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Tuberculous meningitis: where to from here?
- Source :
-
Current opinion in infectious diseases [Curr Opin Infect Dis] 2020 Jun; Vol. 33 (3), pp. 259-266. - Publication Year :
- 2020
-
Abstract
- Purpose of Review: Tuberculous meningitis (TBM) is associated with significant mortality and morbidity yet is difficult to diagnose and treat. We reviewed original research published in the last 2 years, since 1 January 2018, which we considered to have a major impact in advancing diagnosis, treatment and understanding of the pathophysiology of TBM meningitis in children and adults.<br />Recent Findings: Studies have sought to identify a high sensitivity diagnostic test for TBM, with new data on modified Ziehl--Neelsen staining, urinary and cerebrospinal fluid (CSF) lipoarabinomannan and GeneXpert Ultra. Recent studies on CSF biomarkers provide a better understanding of the detrimental inflammatory cascade and neuromarkers of brain damage and suggest potential for novel host-directed therapy. Tryptophan metabolism appears to affect outcome and requires further study. Increased clinical trials activity in TBM focuses on optimizing antituberculosis drug regimens and adjuvant therapy; however, there are few planned paediatric trials.<br />Summary: Tuberculous meningitis still kills or disables around half of sufferers. Although some progress has been made, there remains a need for more sensitive diagnostic tests, better drug therapy, improved management of complications and understanding of host-directed therapy if outcomes are to improve.
Details
- Language :
- English
- ISSN :
- 1473-6527
- Volume :
- 33
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Current opinion in infectious diseases
- Publication Type :
- Academic Journal
- Accession number :
- 32324614
- Full Text :
- https://doi.org/10.1097/QCO.0000000000000648