Rapid diagnosis of tuberculous meningitis: What is the optimal method?

Meningitis remains the most serious complication of infection with Mycobacterium tuberculosis. Patient recovery depends on rapid diagnosis and treatment. Findings from cerebrospinal fluid examination are nonspecific. If performed appropriately, the acid-fast bacilli smear has the same sensitivity as the currently available commercial nucleic acid amplification tests. Modifications to these commercial assays that include dilution or removal of inhibitors and concentration of organisms are encouraging but need more extensive verification on actual clinical samples. We present 2 recent cases of tuberculous meningitis and discuss currently available diagnostic methods.