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Recurrent meningitis in children: etiologies, outcome, and lessons to learn

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Abstract

Purpose

Recurrent meningitis in children is a rare condition. However, its early recognition is important in order to prevent serious complications. This study aims to review cases of recurrent meningitis in children.

Methods

This is a retrospective study that included children diagnosed with recurrent meningitis and who were followed at child neurology clinic at the Jordan University Hospital from January 2001 to June 2017.

Results

Thirteen patients were included (nine males and four females). Age of first episode of meningitis ranged from 2 months to 9.5 years. The delay in diagnosis of the underlying cause after the first episode ranged from 6 months to 2.5 years. Underlying causes included inner ear malformation in one patient, skull fractures in two, and dermal sinuses (thoracic spinal and occipital dermal sinus) in two patients. No identifiable cause was found in eight patients. Streptococcus pneumoniae was identified in four (31%) patients, Staphylococcus aureus in two (15%), and no organism was isolated in seven (54%). Three patients (23.1%) developed neurological sequel including developmental delay, limb spasticity, and epilepsy. Two patients had sensorineural hearing loss related to meningitis, and two patients had sensorineural hearing loss mostly related to their original disease.

Conclusion

A detailed history, examination, and thorough investigations are necessary to determine the underlying cause of recurrent meningitis. In addition, in patients with positive CSF bacterial culture, finding the underlying etiology is very likely.

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References

  1. Tebruegge M, Curtis N (2008) Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev 21:519–537

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Tuygun N, Tanir G, Aytekin C (2010) Recurrent bacterial meningitis in children: our experience with 14 cases. Turk J Pediatr 52:348–353

    PubMed  Google Scholar 

  3. Khan EA, Choudhry S, Roohullah M, Hashmi I, Nazir R (2013) Recurrent meningitis in children. J Pak Med Assoc 63:274–276

    PubMed  Google Scholar 

  4. Drummond DS, de Jong AL, Giannoni C, Sulek M, Friedman EM (1999) Recurrent meningitis in the pediatric patient—the otolaryngologist’s role. Int J Pediatr Otorhinolaryngol 48:199–208

    Article  PubMed  CAS  Google Scholar 

  5. Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS Jr, Swartz MN (1993) Acute bacterial meningitis in adults: a review of 493 episodes. N Engl J Med 328:21–28

    Article  PubMed  CAS  Google Scholar 

  6. Masri A, Bakri FG, Birkenhäger R, Alassaf A, Musharbash AF, Haroun A, Zak I (2011) Mondini malformation associated with diastematomyelia and presenting with recurrent meningitis. J Child Neurol 26:622–624

    Article  PubMed  Google Scholar 

  7. Masri A, Bakri FG, Assaf A, Musharbash A, Haroun AA, Zak I (2009) Intra-axial dermoid tumor mimicking pilocytic astrocytoma. Childs Nerv Syst 25:395–396

    Article  PubMed  Google Scholar 

  8. Joshi VM, Navlekar SK, Kishore GR, Reddy KJ, Kumar (2012) CT and MR imaging of the inner ear and brain in children with congenital sensorineural hearing loss. Radiographics 32:683–698

    Article  PubMed  Google Scholar 

  9. Carrol ED, Latif AH, Misbah SA, Flood TJ, Abinun M, Clark JE, Pugh RE, Cant AJ (2001) Lesson of the week: recurrent bacterial meningitis: the need for sensitive imaging. BMJ 323:501–503

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Adriani KS, van de Beek D, Brouwer MC, Spanjaard L, de Gans J (2007) Community-acquired recurrent bacterial meningitis in adults. Clin Infect Dis 45:e46–e51

    Article  PubMed  Google Scholar 

  11. Kimitsuki T, Inamitsu M, Komune S, Komiyama S (1999) Congenital malformation of the inner ear associated with recurrent meningitis. Eur Arch Otorhinolaryngol 256:S11–S14

    Article  PubMed  Google Scholar 

  12. Givner LB, Kaplan SL (1993) Meningitis due to Staphylococcus aureus in children. Clin Infect Dis 16:766–771

    Article  PubMed  CAS  Google Scholar 

  13. Ohlms LA, Edwards MS, Mason EO, Igarashi M, Alford BR, Smith RJ (1990) Recurrent meningitis and Mondini dysplasia. Arch Otolaryngol Head Neck Surg 116(5):608–612

    Article  PubMed  CAS  Google Scholar 

  14. Muranjan MN, Bharucha BA, Kirtane MV, Deshmukh CT (1999) Mondini dysplasia of the inner ear with CSF leak—a rare cause of recurrent meningitis. Indian Pediatr 36:401–406

    PubMed  CAS  Google Scholar 

  15. Ratilal BO, Costa J, Pappamikail L, Sampaio C (2015) Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev 4:CD004884

    Google Scholar 

  16. van Driel JJ, Bekker V, Spanjaard L, van der Ende A, Kuijpers TW (2008) Epidemiologic and microbiologic characteristics of recurrent bacterial and fungal meningitis in the Netherlands, 1988-2005. Clin Infect Dis 47:e42–e51

    Article  PubMed  Google Scholar 

  17. Kline MW (1989) Review of recurrent bacterial meningitis. Pediat Infect Dis J 8:630–634

    Article  CAS  Google Scholar 

  18. Frank GR, Rubin LG (1989) Mixed meningitis with Bacteroides ovatus caused by an occult congenital dermal sinus. Pediatr Infect Dis J 8:401–403

    Article  PubMed  CAS  Google Scholar 

  19. Okada J, Tsuda T, Takasugi S, Nishida K, Tóth Z, Matsumoto K (1991) Unusually late onset of cerebrospinal fluid rhinorrhea after head trauma. Surg Neurol 35:213–217

    Article  PubMed  CAS  Google Scholar 

  20. Abuabara A (2007) Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal 12:E397–E400

    PubMed  Google Scholar 

  21. Ginsberg L (2004) Difficult and recurrent meningitis. J Neurol Neurosurg Psychiatry 75:i16–i21

    Article  PubMed  PubMed Central  Google Scholar 

  22. Steele RW, McConnell JR, Jacobs RF, Mawk JR (1985) Recurrent bacterial meningitis: coronal thin-section cranial computed tomography to delineate anatomic defects. Pediatrics 76:950–953

    PubMed  CAS  Google Scholar 

  23. Dylewski JS, Bekhor S (2004) Mollaret's meningitis caused by herpes simplex virus type 2: case report and literature review. Eur J Clin Microbiol Infect Dis 23:560–562

    Article  PubMed  CAS  Google Scholar 

  24. Wang HS, Kuo MF, Huang SC (2005) Diagnostic approach to recurrent bacterial meningitis in children. Chang Gung Med J 28:441–451

    PubMed  Google Scholar 

  25. Rosenberg J, Galen BT (2017) Recurrent meningitis. Curr Pain Headache Rep 21:33

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatric, Division of Child Neurology, School of Medicine, The University of Jordan, PO Box 13046, Amman, 11942, Jordan

    Amira Masri

  2. Pediatric Department, School of Medicine, The University of Jordan, Amman, Jordan

    Abeer Alassaf & Najwa Khuri-Bulos

  3. Pediatric Infectious Disease, Vanderbilt University, Nashville, TN, USA

    Najwa Khuri-Bulos

  4. Wayne State University School of Medicine, Detroit, MI, USA

    Imad Zaq

  5. Radiology and Nuclear Medicine Department, Faculty of Medicine, The University of Jordan, Amman, Jordan

    Azmy Hadidy

  6. Department of Internal Medicine, Division of Infectious Diseases, School of Medicine, The University of Jordan, Amman, Jordan

    Faris G. Bakri

  7. Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan

    Faris G. Bakri

Authors
  1. Amira Masri
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  2. Abeer Alassaf
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  3. Najwa Khuri-Bulos
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  4. Imad Zaq
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  5. Azmy Hadidy
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  6. Faris G. Bakri
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Corresponding author

Correspondence to Amira Masri.

Ethics declarations

The institutional review board committee (IRB) of Jordan university Hospital has approved this study.

Conflict of interest

All authors declare no conflict of interest.

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Masri, A., Alassaf, A., Khuri-Bulos, N. et al. Recurrent meningitis in children: etiologies, outcome, and lessons to learn. Childs Nerv Syst 34, 1541–1547 (2018). https://doi.org/10.1007/s00381-018-3815-9

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  • DOI: https://doi.org/10.1007/s00381-018-3815-9

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