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Candidal meningitis in HIV-infected patients: analysis of 14 cases
J L Casado1, C Quereda, J Oliva
1Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain.
Abstract:
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 predisposing factor for candidiasis. Median CD4 cell count was 135/mm3. Headache and fever, in the absence of focal neurologic signs, were the predominant clinical features. The CSF analysis revealed mild pleocytosis and hypoglycorrachia, indistinguishable from those seen in tuberculous or cryptococcal meningitis. Twelve patients (92%) received amphotericin B for a median of 51 days, in combination with flucytosine in five cases. The overall mortality among treated patients was 31%. Although the risk of relapse of candidal meningitis is unknown, maintenance antifungal therapy was given to seven patients (63%), usually with fluconazole. Candida species must be kept in mind as a cause of chronic meningitis in HIV-infected patients who have a known predisposing factor.
Insights
Candidal meningitis is a serious concern in human immunodeficiency virus (HIV)-infected individuals, often presenting with non-specific symptoms. Early recognition and treatment with antifungal agents are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Candidal meningitis is a rare but severe opportunistic infection.
- Human immunodeficiency virus (HIV)-infected patients are at increased risk due to immunosuppression.
Observation:
- Headache and fever are the most common symptoms, often without focal neurological signs.
- Cerebrospinal fluid (CSF) analysis shows mild pleocytosis and hypoglycorrachia, mimicking other forms of meningitis.
- Predisposing factors for candidiasis are present in most affected individuals.
Findings:
- Amphotericin B, often with flucytosine, is the primary treatment, with a 31% mortality rate.
- Maintenance antifungal therapy, frequently with fluconazole, is used to prevent relapse.
- Candida species should be considered in the differential diagnosis of chronic meningitis in HIV patients.
Implications:
- Highlights the importance of considering fungal meningitis in HIV patients with non-specific symptoms.
- Emphasizes the need for prompt diagnosis and aggressive antifungal treatment.
- Suggests a role for maintenance antifungal therapy to reduce relapse rates.