その他の感染症疾患（真菌症・結核・寄生虫を含む）

Other Central Nervous System Infections（Including Fungal Infection, Tuberculosis, and Parasitic Infection）

Point

・真菌・原虫などによる稀な疾患は易感染状態で発症することが多く，既往歴，治療歴の聴取が大切である．

・クリプトコッカス，梅毒は血清の抗原検査がスクリーニングに有用である．

・真菌・結核・原虫感染による髄膜炎・脳炎では，脳生検，水頭症のシャント術，脳室内ドレナージなど外科的な処置が必要になる症例が多い．

　This review describes cryptococcal meningoencephalitis, tuberculous meningitis, neurosyphilis, and toxoplasma encephalitis. Central nervous system infections are neurological emergencies associated with mortality or other outcomes. Therefore, early diagnosis and treatment are critical. Fungal or gondii infections are rare and affect compromised hosts who are HIV positive, have diabetes, or take immunosuppressive or anticancer drugs. Cryptococcal antigens in the serum and cerebrospinal fluid are useful for the diagnosis of cryptococcal meningoencephalitis. RPR and TPHA tests are useful for the diagnosis of neurosyphilis. Cryptococcal meningoencephalitis and tuberculous meningitis often develop into hydrocephalus, making VP shunt necessary. Antifungal drugs for cryptococcal meningitis are limited by the blood-brain barrier, making a full recovery difficult; in such situations, intraventricular antifungal treatment is required.