Candidal meningitis in HIV-infected patients.

Candida meningitis is considered a rare event in HIV-infected patients, and little is known about risk factors, clinical presentation, therapy of choice, or outcome in this population. In a review of 14 cases, we observed a low frequency of the disease, a strong association to other well-known risk factors for systematic candidiasis, such as intravenous drug use, and a chronic course and clinical features that mimic those of cryptococcal or tuberculous meningitis. Although the role of fluconazole treatment remains to be defined, the combination of amphotericin B with flucytosine offers a survival rate similar to non-HIV-infected patients. In addition, the use of suppressive therapy with fluconazole for a prolonged period after clinical improvement seems recommendable.