Abstract
The number of studies about recurrent bacterial meningitis (RBM) diagnostic challenge in children is limited. Structural approach and early diagnosis of an underlying pathology are crucial to prevent further episodes and improve the overall outcome [1]. 1.3% of children with bacterial meningitis had experienced at least one previous episode. Anatomic abnormalities are the most common predisposing factor for RBM, and congenital inner ear malformation is the leading cause [2]. Acquired immune deficiency (HIV) forms an important cause of RBM in some areas [22]. Terminal Complement defect is the leading congenital immunodeficiency that may cause RBM [1]. History of head trauma is an important factor but should not lead to exclude other important factors. Isolation of a specific bacterial organism can guide the diagnostic approach. We want to report a case of recurrent bacterial meningitis in a 12 year old boy with a small nasal ethmoidal CSF- leak fistula activation after 6 years of a head trauma. A diagnostic approach has been suggested depending on review of many trusted studies and clinical experiences.
Highlights
recurrent bacterial meningitis (RBM) by definition is two or more episodes of bacterial meningitis with at least 3 week interval after the completion of therapy for the initial episode, or any interval if caused by a different bacterial organism [1]
History of trauma may indicate the presence of acquired anatomical CSF leak, but it may enhance the presentation of congenital anomalies like nasal meningocele or inner ear dysplasia
Rhinorrhea is extremely rare in children even in the presence of confirmed nasal csf leak
Summary
RBM by definition is two or more episodes of bacterial meningitis with at least 3 week interval after the completion of therapy for the initial episode, or any interval if caused by a different bacterial organism [1]. If the episode is less than 3 weeks and caused by the same bacterial organism it can be relapse or recrudescence [3]. Recurrent bacterial meningitis is an uncommon phenomenon but generally poses a considerable diagnostic challenge. 1.3% of children with acute bacterial meningitis had experienced at least one previous occasion [3]. Mortality of RBM in many studies is less than 15%, much less than mortality of the first episode of bacterial meningitis (25-34%) [4]
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