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Recurrent Meningitis

By John E. Greenlee, MD

Last full review/revision November 2015 by John E. Greenlee, MD

Recurrent meningitis is usually caused by bacteria, viruses, or noninfectious conditions.

Recurrent viral meningitis

Recurrent viral meningitis is most often due to

 Herpes simplex virus type 2 (HSV-2; called Mollaret meningitis)

Typically when HSV-2 is the cause, patients have ≥ 3 episodes of fever, nuchal rigidity, and
CSF lymphocytic pleocytosis; each episode lasts from 2 to 5 days, then resolves
spontaneously. Patients can also have other neurologic deficits (eg, altered sensorium,
seizures, cranial nerve palsies).

The cause is treated if possible. Mollaret meningitis is treated with acyclovir. Most patients
recover fully.

Recurrent acute bacterial meningitis

Acute bacterial meningitis may recur if it is acquired via a congenital or acquired defect at the
skull base or in the spine and that defect is not corrected. If the cause is an injury, meningitis
may not develop until many years later.

If patients have recurrent bacterial meningitis, clinicians should thoroughly check for such
defects. High-resolution CT can usually show defects in the skull. Clinicians should check the
patient's lower back for a dimple or tuft of hair, which may indicate a defect in the spine (eg,
spina bifida).

Rarely, recurrent bacterial meningitis (usually due to Streptococcus pneumoniae or Neisseria
meningitidis) results from a deficiency in the complement system. Treatment is the same as
that used in patients without complement deficits. Vaccination against S. pneumoniae and N.
meningitidis (repeated every 3 yr) may reduce likelihood of infection.

Other recurrent meningitides

Acute meningitis secondary to NSAIDs or other drugs may recur when the causative drug is
used again.