Chronic meningitis: diagnostic and therapeutic challenges.

IF 3.6 3区医学 Q2 INFECTIOUS DISEASES

Current Opinion in Infectious Diseases Pub Date : 2025-06-01 Epub Date: 2025-04-04 DOI:10.1097/QCO.0000000000001107

Matthew Smyth, Monica Diaz, Deanna Saylor

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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.

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慢性脑膜炎：诊断和治疗的挑战。

综述目的：我们回顾了慢性脑膜炎诊断和治疗的最新进展，重点关注结核性脑膜炎（TBM）、隐球菌性脑膜炎（CM）、梅毒性脑膜炎、神经源性脑膜炎和复发性慢性脑膜炎。此外，还考虑了非感染性病因以及在资源有限的环境中所面临的独特挑战：新发现的生物标记物可能有助于诊断TBM（即干扰素-γ诱导的单克因（MIG）、纤溶酶原结合蛋白）和梅毒性脑膜炎（即CXCL13、神经丝蛋白等），但需要更多的验证。CM 的诊断和治疗已取得了很大进展，一种新的半定量侧流测定显示出很高的诊断和预后效用，临床试验表明，口服脂质纳米晶体制剂和单剂量两性霉素 B 脂质体制剂的治疗方案可保持临床疗效，且副作用有所改善。目前正在进行的头孢曲松治疗梅毒性脑膜炎的临床试验和利奈唑胺治疗TBM的早期研究也可能在不久的将来改变这些疾病的推荐治疗方案。不过，用于诊断和病程的潜在新生物标志物的出现令人乐观。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Infectious Diseases 医学-传染病学

CiteScore

6.70

自引率

2.60%

发文量

121

审稿时长

6-12 weeks

期刊介绍： This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.