TY - JOUR
T1 - Benign recurrent lymphocytic meningitis (Mollaret's meningitis) in Denmark
T2 - a nationwide cohort study
AU - Petersen, Pelle Trier
AU - Bodilsen, Jacob
AU - Jepsen, Micha Phill Grønholm
AU - Hansen, Birgitte Rønde
AU - Storgaard, Merete
AU - Larsen, Lykke
AU - Helweg-Larsen, Jannik
AU - Wiese, Lothar
AU - Lüttichau, Hans Rudolf
AU - Andersen, Christian Østergaard
AU - Mogensen, Trine Hyrup
AU - Nielsen, Henrik
AU - Brandt, Christian Thomas
AU - Danish Study Group of Infections of the Brain (DASGIB)
N1 - © 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2024/1
Y1 - 2024/1
N2 - BACKGROUND AND PURPOSE: Data on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited.METHODS: This was a nationwide population-based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV-2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single-episode HSV-2 meningitis were included for comparison.RESULTS: Forty-seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single-episode HSV-2 meningitis were included. The progression risk from HSV-2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%-30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single-episode HSV-2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1-4) were less frequent in BRLM at all post-discharge follow-up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%-12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02-15.3) for patients with three or more previous episodes of meningitis.CONCLUSIONS: Clinical features of BRLM were similar to those of single-episode HSV-2 meningitis, whilst post-discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.
AB - BACKGROUND AND PURPOSE: Data on clinical features and outcomes of benign recurrent lymphocytic meningitis (BRLM) are limited.METHODS: This was a nationwide population-based cohort study of all adults hospitalized for BRLM associated with herpes simplex virus type 2 (HSV-2) at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with single-episode HSV-2 meningitis were included for comparison.RESULTS: Forty-seven patients with BRLM (mean annual incidence 1.2/1,000,000 adults) and 118 with single-episode HSV-2 meningitis were included. The progression risk from HSV-2 meningitis to BRLM was 22% (95% confidence interval [CI] 15%-30%). The proportion of patients with the triad of headache, neck stiffness and photophobia/hyperacusis was similar between BRLM and single-episode HSV-2 meningitis (16/43 [37%] vs. 46/103 [45%]; p = 0.41), whilst the median cerebrospinal fluid leukocyte count was lower in BRLM (221 cells vs. 398 cells; p = 0.02). Unfavourable functional outcomes (Glasgow Outcome Scale score of 1-4) were less frequent in BRLM at all post-discharge follow-up visits. During the study period, 10 (21%) patients with BRLM were hospitalized for an additional recurrence (annual rate 6%, 95% CI 3%-12%). The hazard ratio for an additional recurrence was 3.93 (95% CI 1.02-15.3) for patients with three or more previous episodes of meningitis.CONCLUSIONS: Clinical features of BRLM were similar to those of single-episode HSV-2 meningitis, whilst post-discharge outcomes were more favourable. Patients with three or more previous episodes of meningitis had higher risk of an additional recurrence.
KW - Adult
KW - Aftercare
KW - Cohort Studies
KW - Denmark/epidemiology
KW - Herpesvirus 2, Human/genetics
KW - Humans
KW - Meningitis, Aseptic
KW - Meningitis, Viral/epidemiology
KW - Patient Discharge
KW - Polymerase Chain Reaction
KW - Recurrence
KW - viral meningitis
KW - aciclovir
KW - aseptic meningitis
KW - herpes simplex virus type 2
UR - http://www.scopus.com/inward/record.url?scp=85173496086&partnerID=8YFLogxK
U2 - 10.1111/ene.16081
DO - 10.1111/ene.16081
M3 - Journal article
C2 - 37797296
SN - 1351-5101
VL - 31
JO - European Journal of Neurology
JF - European Journal of Neurology
IS - 1
M1 - e16081
ER -