THERAPY OF FUNGAL MENINGITIS

There has been an increase in recent years in the number of reported c ases of meningitis and brain abscesses caused by fungi. This increase is due to the availability of better diagnostic techniques for fungal infections and the ever-increasing population of immunocompromised hos ts (1,2). The patients most susceptible to invasive fungal infections include those with hematologic malignancies; those receiving hyperalim entation, corticosteroids, or cytotoxic drugs; transplant recipients; injection drug abusers; and those with the acquired immunodeficiency s yndrome (AIDS). Although many fungi infect only immunologically impair ed patients; some will infect normal hosts as well. The successful tre atment of central nervous system (CNS) fungal infections is highly dep endent on the underlying immune status of the host, as well as on the prompt initiation of appropriate antifungal therapy. However, the diag nosis of these infections may be difficult, and proper therapy often d elayed. Furthermore, information on treatment regimens ranges from ext ensive, as in the case of cryptococcal meningitis, to scanty or nonexi stent in the case of rare, opportunistic fungi. For >3 decades, the st andard antifungal agent for the treatment of CNS fungal infections has been amphotericin B. However, the effectiveness of amphotericin B is often limited by poor CNS penetration, fungal resistance, and toxicity (3). Because of the problems associated with use of amphotericin B, n ewer azole antifungal agents have been developed, some of which are ef ficacious in the therapy of fungal meningitis. We give an overview of the antifungal agents currently available for clinical use and their u tility in the treatment of fungal meningitis.