neurologic disorders
Subacute and Chronic Meningitis
Introduction
Subacute meningitisdevelops over days to a few weeks.Chronic meningitislasts ≥ 4 weeks. Possible causes include fungi,Mycobacterium tuberculosis, rickettsiae, spirochetes,Toxoplasma gondii, HIV, enteroviruses, and disorders such as autoimmune rheumatic disorders (eg, systemic lupus erythematosus [SLE], rheumatoid arthritis [RA]) and cancer. Symptoms and signs are similar to those of other meningitides but more indolent. Cranial nerve palsies and infarction (due to vasculitis) may occur. Diagnosis requires analysis of a large volume of cerebrospinal fluid (CSF) that is typically obtained via repeated lumbar punctures, sometimes using next-generation sequencing (if available), and sometimes biopsy or ventricular or cisternal puncture. Treatment is directed at the cause. (See also Overview of Meningitis .) Chronic meningitis may last > 10 years. Rarely, chronic meningitis has a protracted benign course, then resolves spontaneously. Subacute and chronic meningitis may result from a wide variety of organisms and conditions. 