immunocompromised and debilitated individuals. Balamuthia mandrillaris causing chronic meningoencephalitis in immunocompetent hosts.Helminthic CausesCysticercosis (infection with cysts of Taenia solium)Usually with multiple cysts in basal meninges and hydrocephalus; cerebral cysts, muscle calcificationGnathostoma spinigerumHistory of eating raw fish; common in Thailand and Japan; subarachnoid hemorrhage; painful radiculopathyAngiostrongylus cantonensisHistory of eating raw shellfish; common in tropical Pacific regions; often benignBaylisascaris procyonis (raccoon as-carid)Infection follows accidental ingestion of B. procyonis eggs from raccoon feces; fatal meningoencephalitisRare Helminthic CausesTrichinella spiralis (trichinosis); Fasciola hepatica (liver fluke), Echinococcus cysts; Schistosoma sp. The former may produce a lymphocytic pleocytosis whereas the latter two may produce an eosinophilic response in CSF associated with cerebral cysts (Echinococcus) or granulomatous lesions of brain or spinal cordViral causesMumpsNo prior mumps or immunization; may produce meningoencephalitis; may persist for 3--4 weeksLymphocytic choriomeningitisContact with rodents or their excreta; may persist for 3-4 weeksEchovirusCongenital hypogammaglobulinemia; history of recurrent meningitisHIV (acute retroviral syndrome)HIV risk factors; rash, fever, lymphadenopathy; lymphopenia in peripheral blood; syndrome may persist long enough to be considered as "chronic meningitis"; or chronic meningitis may develop in later stages (AIDS) due to HIVHerpes simplex (HSV)Recurrent meningitis due to HSV-2 (rarely HSV-1) often associated with genital recurrences; EBV associated with myeloradiculopathy, CMV with polyradiculopathy
Acetaminophen
Ibuprofen
Acyclovir
Beta-lactams
Miscellaneous