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Cerebrospinal fluid analysis in tuberculous meningitis: A literature review

Akhmad Imron1, Yulius Hermanto1, Ahmad Rizal2

  • 1Department of Neurosurgery, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.

Surgical Neurology International
|July 14, 2025
PubMed
Abstract

Insights

Tuberculous meningitis (TBM) treatment requires drugs that penetrate the central nervous system. Isoniazid and levofloxacin show good cerebrospinal fluid penetration, aiding TBM management.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pharmacology

Background:

  • Tuberculous meningitis (TBM) is a severe central nervous system infection caused by Mycobacterium tuberculosis.
  • TBM increases morbidity and mortality due to neurological deficits.
  • Effective anti-tuberculosis drugs must cross the blood-brain and blood-cerebrospinal fluid barriers for adequate treatment.

Purpose of the Study:

  • To determine the cerebrospinal fluid (CSF) penetration rate of first-line anti-tuberculosis (TB) drugs used in TBM patients.
  • To identify anti-TB drugs with sufficient efficacy for treating central nervous system infections.

Main Methods:

  • Systematic journal searches were conducted on PubMed/PMC and BioMed Central/BMC.
  • Critical appraisal analysis was performed on selected studies.
  • Cerebrospinal fluid (CSF) sampling and analysis are crucial for TBM diagnosis, showing lymphocyte pleocytosis, elevated protein, and decreased glucose.

Main Results:

  • Isoniazid (INH), pyrazinamide, and fluoroquinolones, particularly levofloxacin, demonstrate favorable CSF penetration.
  • CSF analysis results are dependent on sample volume, transport, and technical expertise.
  • Empirical treatment may be initiated for suspected TBM even with negative initial CSF analysis.

Conclusions:

  • Isoniazid (INH) offers high bactericidal activity and is beneficial for TBM treatment.
  • Levofloxacin exhibits good CSF penetration, making it a valuable option.
  • Fluoroquinolones like gatifloxacin and ciprofloxacin are safe alternatives, though with less optimal CSF penetration than levofloxacin.
Keywords:
Anti-tuberculosis drug penetrationCerebrospinal fluidTuberculous meningitis

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