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.