Pathogenesis of tuberculous meningitis (TBM): a mini-review

Abstract

Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent (Mycobacterium tuberculosis) and killed nearly 1.5 million people in 2018. TB mostly manifests as a pulmonary disease but can also affect other parts of the body, causing extrapulmonary TB. Approximately 5% of all cases of extrapulmonary TB are tuberculous meningitis (TBM), which is caused by the spread of M. tuberculosis to the meninges and cerebrospinal fluid (CSF). Result: TBM is the most devastating form of TB and causes high rates of morbidity and mortality, with an estimated 50% of patients dying or suffering from neurological sequelae and complications. Meningitis is categorized as a medical emergency because it can cause death due to inflammation that occurs in the brain and spinal cord. Most meningitis patients present with fever, and signs and symptoms of meningeal inflammation include headache, neck stiffness and altered mental status. Disease management has limitations due to the limited availability of available diagnostic approaches. Until now, knowledge about the pathogenesis of TBM has been limited. Conclusion: Further research is urgently needed to improve understanding of disease pathogenesis and diagnostic approaches based on biomarkers of disease. Current knowledge on the pathogenesis of TBM summarize the literature on diagnostic approaches based on biomarkers, which may be useful in the management of TBM.