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Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe

  • Infection (J Halperin, Section Editor)
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Abstract

Purpose of Review

Tuberculous meningitis is the most devastating manifestation of infection with Mycobacterium tuberculosis and represents a medical emergency. Approximately one half of tuberculous meningitis patients die or suffer severe neurologic disability. The goal of this review will be to review the pathogenic, clinical, and radiologic features of tuberculous meningitis and to highlight recent advancements in translational and clinical science.

Recent Findings

Pharmacologic therapy includes combination anti-tuberculosis drug regimens and adjunctive corticosteroids. It is becoming clear that a successful treatment outcome depends on an immune response that is neither too weak nor overly robust, and genetic determinants of this immune response may identify which patients will benefit from adjunctive corticosteroids. Recent clinical trials of intensified anti-tuberculosis treatment regimens conducted in Indonesia and Vietnam, motivated by the pharmacologic challenges of treating M. tuberculosis infections of the central nervous system, have yielded conflicting results regarding the survival benefit of intensified treatment regimens. More consistent findings have been observed regarding the relationship between initial anti-tuberculosis drug resistance and mortality among tuberculous meningitis patients.

Summary

Prompt initiation of anti-tuberculosis treatment for all suspected cases remains a key aspect of management. Priorities for research include the improvement of diagnostic testing strategies and the optimization of host-directed and anti-tuberculosis therapies.

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Alyssa Mezochow

  2. Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Kiran Thakur

  3. Public Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, 225 Warren Street, Newark, NJ, 07103, USA

    Christopher Vinnard

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  1. Alyssa Mezochow
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Correspondence to Christopher Vinnard.

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Mezochow, A., Thakur, K. & Vinnard, C. Tuberculous Meningitis in Children and Adults: New Insights for an Ancient Foe. Curr Neurol Neurosci Rep 17, 85 (2017). https://doi.org/10.1007/s11910-017-0796-0

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