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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(11): 1167-1177
DOI: 10.1055/s-0042-1758645
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Diagnostic and therapeutic approach to chronic meningitis in Brazil: a narrative review

Abordagem diagnóstica e terapêutica da meningite crônica no Brasil: uma revisão narrativa
Guilherme Diogo Silva 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Bruno Fukelmann Guedes 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Ióri Rodrigues Junqueira 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Hélio Rodrigues Gomes 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
José Ernesto Vidal 
2   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Doenças Infecciosas, São Paulo SP, Brazil.
3   Instituto de Infectologia Emílio Ribas, Departamento de Neurologia, São Paulo SP, Brazil.
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Abstract

Background Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce.

Objective To critically review the literature on CM and propose a rational approach in the Brazilian scenario.

Methods Narrative literature review discussing the epidemiology, clinical evaluation, basic and advanced diagnostic testing, and empirical and targeted therapy for the most relevant causes of CM. The present review was contextualized with the local experience of the authors. In addition, we propose an algorithm for the management of CM in Brazil.

Results In Brazil, tuberculosis and cryptococcosis are endemic and should always be considered in CM patients. In addition to these diseases, neurosyphilis and other endemic conditions should be included in the differential diagnosis, including neurocysticercosis, Baggio-Yoshinari syndrome, and endemic mycosis. After infectious etiologies, meningeal carcinomatosis and autoimmune diseases should be considered. Unbiased and targeted methods should be used based on availability and clinical and epidemiological data.

Conclusion We propose a rational approach to CM in Brazil, considering the epidemiological scenario, systematizing the etiological investigation, and evaluating the timely use of empirical therapies.

Resumo

Antecedentes A meningite crônica (MC) é caracterizada por sintomas neurológicos associados à evidência de pleiocitose do líquido cefalorraquidiano por > 4 semanas. Os estudos sobre o manejo da MC no Brasil são escassos.

Objetivo Rever criticamente a literatura sobre MC e propor uma abordagem racional no cenário brasileiro.

Métodos Revisão da literatura narrativa discutindo a epidemiologia, avaliação clínica, testes diagnósticos básicos e avançados, além da terapia empírica e direcionada para as causas mais relevantes do MC. A presente revisão foi contextualizada com a experiência local dos autores. Além disso, propomos um algoritmo para o manejo da MC no Brasil.

Resultados No Brasil, a tuberculose e a criptococose são endêmicas e devem ser sempre consideradas em pacientes com MC. Além destas doenças, a neurossífilis e outras condições endêmicas devem ser incluídas no diagnóstico diferencial, incluindo: neurocisticercose, síndrome de Baggio-Yoshinari e micoses endêmicas. Após etiologias infecciosas, devem ser consideradas a carcinomatose meningeal e doenças autoimunes sistêmicas. Métodos diagnósticos devem ser utilizados com base na disponibilidade, nos dados clínicos e nos dados epidemiológicos.

Conclusão Propomos uma abordagem racional para a MC no Brasil, considerando o cenário epidemiológico, sistematizando a investigação etiológica e avaliando o uso oportuno de terapias empíricas.

Keywords

Meningitis - Diagnosis - Tuberculosis, Meningeal - Meningitis, Cryptococcal - Brazil

Palavras-chave

Meningite - Diagnóstico - Tuberculose Meníngea - Meningite Criptocócica - Brasil

Authors' Contributions

GDS: drafted the original manuscript and contributed to the study design; BFG: revised the manuscript for intellectual content; IRJ: drafted the original manuscript; HRG: revised the manuscript for intellectual content; JEV: revised the manuscript for intellectual content and designed the work.




Publication History

Received: 03 August 2021

Accepted: 08 December 2021

Article published online:
28 December 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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