Meningitis, Recurrent
- Recurrent meningitis requires evaluation of underlying cause:
- congenital anatomical defect (epidermoid/dermoid cysts, neural tube defects, asplenia)
- acquired anatomical defect (head injuries, basal skull fracture, malignancy)
- congenital immunodeficiencies (complement deficiency, agammaglobulinemia, IgG subclass deficiency, IRAK 4 deficiency)
- acquired immunodeficiencies - HIV
- chronic parameningeal infections (sinusitis, otitis media, mastoiditis)
NB:
- Anatomical defects most commonly cause recurrent S. pneumoniae or H. influenzae meningitis.
- Complement deficiency is associated with recurrent N. meningitidis meningitis. Vaccination for S. pneumoniae, N. meningitidis, H. influenzae recommended for asplenia or complement deficiency.
Usual Pathogens
Bacterial:
S. pneumoniae
N. meningitidis
H. influenzae
S. aureus
Enterobacterales
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 60mg/kg/d IV div q6h | S. pneumoniae, N. meningitidis, H. influenzae - 10 days S. aureus -14 days after last positive blood culture Enterobacterales - 21 days |
| + | ||
| Ceftriaxone | 100mg/kg/d IV div q12h |