Tuberculous meningitis

on behalf of the Tuberculous Meningitis International Research Consortium

Research output: Contribution to journalReview article

Abstract

Tuberculosis remains a global health problem, with an estimated 10.4 million cases and 1.8 million deaths resulting from the disease in 2015. The most lethal and disabling form of tuberculosis is tuberculous meningitis (TBM), for which more than 100,000 new cases are estimated to occur per year. In patients who are co-infected with HIV-1, TBM has a mortality approaching 50%. Study of TBM pathogenesis is hampered by a lack of experimental models that recapitulate all the features of the human disease. Diagnosis of TBM is often delayed by the insensitive and lengthy culture technique required for disease confirmation. Antibiotic regimens for TBM are based on those used to treat pulmonary tuberculosis, which probably results in suboptimal drug levels in the cerebrospinal fluid, owing to poor blood-brain barrier penetrance. The role of adjunctive anti-inflammatory, host-directed therapies-including corticosteroids, aspirin and thalidomide-has not been extensively explored. To address this deficit, two expert meetings were held in 2009 and 2015 to share findings and define research priorities. This Review summarizes historical and current research into TBM and identifies important gaps in our knowledge. We will discuss advances in the understanding of inflammation in TBM and its potential modulation; vascular and hypoxia-mediated tissue injury; the role of intensified antibiotic treatment; and the importance of rapid and accurate diagnostics and supportive care in TBM.

Original languageEnglish (US)
Pages (from-to)581-598
Number of pages18
JournalNature Reviews Neurology
Volume13
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Meningeal Tuberculosis
Tuberculosis
Anti-Bacterial Agents
Culture Techniques
Thalidomide
Penetrance
Blood-Brain Barrier
Pulmonary Tuberculosis
Research
Aspirin
Blood Vessels
Cerebrospinal Fluid
HIV-1
Adrenal Cortex Hormones
Anti-Inflammatory Agents
Theoretical Models
Inflammation
Mortality
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

Cite this

on behalf of the Tuberculous Meningitis International Research Consortium (2017). Tuberculous meningitis. Nature Reviews Neurology, 13(10), 581-598. https://doi.org/10.1038/nrneurol.2017.120

Tuberculous meningitis. / on behalf of the Tuberculous Meningitis International Research Consortium.

In: Nature Reviews Neurology, Vol. 13, No. 10, 01.10.2017, p. 581-598.

Research output: Contribution to journalReview article

on behalf of the Tuberculous Meningitis International Research Consortium 2017, 'Tuberculous meningitis', Nature Reviews Neurology, vol. 13, no. 10, pp. 581-598. https://doi.org/10.1038/nrneurol.2017.120
on behalf of the Tuberculous Meningitis International Research Consortium. Tuberculous meningitis. Nature Reviews Neurology. 2017 Oct 1;13(10):581-598. https://doi.org/10.1038/nrneurol.2017.120
on behalf of the Tuberculous Meningitis International Research Consortium. / Tuberculous meningitis. In: Nature Reviews Neurology. 2017 ; Vol. 13, No. 10. pp. 581-598.
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