Diagnosis and Treatment of Tuberculous Meningitis

Abstract

Tuberculous meningitis (TBM) is the most fatal form among various types of tuberculosis. It is also the most difficult form for diagnosis. The prevalence of TBM is still high in South Korea compared to that in Western countries. TBM should be differentiated from viral or bac terial meningitis. However, diagnosing TBM is challenging. Clinical samples obtained from cerebrospinal fluid (CSF) are paucibacillary that decreases the sensitivity of mycobacterial diagnostic tests such as acid-fast bacilli (AFB) and Mycobacterium tuberculosis culture. Adenosine deaminase (ADA) is widely used as an adjunct diagnosis of TBM. However, ADA is not a specific marker for TBM. Therefore, more specific test is urgently needed for the confirmation of TBM. Recently, IFN-gamma releasing assay using peripheral blood mononuclear cells and CSF-mononuclear cells as well as the newly-developed Xpert MTB/RFP showed promising results in the rapid diagnosis of TBM. In general, anti-tuberculous therapy for patients with TBM except adjuvant steroid use is similar to that for patients with pulmonary tuberculosis. However, treatment of TBM can be occasionally complicated due to paradoxical response during anti-tuberculous therapy. J Neurocrit Care 2014;7(2):78-85