Princeton University, Princeton, NJ, USA.
Future Microbiol. 2012 Sep;7(9):1101-16. doi: 10.2217/fmb.12.86.
Tuberculous meningitis (TBM) is the most severe form of TB. Despite treatment, mortality and long-term disability remain unacceptably high. Prevention, early recognition, diagnosis and treatment are fundamental to improving outcomes. However, an effective vaccine remains elusive, initial symptoms are nonspecific, and sensitive diagnostic tests are not available. There has been progress in our understanding of the immunopathology of TBM, and several factors have been found to be associated with susceptibility to infection, disease progression and clinical outcome. However, these have not yet impacted on treatment. Early treatment initiation and uninterrupted continuation, severity on presentation, seizures, stroke, cranial nerve involvement, cerebrospinal fluid cell count and lactate levels, hyponatreamia and coinfection with HIV are all found to be important prognostic factors for outcome. Pathogen lineage (Beijing genotype) and host genetics (polymorphisms in TLR2, TIRAP and LTA4H genes) can influence susceptibility to TBM. However, these findings have not yet impacted on treatment. Progress in vaccine development, opportunities for better diagnostic tests, novel insights into pathogenesis and an increasing evidence base for improving treatment should impact the current high mortality and morbidity, if translated to global and local guidelines.
结核性脑膜炎（TBM）是最严重的结核病形式。尽管进行了治疗，但死亡率和长期残疾率仍然高得令人无法接受。预防、早期识别、诊断和治疗是改善结局的基础。然而，有效的疫苗仍然难以捉摸，初始症状不具有特异性，也没有可用的敏感诊断测试。我们对 TBM 的免疫病理学有了更深入的了解，发现了几个与感染易感性、疾病进展和临床结局相关的因素。然而，这些因素尚未影响治疗。早期开始治疗并持续不间断、发病时的严重程度、癫痫发作、中风、颅神经受累、脑脊液细胞计数和乳酸水平、低钠血症以及与 HIV 的合并感染，都是预后的重要预测因素。病原体谱系（北京基因型）和宿主遗传（TLR2、TIRAP 和 LTA4H 基因的多态性）会影响 TBM 的易感性。然而，这些发现尚未影响治疗。疫苗开发方面的进展、更好的诊断测试机会、对发病机制的新认识以及改善治疗的证据基础不断增加，如果转化为全球和本地指南，应该会影响目前的高死亡率和发病率。
