Guidelines versus ground lines: Tuberculosis of the central nervous system

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Central nervous system tuberculosis (CNS TB) presents diagnostic and therapeutic challenges.
• Understanding current management practices among neurologists is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the current practices of Indian neurologists in managing various aspects of CNS TB.
• To identify areas of consensus and discrepancy in CNS TB management.

Main Methods:

• A national cross-sectional survey was conducted using a questionnaire distributed via email to practicing neurologists in India.
• Responses from 144 neurologists were analyzed using inferential statistics.

Main Results:

• Significant variability was observed in antitubercular drug regimens, treatment durations for tuberculous meningitis (TBM) and tuberculoma, follow-up strategies, and linezolid use.
• While the use of cerebrospinal fluid (CSF) TB polymerase chain reaction (PCR) and steroids aligned with guidelines, there were discrepancies in CSF adenosine deaminase (ADA) usage and the utilization of histological aids.
• Knowledge regarding drug-resistant cases and strategies for drug cessation also showed variation.

Conclusions:

• This survey provides the first ground-level data on CNS TB practices among Indian neurologists, highlighting considerable diversity in therapeutic and monitoring approaches.
• Investigational aspects like TB PCR and neuroimaging show good clinical practice, but CSF parameters require standardization.
• The findings identify key areas for future research and intervention to standardize CNS TB management in India.