Smyth Matthew, Diaz Monica, Saylor Deanna
University Teaching Hospital, Lusaka, Zambia.
Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Curr Opin Infect Dis. 2025 Jun 1;38(3):252-260. doi: 10.1097/QCO.0000000000001107. Epub 2025 Apr 4.
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.
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.
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.
我们综述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、神经莱姆病和复发性慢性脑膜炎。还考虑了资源有限环境中面临的非感染性病因和独特挑战。
正在鉴定可能有助于诊断TBM的新型生物标志物[即干扰素-γ诱导的单核因子（MIG）、纤溶酶原结合蛋白]和梅毒性脑膜炎（即CXCL13、神经丝轻链蛋白等），但需要更多验证。CM的诊断和治疗取得了很大进展，一种新的半定量侧向流动分析法显示出高诊断和预后效用，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脂质体制剂的方案在维持临床疗效的同时副作用有所改善。正在进行的头孢曲松治疗梅毒性脑膜炎的临床试验以及利奈唑胺治疗TBM的早期研究可能也会在不久的将来导致这些疾病推荐治疗方案的改变。
慢性脑膜炎的诊断和管理仍然是一项重大挑战，需要进一步研究以改善我们的诊断和治疗手段。然而，出现潜在的用于诊断和病程的新生物标志物是令人乐观的理由。
