Central nervous system tuberculosis.

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Central nervous system tuberculosis (CNS-TB) encompasses tuberculous meningitis (TBM), spinal cord disorders, and tuberculomas.
• Co-infection with human immune-deficiency virus (HIV) complicates CNS-TB, often leading to a more severe disease presentation globally.

Purpose of the Study:

• To review the diverse aspects of central nervous system tuberculosis (CNS-TB).
• To discuss diagnostic modalities and therapeutic challenges associated with CNS-TB.

Main Methods:

• Review of conventional and modern molecular diagnostic techniques for TBM.
• Analysis of characteristic features in computerized tomography (CT) and magnetic resonance imaging (MRI) for CNS-TB diagnosis.
• Evaluation of current therapeutic regimens extrapolated from pulmonary TB treatment.

Main Results:

• Diagnostic tests for TBM show high specificity but variable sensitivity.
• Advanced imaging techniques like CT and MRI significantly enhance the diagnostic accuracy of CNS-TB.
• Optimal drug regimens, dosages, and durations for CNS-TB are not yet established.

Conclusions:

• CNS-TB, particularly with HIV co-infection, poses a significant global health challenge.
• Emerging multidrug-resistant TB (MDR-TB) in the CNS requires urgent attention due to delayed recognition and lack of established treatment protocols, contributing to high mortality.