Case history
Case history #1
A 35-year-old man originally from sub-Saharan Africa presents with a 3-week history of headache and fever. On questioning, he has had intermittent diarrhoea and weight loss of 10 kg over the last year. The patient's Glasgow Coma Scale score is 15, he is haemodynamically stable, and the only positive findings on examination are a fever of 38.5°C (100.4°F) and oral candidiasis.
Case history #2
A 25-year-old woman presents with increasing headache for 3 to 4 weeks together with confusion, nausea and vomiting, and diplopia for 1 week. On examination she is drowsy, but is able to cooperate with the medical examination. On neurological examination she has a left 6th cranial nerve palsy and has reduced visual acuity and papilloedema. There are no further positive findings on examination.
Other presentations
Patients with fungal meningitis may also present with altered personality, drowsiness, seizures, nausea and/or vomiting, hearing loss, and fever without prominent headache. In particular, patients with cryptococcal meningitis may present with signs and symptoms of raised intracranial pressure such as severe headache, nausea or vomiting, visual loss, and altered mental status. Symptoms and signs of hydrocephalus commonly occur in patients diagnosed with coccidioidal meningitis either at presentation or as a late complication.
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