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Everything To Know About Mollaret's Meningitis

Mollaret's meningitis is a rare type of meningitis that causes recurring episodes of inflammation around the brain and spinal cord.

Mollaret's meningitis is a rare and chronic form of aseptic (nonbacterial) meningitis, involving recurrent episodes of meningitis-like symptoms, including severe headaches, fever, and neck stiffness. Its other names include benign recurrent lymphocytic meningitis and idiopathic recurrent meningitis.

Unlike bacterial meningitis, this condition does not result from bacteria but rather from viral infections, particularly herpes simplex virus type 2 (HSV-2). HSV-2 is commonly known for causing genital herpes. In rare cases, it can also lead to recurrent meningitis, where the virus affects the meninges — the protective membranes around the brain and spinal cord.

While these episodes can be severe, they typically resolve independently after a few days with supportive care. However, doctors may opt to prescribe antiretroviral treatments.

This article covers Mollaret's meningitis, including its symptoms, causes, and treatment options.

Mollaret's meningitis is a rare form of aseptic, recurrent meningitis primarily linked to viral infections, particularly HSV-2. It was first described by Dr. Pierre Mollaret in 1944.

The condition occurs when the virus directly infects the central nervous system and remains dormant for extended periods without causing symptoms. When the infection reactivates, it triggers recurrent episodes of meningitis-like symptoms.

Approximately 1 in 5 people who develop HSV-2 meningitis experience recurrences. When symptoms occur more than three times, the condition is Mollaret's meningitis.

Unlike bacterial meningitis, which requires antibiotics, Mollaret's meningitis usually resolves independently and is not life threatening. However, the condition's recurrent nature can lead to significant discomfort, even though it does not typically cause long-term damage.

Mollaret's meningitis most commonly results from viral infections with HSV-2, although other viral agents such as HSV-1 and Epstein-Barr virus (EBV) may also contribute. The virus can remain dormant in the body and reactivate intermittently, causing recurrent episodes of inflammation in the meninges.

Other potential triggers include intracranial cystic anomalies. These fluid-filled sacs develop within the brain or skull due to congenital conditions, infections, or trauma. They may release irritant material into the meninges and provoke a hypersensitivity reaction. Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may also have this effect.

Additionally, immune system deficiencies may predispose individuals to recurrent viral infections, leading to meningitis. Certain autoimmune disorders, such as lupus, also link to Mollaret's meningitis. However, Mollaret's meningitis is idiopathic, meaning its cause remains unknown.

Treatment for Mollaret's meningitis depends on the underlying cause, the symptoms' severity, and the recurrence frequency.

Healthcare professionals may prescribe antiviral medications, such as acyclovir or valacyclovir, to suppress herpes virus activity. These medications can reduce the frequency and severity of attacks in patients with HSV-related Mollaret's meningitis.

In other cases, treatment focuses on symptom management, using pain relievers, anti-inflammatory drugs, and fluids to alleviate headaches, fever, and discomfort.

Hospitalization may be necessary if symptoms are severe or there is concern about the possibility of bacterial meningitis.

There is no guaranteed method to prevent Mollaret's meningitis entirely, but reducing the risk of viral infections, particularly HSV, could help. That said, only a small proportion of those with HSV-2 will develop Mollaret's meningitis.

Practicing good hygiene, avoiding contact with individuals experiencing active herpes lesions, and managing immune health may lower the risk of triggering an episode.

In some cases, doctors may recommend suppressive viral therapy with acyclovir to prevent recurrences.

Mollaret's meningitis is a rare and recurrent form of viral meningitis that can cause significant discomfort through repeated episodes of headache, fever, and neck stiffness. Although the condition is not life threatening, it can affect a person's quality of life.

Timely diagnosis, treatment with antivirals, and symptom management can help people manage the condition and may reduce the frequency of attacks.

Individuals with meningitis symptoms should consult a healthcare professional to explore treatment options and rule out serious causes.

Mum's Heartbreak As 18-day-old Daughter Dies From Fatal Kiss

Oh goodness, this is such a sad story, but one we felt it was important to share here at MFM HQ.

On the day of their own wedding, Nicola and Shane Sifrit noticed that their tiny baby, Mariana - just a week old - was not her usual self.

She was refusing to eat and was unresponsive, so they rushed her to hospital, where it was discovered the newborn had contracted meningitis as a result of getting HSV-1 - the same virus that causes cold sores.

Neither Nicola or Shane carry the virus themselves - and there's no way of telling who Mariana might have contracted it from - but what we do know is that HSV-1 is usually passed on by direct contact from a cold sore on the lips of one person to the lips of another.

If a newborn (especially one under the age of 6 weeks) gets the HSV-1 virus it can be really dangerous, though with swift medical intervention recovery can be made: take a look at the story we shared about a new baby who survived after contracting it when she was kissed by a stranger.

But on very rare occasions, when HSV-1 turns into meningitis - it is much more serious and, as in Mariana's case, often proves fatal.

Sharing her heartbreaking story on Facebook just days before Mariana died, Nicole said this:

"For people who don't understand what we are going through, please read this story. If you gather anything from it DON'T LET ANYONE kiss your baby.

"This story is what I'm living through right now. Our princess is fighting for her life on life support after being discharged 100% healthy this has to be the worse nightmare I've ever lived!

"Please keep our princess of the sea Mariana, her daddy, and myself in your prayers ♡"

It's a stark warning, which we totally get - and we would say that you shouldn't let anyone who has a cold sore - or the early symptoms of one (like that tingling sensation) to kiss your newborn, especially if they're under 6 weeks old.

Our heart goes out to Mariana's family - we can't imagine what they must be going through - but we're so glad they felt able to share their story to help others ???

Read more

Getting To Know Lip Herpes Better

Generally, the primary infection is asymptomatic and can go unnoticed. However, if symptoms do occur, they can be quite severe. There are usually prodromal symptoms a few days before the onset (fever, weakness, burning or tingling sensation). The primary infection may present as acute gingival stomatitis in children and severe pharyngitis in adults. Sometimes there is fever, muscle pain, malaise, and lymphadenopathy. Herpetic gingival stomatitis can also occur in adults, especially those who are immunocompromised.

Typically, the course is favourable, with spontaneous healing in less than 15 days. LH can occur as a single occurrence or become recurrent. After the primary infection, the virus remains latent in the neurons of nearby sensory ganglia (usually the trigeminal ganglion). In some individuals, the virus remains inactive, while in others, it can reactivate after a variable period, leading to recurrent outbreaks of LH, followed by a return to latency. Approximately one-third of those infected experience at least one recurrence during their lifetime.

LH is easily recognizable by the individual, who often senses its impending eruption through sensations in the area where it previously appeared. These sensations include burning, tingling, or itching localized to a small area, typically affecting the lips and surrounding skin. Subsequently, a red macule quickly develops into vesicles within six hours to two days after the initial symptoms. Over a few days, the vesicles rupture and form ulcers, which are then covered by a yellowish crust that eventually falls off without scarring. Lesions may also occur on the oral mucosa or skin, occasionally around the nose or cheek.

Outbreaks vary in frequency and severity, ranging from one to two episodes per year to monthly occurrences. As individuals age, recurrences tend to decrease in intensity and frequency.

In immunocompetent individuals, HSV-1 infections are usually self-limiting and rarely severe. Typically, LH resolves completely within seven to ten days, although longer durations of two to three weeks have been reported.

LH poses an aesthetic concern with potential psychosocial implications. For those experiencing recurrent LH, the painful and unpleasant lesions can cause significant stress and anxiety.

HSV-1 is highly contagious and spreads through direct contact with infected individuals, their oral secretions, or lesions. Indirect transmission is also possible as the virus remains viable on surfaces for several hours. Infection is most contagious during active replication but can also occur asymptomatically. While HSV-1 infection is common, its prevalence has been decreasing in developed countries. Other clinical manifestations of HSV-1 infection include skin and mucous membrane lesions, genital herpes, eye infections, and severe systemic conditions like encephalitis, meningitis, or respiratory infections.

Various triggers have been identified for LH recurrences, including sunlight exposure, fever, menstruation, stress, fatigue, local trauma, infectious diseases, or immunosuppression. However, some recurrences may occur without an identifiable trigger.

For more information please contact Grupo HPA Saude on (+351) 282 420 400.

Disclaimer:The views expressed on this page are those of the author and not of The Portugal News.

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