CANDIDAL MENINGITIS IN HIV-INFECTED PATIENTS - ANALYSIS OF 14 CASES

Five cases of candidal meningitis in human immunodeficiency virus (HIV )-infected patients have been diagnosed in our hospital. This article describes these cases and reviews another nine previously reported in the literature. Most patients (71%) had at least one well-known predis posing factor for candidiasis. Median CD4 cell count was 135/mm(3). He adache and fever, in the absence of focal neurologic signs, were the p redominant clinical features. The CSF analysis revealed mild pleocytos is and hypoglycorrachia, indistinguishable from those seen in tubercul ous or cryptococcal meningitis. Twelve patients (92%) received amphote ricin B for a median of 51 days, in combination with flucytosine in fi ve cases. The overall mortality among treated patients was 31%. Althou gh the risk of relapse of candidal meningitis is unknown, maintenance antifungal therapy was given to seven patients (63%), usually with flu conazole. Candida species must be kept in mind as a cause of chronic m eningitis in HIV-infected patients who have a known predisposing facto r.