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Advances in management and treatment of tubercular meningitis - a narrative review
Manal Arshad Malik1, Aleena Kamran2, Dua Ahsan3
1Liaquat National Hospital, Karachi, Pakistan.
Background:
Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to be a major global health issue, particularly due to its potential to cause severe complications such as tubercular meningitis (TBM), which is a fatal condition that proves difficult to diagnose and treat effectively and often results in poor outcomes, especially in children, due to delayed diagnosis, drug resistance, and limited diagnostic techniques.
Methods:
This review provides a comprehensive overview of recent advancements in TBM management and treatment. A systematic search was performed across major databases, including PubMed, Google Scholar, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and the ISRCTN Registry. The search strategy used terms like ("tubercular meningitis" OR "TBM" OR "TB meningitis") AND ("diagnosis" OR "treatment" OR "clinical trials"). Inclusion criteria focused on studies published from January 2014 to September 2024, highlighting novel diagnostics, therapeutic advances, and clinical trials for TBM. Exclusion criteria involved studies unrelated to TBM or older than 10 years.
Results:
Diagnostic methods for TBM, such as microbiological and molecular techniques (Fig. 1), vary in sensitivity, with polymerase chain reaction assays being the most sensitive. While anti-TB drugs are available, drug resistance and poor cerebrospinal fluid penetration limit effectiveness. New molecular diagnostics and therapies, including anti-TNF agents, anti-inflammatory drugs, and antibiotics, show promise for improving outcomes.Figure 1.A summary of the diagnosis and management of tuberculosis meningitis.
Conclusion:
Despite recent advancements in TBM diagnostics and treatment, substantial challenges remain, particularly in addressing drug resistance and improving drug efficacy in the central nervous system. Continued innovation in molecular diagnostics and treatment approaches is essential to enhance TBM care and mitigate its devastating consequences.
Insights
Tubercular meningitis (TBM) remains a severe global health threat. Recent advancements in diagnostics and treatments show promise, but drug resistance and CNS penetration challenges persist, necessitating continued innovation.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Tuberculosis (TB) poses a significant global health challenge, with tubercular meningitis (TBM) being a particularly severe and often fatal complication.
- TBM is difficult to diagnose and treat effectively, leading to poor outcomes, especially in children, due to factors like delayed diagnosis and drug resistance.
Purpose of the Study:
- To provide a comprehensive review of recent advancements in the management and treatment of tubercular meningitis (TBM).
- To highlight novel diagnostic techniques and therapeutic strategies for TBM based on recent clinical trials and research.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Google Scholar, ClinicalTrials.gov, etc.) for studies published between January 2014 and September 2024.
- Search terms included "tubercular meningitis," "TBM," "TB meningitis," "diagnosis," "treatment," and "clinical trials."
- Inclusion criteria focused on recent advancements in TBM diagnostics, therapeutics, and clinical trials, excluding older or unrelated studies.
Main Results:
- Molecular diagnostic techniques, such as polymerase chain reaction (PCR) assays, offer the highest sensitivity for TBM diagnosis.
- Current anti-TB drugs face limitations due to drug resistance and poor penetration into the cerebrospinal fluid (CSF).
- Emerging therapies, including anti-TNF agents, anti-inflammatory drugs, and novel antibiotics, show potential for improved TBM patient outcomes.
Conclusions:
- Despite progress, significant challenges in TBM management persist, particularly concerning drug resistance and achieving effective drug concentrations in the central nervous system.
- Continued innovation in molecular diagnostics and therapeutic approaches is crucial for improving TBM care and reducing its mortality and morbidity.
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