Recurring Meningitis

According to the Meningitis Foundation of America, benign recurrent meningitis is known as Mollaret's Meningitis. The Journal of the American Board of Family Medicine describes Mollaret's Meningitis as "a rare form of aseptic recurrent meningitis that is mild and self-limiting." Aseptic meningitis is defined as severe inflammation of the lining of the brain or meninges, usually accompanied by an elevated white blood cell count. It is a disease that can occur at any age. It is common and not usually fatal. However, in rare cases, encephalitis (swelling of the brain) can develop.

Features of Aseptic Meningitis

Aseptic recurrent meningitis, caused by epidermoid tumors (non-cancerous neoplasm of the brain), is difficult to distinguish from Mollaret's Meningitis, according to the MFA. "The cyst ruptures and the contents, which become hard to find, contain cell debris and ghost cells identical to those seen in the cerebrospinal fluid of patients with Mollaret's Meningitis," states the MFA. While aseptic meningitis appears to be similar to bacterial forms of meningitis, it is viral in nature, therefore you can reduce your risk of developing it by practicing good hygiene and getting vaccinations.

Causes of Recurrent Meningitis

"Viruses that have been associated with Mollaret's Meningitis include Epstein-Barr virus, Coxsackie viruses B5 and B2, echoviruses 9 and 7 and herpes simplex virus types 1 and 2," according to the MFA. A 2004 JABFM report by Beloo Mirakhur, M.D., Ph.D., and Marc McKenna, M.D., of the Chestnut Hill Hospital, Philadelphia, Pennsylvania, states: "When initially described by Mollaret, this form of aseptic meningitis had no identifiable infecting agent. New sophisticated diagnostic tools have now identified Herpes simplex type 2 virus as the most commonly isolated agent." Infections, fungi, some medications, tick-borne diseases and tuberculosis can cause other forms of aseptic meningitis.

Symptoms

Symptoms of Mollaret's Meningitis include irritability, below-normal fever, high fever, headache, stiff neck and muscle aches and intolerance of bright light. Symptoms come on suddenly, becoming intense within a few hours and persisting for days, even weeks. Symptoms can go away and then reoccur over a period of many years and then disappear. The 2004 JABFM report cites a case report of a 52-year-old who experienced recurrent symptoms such as malaise, nausea, fever, vomiting, headache and photosensitivity. Her "meningitis episodes lasted three to 10 days and subsequently cleared without any residual symptoms" and spanned a period of 20 years.

Diagnosis

According to the MFA, diagnosis is done by taking a sample of your spinal fluid by means of a spinal tap or lumbar puncture. A bacterial culture is then taken from the sample. The established diagnostic criteria or characteristics of Mollaret's Meningitis, according to the MFA, includes recurrent episodes of meningitis, cerebrospinal fluid pleocytosis, which means "a transient increase in the number of leukocytes (white blood cells)," according to Medical Dictionary Online, with large granular and non-granular white blood cells known as neutrophils and lymphocytes, and attacks, followed by periods of remission of symptoms for weeks or months. The attacks may or may not include other non-meningitis symptoms of joint pains, myalgia, vertigo, partial or complete loss of consciousness, cranial nerve paralysis and coma.

Treatment

Acyclovir is administered intravenously or orally, and Valacyclovir is given orally to treat Mollaret's Meningitis. Other therapies tried include steroids and colchicine. The same 2004 JABFM report states this about the effectiveness such treatments: "The rarity of Mollaret syndrome precludes well-documented clinical trials studying the efficacy of various antiviral drugs. Although acyclovir is a safe, effective and specific anti-Herpes drug...it has not been shown to definitively alter the natural history of the disease, whereas other therapies, including estrogen, steroids, antihistamine, phenylbutazonum and colchicine have been unsuccessful in the treatment of Mollaret Meningitis."