Rock R Bryan, Olin Michael, Baker Cristina A, Molitor Thomas W, Peterson Phillip K
Center for Infectious Diseases and Microbiology Translational Research, and Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Clin Microbiol Rev. 2008 Apr;21(2):243-61, table of contents. doi: 10.1128/CMR.00042-07.
Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.
中枢神经系统（CNS）结核是一种极具破坏性的结核病形式，即使在接受适当抗结核治疗的情况下，其发病率和死亡率仍高得令人难以接受。尽管有前景的分子诊断技术不断发展，但中枢神经系统结核的诊断很大程度上仍依赖于不敏感的微生物学方法，因此，中枢神经系统结核仍然是一项严峻的诊断挑战。迫切需要深入了解结核分枝杆菌的基本神经发病机制，并建立合适的动物模型。治疗的最佳方案和疗程在很大程度上尚不清楚，而且随着耐多药结核分枝杆菌菌株的发病率不断上升，仍然需要开发耐受性良好且有效的抗生素。尽管世界上使用最广泛的疫苗主要针对这种结核病表现形式，但卡介苗尚未实现消除中枢神经系统结核的承诺。我们撰写本综述旨在突出对结核分枝杆菌神经发病机制的当前认识，讨论中枢神经系统结核的某些流行病学、临床、诊断和治疗方面，并强调这一重要领域中许多未满足的需求。
