Recurrent meningitis is defined as two or more episodes of culture-proven meningitis separated by a period of complete resolution. The same pathogen or different pathogens can cause the infections. In contrast, relapse or recrudescence of infection refers to persistence of the initial infection, and each episode is caused by the same organism.
An underlying condition is identified in most patients. In the pediatric age group, 75% of patients will have an unrecognized congenital CNS fistula. Malformations of the middle ear, basiethmoidal or cribiform plate defects, or a dermal sinus tract connecting the skin with the lumbar or occipital spine are the most
common predisposing conditions. About 10% of patients with recurrent meningitis will have an immune defect identified, particularly an immunoglobulin or complement deficiency. In adults, previous trauma is commonly the cause of the fistulous tract.
The bacterial etiology and treatment of nontraumatic recurrent meningitis are identical to that of early post-traumatic meningitis. Patients with a dermal sinus tract are more likely to develop meningitis with S. aureus or coliform Gram-negative bacilli such as E. coli.
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