Background: HIV infection and parenteral drug abuse (PDA) are frequently associated conditions. Both are at increased risk of developing specific types of Candida infections. Localized CNS infection is an exceptional finding.
Methods: We report two cases of meningitis in PDA due to Candida albicans--one of them HIV positive, and review the literature emphasizing the characteristics of 8 HIV positive patients 4 of them PDA.
Results: Most frequent presentation symptoms were fever and headache for more than two weeks. Three patients were found normal on neurologic examination. In two cases CT scan showed hydrocephalus. In one case CNS infarcts were demonstrated on MRI. Median CSF cell counts were 109, mostly lymphocytic. Two cases had elevated adenosine deaminase levels in CSF. Two cases were treated with fluconazole, one improved and the other was cured. Four patients died due to the infection, one of them received no specific treatment.
Conclusions: Candida meningitis can be a manifestation of HIV related immunosuppression. Clinical and CSF findings are mild. Mortality is high. Probably a maintenance therapy is required.