Abstract
Central nervous system (CNS) involvement of tuberculosis (TB) is the most severe manifestation
of TB and accounts for approximately 5 to 10% of all extrapulmonary TB (EPTB) cases
and approximately 1% of all TB cases. TB meningitis (TBM) is the most common form
of CNS TB, though other forms occur, often in conjunction with TBM, including intracranial
tuberculomas, tuberculous brain abscesses, and spinal tubercular arachnoiditis. CNS
TB often presents with nonspecific clinical features that mimic symptoms of other
neurological conditions, often making diagnosis difficult. Defining neuroimaging characteristics
of TBM include thick basal meningeal enhancement, hydrocephalus, and parenchymal infarctions
most commonly involving the basal ganglia and internal capsule. Traditional cerebrospinal
fluid sample analysis frequently requires lengthy times-to-result and have low sensitivity.
Given the pitfalls of conventional CNS TB diagnostic methods, various molecular-based
methods, including immunoassays and polymerase chain reaction (PCR)-based assays have
emerged as alternative diagnostic tools due to their rapidity, sensitivity, and specificity.
Expert panels on TBM have recently emphasized the need for standard research procedures
with updated case definitions and standardized study methods, which will hopefully
pave the way for more robust multicenter international studies. In this article, we
review the epidemiology, diagnosis, molecular factors associated with disease presentation
and outcome, and treatment of CNS TB.
Keywords
tuberculosis - meningitis - human immunodeficiency virus - drug resistance - global
health
