Last reviewed:December 2019
Last updated:May  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • progressive headache
  • severe headache
  • meningismus
  • symptoms of hydrocephalus (impaired cognitive function, confusion, coordination and gait disturbances, and urinary incontinence)
  • behavioural or personality change
  • reduced visual acuity and papilloedema

Other diagnostic factors

  • nausea or vomiting
  • fever
  • reduced conscious level
  • cranial nerve palsies
  • seizures
  • weight loss
  • mouth ulcers
  • focal neurological signs
  • lymphadenopathy, hepatosplenomegaly
  • dyspnoea
  • papular umbilicated skin lesions
  • retinal defects
  • nasal or palatal eschar

Risk factors

  • HIV infection
  • corticosteroid use
  • underlying chronic disease (e.g., malignancy, organ failure, autoimmune disease, organ transplant)
  • residing in or visiting northern Australia, Papua New Guinea, or Vancouver Island, Canada
  • exposure to disturbed soil, chicken guano, or bat caves
  • impaired cell-mediated immunity
  • Filipinos and African Americans
  • neutropenia or impaired phagocytic function
  • neurosurgery
  • infants and neonates
  • central vascular catheters
  • sinonasal disease
  • antibacterial usage
  • prior surgery
  • hyperalimentation
  • intravenous drug abuse

Diagnostic investigations

Treatment algorithm


Consultant Neurologist

Clinical Lead of Neuroinflammation

Department of Neurology

Queen's Hospital




AC has received honoraria, speaker fees, and travel or international meeting sponsorship from Biogen, Genzyme, Merck, Novartis and Teva; he may receive travel and/or meeting sponsorship from Bial and Genzyme in 2018-2019. AC has attended or may attend the Advisory Board meetings for product development and/or marketing with Bial, Merck, Novartis, and Teva. AC declares that these posts and payments do not constitute any competing interest in relation to the topic of fungal meningitis.

Dr Abhijit Chaudhuri would like to gratefully acknowledge Dr Thomas S. Harrison and Dr Angela Loyse, previous contributors to this monograph. TSH and AL declare that they have no competing interests.

Peer reviewersVIEW ALL

Associate Professor of Medicine

University of Southern California

Keck School of Medicine

Los Angeles



RAL declares that he has no competing interests.

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