Abstract
PURPOSE OF REVIEW: We review recent advances in diagnosis and treatment of chronic meningitis, focusing on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent chronic meningitis. Noninfectious causes and unique challenges faced in resource-limited settings are also considered. RECENT FINDINGS: Novel biomarkers are being identified that may be useful for the diagnosis of TBM [i.e. monokine induced by interferon-γ (MIG), plasminogen binding proteins] and syphilitic meningitis (i.e. CXCL13, neurofilament light protein, etc.) but require more validation. Much progress has been made regarding diagnosis and treatment of CM, with a new semiquantitative lateral flow assay showing high diagnostic and prognostic utility and clinical trials demonstrating that regimens of oral lipid nanocrystal formulation and a single dose of liposomal formulation of amphotericin B maintain clinical efficacy with improved side effect profiles. An ongoing clinical trial of ceftriaxone for treatment of syphilitic meningitis and early stage studies of linezolid for TBM treatment may also lead to changes in recommended treatment regimens for these conditions in the near future. SUMMARY: Diagnosis and management of chronic meningitis remains a significant challenge, and further research is needed to improve our diagnostic and therapeutic armamentariums. However, emergence of potential new biomarkers for diagnosis and disease course is cause for optimism.