title: [Recurrent meningitis due to anatomical defects: The bacteria indicates its origin].
abstract: BACKGROUND
  Recurrent meningitis is a rare disease. Anatomical abnormalities and immunodeficiency states are predisposing factors. Four cases, in which immunodeficiency was excluded, are presented. The causal microorganism led to the detection of the anatomical defect responsible for the recurrences.
  
  
  METHODS
  Retrospective review of 4 cases with clinical diagnosis of recurrent bacterial meningitis.
  
  
  RESULTS
  Case 1: a thirty month-old boy with unilateral hearing loss, diagnosed with Mondini abnormality by magnetic resonance imaging (MRI) after 2 episodes of Haemophilus influenzae meningitis. Surgical repair after third recurrence. Case 2: fourteen year-old girl diagnosed by MRI with cribriform plate defect after 3 episodes of meningitis due to Streptococcus pneumoniae. Ventriculoperitoneal shunt was placed. Case 3: girl with meningitis due to Staphylococcus aureus at 2 and 7 months. MRI shows occipital dermal sinus requiring excision. Complication with cerebellar abscesses because of a coexisting dermoid cyst. Case 4: child with meningitis due to Streptococcus bovis at 9 days and Enterococcus faecium, Klebsiella pneumoniae and Escherichia coli at 7 months, with positive cultures to Citrobacter freundii and E. faecium later on. Spinal MRI led to the diagnosis of Currarino syndrome with CSF fistula, which was surgically repaired. The 4 patients had undergone image studies reported as normal during the first episodes.
  
  
  CONCLUSIONS
  In patients with recurrent meningitis the possibility of an anatomical defect should be considered. The isolated microorganism should help to locate it. It is essential to know the normal flora of the different anatomical sites. The definitive treatment is usually surgical.
authors.affiliation: Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Morgenstern Isaak
authors.affiliation: Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Bach Faig
authors.affiliation: Unidad de Infectología Pediátrica, Hospital Miguel Servet, Zaragoza, España.
authors.forename: S
authors.initials: S
authors.lastname: Martínez
authors.affiliation: Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Martín-Nalda
authors.affiliation: Servei de Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: Vázquez Méndez
authors.affiliation: Unitat d'Otorrinolaringologia Pediàtrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Pumarola Segura
authors.affiliation: Unitat de Patologia Infecciosa i Immunodeficiències Pediàtriques, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: psoler@vhebron.net.
authors.forename: P
authors.initials: P
authors.lastname: Soler-Palacín
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D000013:Congenital Abnormalities; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology / Q000382:microbiology*; D012008:Recurrence; D012189:Retrospective Studies
keywords: Congenital anatomical defect; Currarino triad; Defecto anatómico congénito; Malformación de Mondini; Meningitis bacteriana recurrente; Mondini abnormality; Recurrent bacterial meningitis; Síndrome de Currarino