[Diagnosis in recurrent bacterial meningitis; a literature study].
Recurrent bacterial meningitis can be caused by different mechanisms. In order to make the diagnostics more efficient, we studied literature to find these underlying mechanisms. Two groups could be identified: group I, patients with a congenital or posttraumatic defect in the bones of the skull and group II, patients with a deficiency of a component of complement. The patients in group I were much younger at the time of their first meningitis and suffered more often from otitis, rhinorrhoea and deafness diagnosed before the first meningitis. Streptococcus pneumoniae was most frequently cultured in the cerebrospinal fluid, the group with complement deficiency showed Neisseria meningitidis almost exclusively. Family history revealed more members with infections caused by neisseriae spp. Although it was difficult to diagnose the bony defects, physical examination, radiography and high resolution CT scanning of the skull were helpful. Age, history, physical examination and cerebrospinal fluid culture were the most helpful in diagnostic factors.