Diagnostic Approaches to Chronic Fungal and Tuberculous Meningitis

Bacterial meningitis is common in Brazil and in endemic region of Sub-SaharanAfrica. Chronicmeningitis (CM) is defined as meningitis lasting for four weeks or more and have signs of chronic inflammation in the cerebrospinal fluid.CM is a diagnostic dilemma, with limited literature on the subject.CM is common in immunocompromised, immunocompetent and in patients infected with immunodeficiency virus (AIDS).Less common Mollaret’s meningitis and Bachet’sdisease, a chronic multisystem disorder. Common pathogens isolated include enteroviruses,Mycobacterium tuberculosis,Cryptococcus neoformans, Treponema pallidum,Coccidioides immitis,rare pathogens include Angiostrongylus cantonennesis, Naegleriafowleri. Treatment of choice in tuberculous meningitiswith four-drug regimen,and amphotericin B with flucocytosine or fluconazole for 4 to 6 weeks for cryptococcal meningitis. Prompt diagnosis and antibiotic therapy with longterm follow up have a better outcome.