TABLE 1.

Anatomical problems associated with recurrent bacterial meningitisa

ConditionTotal no. of casesMedian age at onsetb (range)Median age at diagnosis (range)Organism(s)c isolated (no. of occasionsd)Reference(s)
Cranial and cervical anatomical defects
    Heterotopic brain tissue (congenital) (meningocele/meningoencephalocele)197 yr (6 wk-40 yr)13.5 yr (3 yr-65 yr)S. pneumoniae (15), S. aureus (2), N. meningitidis (1)16, 28, 40, 48, 60, 74, 75, 82, 127, 128, 140, 162, 183, 196, 224
    Meningioma149 yr53 yrS. pneumoniae (1)91
    Skull base defects (likely congenital)
        Ethmoid bone33.5 yr (3 yr-4 yr)6 yr (5 yr-12 yr)S. pneumoniae (5)24, 159, 183
        Petrosal bone52 yr (1.5 yr-4 yr)6.5 yr (6 yr-29 yr)S. pneumoniae (8), H. influenzae (2), N. meningitidis (1)13, 19, 107, 138, 222
        Sphenoid sinus3n.a.47 yr (32 yr-63 yr)S. pneumoniae (1)e72, 183
    Dermoid cyst/epidermoid cyst/dermal sinus tract50.5 yr (2 wk-2 yr)1 yr (3 mo-3 yr)E. coli (4), P. mirabilis (3), S. aureus (3)26, 80, 103, 110, 172, 198
    Cranial lymphangiomatosis119 mo3.5 yrH. influenzae (2), group A streptococcus (2), S. pneumoniae (1)145
    Neurenteric cyst40.1 yr (1 wk-1 mo)9 yr (4 yr-13 yr)S. pneumoniae (13), H. influenzae (12), S. aureus (8), group B streptococcus (1), group D streptococcus (1)2, 70, 115, 131
    Inner ear abnormality (unspecified)421.7 yr (1 mo-23 yr)5 yr (4 mo-24 yr)S. pneumoniae (36), H. influenzae (8), N. meningitidis (3), viridans streptococcus (1)15, 31, 81, 87, 93, 116, 121, 122, 133, 137, 142, 160, 164, 165, 171, 178,g 203, 208, 209
    Mondini dysplasia134 yr (1 yr-8 yr)5.9 yr (1.5 yr-9 yr)S. pneumoniae (15), N. meningitidis (2), H. influenzae (1), viridans streptococcus (1)3,h 76, 95, 120, 137, 141, 143, 154, 178,g 212, 215
    Head injury/basal skull fracturesf1029 yr (8 mo-36 yr)16.5 yr (3 mo-56 yr)S. pneumoniae (100), H. influenzae (7), N. meningitidis (4), group B streptococcus (1)1, 4, 5, 8, 14, 22, 24, 36, 42, 46, 54, 58, 64, 66, 69, 78, 79, 90, 92, 94, 98, 100, 105, 118, 124, 139, 146, 156, 163, 167, 172, 201, 205, 217, 223, 227
Lumbosacral anatomical defects
    Meningocele14 mo1 yrK. pneumoniae (1), Proteus mirabilis (1)59
    Dermal sinus/dermoid cyst151 yr (2 mo-5 yr)1.5 yr (1 yr-5 yr)E. coli (14), enterococci (3), S. pneumoniae (1), Klebsiella (1)6, 10, 115, 172
  • a Patients with more than one risk factor were recorded in all the relevant categories. All patient included had at least two episodes of meningitis (clinical features and results suggestive of bacterial meningitis), but the causative organism was not identified in all episodes.

  • b Age at onset is age at the first episode of meningitis. n.a., no data available.

  • c Organisms determined by CSF culture, CSF antigen testing, or positive blood culture with CSF analysis suggestive of bacterial meningitis

  • d Number of separate occasions at which an organism was isolated; i.e., one patient may have had several episodes caused by different organisms.

  • e The actual number of S. pneumoniae-positive meningitis episodes is probably higher; the second article provided insufficient details.

  • f The patient described by Hristea et al. with 28 episodes of pneumococcal meningitis was included as a single episode (79).

  • g Additional data that were not included in the original publication were provided by the author; V. Rupa confirmed that the CSF findings are indicative of bacterial meningitis.

  • h Additional data that were not included in the original publication were provided by the author. L. Al-Shamsan provided the number of meningitis episodes and age at onset.