There has been an increase in recent years in the number of reported cases of
meningitis and
brain abscesses caused by fungi. This increase is due to the availability of better diagnostic techniques for
fungal infections and the ever-increasing population of immunocompromised hosts (1,2). The patients most susceptible to
invasive fungal infections include those with
hematologic malignancies; those receiving hyperalimentation,
corticosteroids, or cytotoxic drugs; transplant recipients; injection drug abusers; and those with the
acquired immunodeficiency syndrome (
AIDS). Although many fungi infect only immunologically impaired patients, some will infect normal hosts as well. The successful treatment of central nervous system (
CNS) fungal infections is highly dependent on the underlying immune status of the host, as well as on the prompt initiation of appropriate antifungal
therapy. However, the diagnosis of these
infections may be difficult, and proper
therapy often delayed. Furthermore, information on treatment regimens ranges from extensive, as in the case of
cryptococcal meningitis, to scanty or nonexistent in the case of rare, opportunistic fungi. For > 3 decades, the standard
antifungal agent for the treatment of
CNS fungal infections has been
amphotericin B. However, the effectiveness of
amphotericin B is often eliminated by poor CNS penetration, fungal resistance, and toxicity (3). Because of the problems associated with use of
amphotericin B, newer
azole antifungal agents have been developed, some of which are efficacious in the
therapy of
fungal meningitis. We give an overview of the
antifungal agents currently available for clinical use and their utility in the treatment of
fungal meningitis.