Neurological infections are a significant cause of morbidity and mortality worldwide. Increasing travel to exotic destinations and the rising HIV prevalence are resulting in increasing incidences of previously rare diseases. Timely treatment is key in determining a successful outcome. This depends upon taking a meticulous history that details the timing and presence of risks and exposures, which, with knowledge of incubation periods, enables generation of a differential diagnosis leading to focused investigations. Recent trials have generated good evidence to improve outcome in important infections: for example, artesunate has been shown to be the best drug to use in severe malaria, and the value of adjunctive steroids in pyogenic bacterial and TBM has been clearly demonstrated. However, evidence is lacking on the best treatment for other infections. The rising incidence of syphilis in the UK in the last few years has posed difficult questions regarding antibiotic choices, since good clinical data do not exist; randomised controlled trials are urgently needed. In HIV, the advent of HAART has reduced the incidence of opportunistic infections in those fortunate enough to receive it. However, central nervous system infections continue to account for considerable morbidity and mortality in these patients around the world and in patients presenting with AIDS in the UK.
