Diagnosing tuberculous meningitis – have we made any progress?

Abstract

Tuberculous meningitis (TBM) comprises a significant proportion of TB cases globally and causes substantial morbidity and mortality, especially in children and HIV-infected patients. It is a challenging condition to diagnose due to its non-specific clinical presentation and the limited sensitivity of existing laboratory techniques. Smear microscopy and culture are the most widely available diagnostic tools yet are negative in a significant proportion of TBM cases. Simplified and more affordable nucleic acid amplification tests (NAATs) are increasing in use in resource-limited settings but have not been optimised for cerebrospinal fluid (CSF) samples. Novel diagnostic methods such as CSF interferon-gamma release assays and various biomarkers have been developed but require further evaluation to establish their utility as diagnostic tools. There is an urgent need for further research into optimal diagnostic strategies to decrease the morbidity and mortality as a result of delayed or missed diagnosis of TBM. In this review, we discuss current and novel diagnostic tests in TBM and areas where future research should be prioritised.

Case Report Overwhelming postsplenectomy infection

“…Our patient was diagnosed with tuberculous OPSI, an even rarer condition than OPSI from other causes. Normally, CSF acid-fast staining has a very low positive rate; for example, no positive CSF acid-fast staining was observed among 83 patients with tuberculous meningitis (Ho et al, 2013). However, in our patient, CSF acid-fast staining was positive, which suggests a large number of acid-fast bacilli and is in line with the characteristics of OPSI bacterial infection.…”

Tuberculous Meningitis in The Differential Diagnosis of Cns Infection and the Urgency of Antituberculosis Treatment

“…Tuberculous meningitis is a serious and challenging problem worldwide [4,9]. Our patient was coming from Somalia where tuberculosis is endemic.…”

“…The best approaches to prevent, diagnose and treat tuberculous meningitis are still inadequate [1,2]. Tuberculous meningitis is one of the most serious infections of central nervous system especially in developing countries with high morbidity and mortality rates [3,4]. In a study Ruslami et al determined that 50% of the patients with tuberculous meningitis were mortal [5].…”

Tuberculous meningitis: a diagnostic challenge and a devastating outcome

“…They are expected to be more sensitive than culture and provide a rapid identification of Mycobacterium tuberculosis and for some tests susceptibility to rifampicin. 4 Nevertheless, bacteriological confirmation remains of importance especially to identify resistant isolates. Rohlwink et al 3 report a high yield (53%) from CSF cultures and ascertain the diagnosis of tuberculous meningitis in a substantially higher proportion than results compiled in a recent meta-analysis.…”

“…Suggested approaches to improve adherence in this group involve modifying clinician behavior to focus on improving the adolescent's knowledge about epilepsy and treatment, along with minimizing disagreement between the adolescent and caregiver regarding epilepsy and medication efficacy. 4 It is important that the clinician provide an environment in which there is open communication so that the adolescent is not fearful to report non-adherence. While adherence to medication is particularly poor in the adolescent age group, adherence to lifestyle recommendations is even worse; only 18% of…”