Chronische Meningitis

Zusammenfassung

Die chronische Meningitis ist eine progressive Erkrankung mit subakutem Beginn für mindestens ein Monat und persistierender Liquor-cerebrospinalis-Pleozytose. Das differenzialdiagnostische Spektrum ist sehr breit und umfasst sowohl primär infektiöse (zum Beispiel Mycobacterium tuberculosis, Cryptococcus neoformans und andere opportunistische Erreger) als auch nichtinfektiöse Ursachen (zum Beispiel Meningeosis carcinomatosa, Erkrankungen aus dem kollagen-vaskulitischen Formenkreis). Die Vielzahl möglicher Differenzialdiagnosen macht es besonders notwendig, bei jedem Patienten eine genaueste Anamnese (Reiseexposition usw.) und gründliche allgemeinmedizinische Untersuchung durchzuführen. Die Vorgehensweise bei chronischer Meningitis wurde bisher noch nicht in Studien standardisiert. In diesem Review werden die häufigsten Ursachen einer chronischen Meningitis beschrieben und die wichtigsten diagnostischen Schritte speziell in Tabellen angeführt. Durch das Auftreten der HIV-Pandemie im speziellen und durch die zunehmende Anzahl an immunsupprimierten Patienten hat sich das Erregerspektrum und die Prognose deutlich verändert. Die chronische Meningitis stellt immer noch eine Herausforderung für jeden Kliniker dar. Trotz zum Teil aufwändigster und hochspezifischer diagnostischer Verfahren bleibt bei zirka einem Drittel der Patienten mit einer chronischen Meningitis die Ätiologie ungeklärt. Die Prognose ist erregerabhängig und vor allem bei der chronisch idiopathischen Meningitis günstig.

Abstract

Chronic meningitis is an inflammation of the meninges with subacute onset and persisting cerebrospinal fluid (CSF) abnormalities lasting for at least one month. Several non-infectious (meningeosis carcinomatosa, collagen vascular diseases, toxic) and infectious aetiologies (e. g., Mycobacterium tuberculosis, Cryptococcus neoformans and other opportunistic pathogens) are known to be causative. The wide range of different aetiologies renders the approach to patients with this syndrome particularly difficult. There is no standardized diagnostic procedure, thus, taking an in depth history combined with a complete physical examination is mandatory in every patient. We review the most important infectious and non-infectious causes of chronic meningitis in terms of epidemiology, diagnosis, therapy and prognosis and summarise important clues for diagnosis and CSF findings in tables. Immunodeficiency (HIV, organ transplant, medication) has a tremendous impact on the chronic meningitis syndrome and will be discussed separately. This syndrome is still a diagnostic challenge for each and every physician. Despite sophisticated laboratory analyses, the aetiology of the disease in one-third of the patients still remains unclear. However, most patients with idiopathic chronic meningitis have a relatively good outcome.

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