ABSTRACT

Introduction: Tuberculous meningitis (TBM) is the most devastating form of central nervous system tuberculosis (TB) and causes high mortality worldwide. Nonspecific clinical manifestations and limited sensitivity of existing laboratory methods make the diagnosis elusive due to the paucibacillary nature of the infection.

Areas Covered: We reviewed current literature on the adequacy and limitations of globally existing laboratory methods for diagnosing TBM.

Expert opinion: TBM is deadliest among all TB forms, as the outcome may lead to death in 50% of cases, and survivors undergo irreversible neurological disorders. Therefore, early diagnosis and prompt treatment are cornerstones of effective disease management. Conventional microscopy and culture are widely used modalities but remain inadequate in most TBM cases. Although expanded use of rapid molecular tests such as real-time PCR and Xpert Ultra, even in resource-limited settings, hold promising results for TB diagnosis but need optimization for early detection of TBM. Moreover, CSF IGRA is also used but unable to differentiate between active and latent TB. Overall no single test for diagnosing TBM has adequate accuracy so, there is an urgent need to devise a point-of-care test.

摘要

简介: 结核性脑膜炎 (TBM) 是最具破坏性的中枢神经系统结核病 (TB)，在全球范围内导致高死亡率。由于感染的少杆菌性质，现有实验室方法的非特异性临床表现和有限的敏感性使得诊断难以捉摸。

涵盖的领域：我们回顾了当前关于全球现有实验室诊断 TBM 方法的充分性和局限性的文献。

专家意见：在所有结核病形式中，TBM 是最致命的，因为其结果可能导致 50% 的病例死亡，并且幸存者会出现不可逆转的神经系统疾病。因此，早期诊断和及时治疗是有效疾病管理的基石。常规显微镜和培养是广泛使用的方式，但在大多数 TBM 病例中仍然不足。尽管实时 PCR 和 Xpert Ultra 等快速分子检测的扩展使用，即使在资源有限的环境中，也为结核病诊断提供了有希望的结果，但需要优化以实现结核病的早期检测。此外，CSF IGRA 也被使用，但无法区分活动性和潜伏性结核病。总体而言，没有一种用于诊断 TBM 的单一测试具有足够的准确性，因此迫切需要设计一种即时测试。