The major causes of meningitis are M. tuberculosis, which can occur at any stage of HIV disease, and C. neoformans at CD4 counts below 125 * 106/l. The frequency of pyogenic meningitis is not increased in HIV-infected patients, although cases due to Listeria monocytogenes may be more common.
Tuberculous and cryptococcal meningitis both have a subacute onset. Initial features include mild to moderate fever and a headache that is not severe. At this stage, neck stiffness and photophobia are absent in 50 per cent or more of the patients. As the meningitis progresses over days or weeks, the classic signs are more likely to be found as are diminished levels of consciousness and focal neurological signs.
Intensive monitoring and management of respiratory failure due to diminished consciousness is appropriate at initial presentation. The expected survival rate is approximately 50 per cent.
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