Mai Nguyen T H, Thwaites Guy E
aHospital for Tropical Diseases bOxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam cNuffield Department of Medicine, University of Oxford, Oxford, UK.
Curr Opin Infect Dis. 2017 Feb;30(1):123-128. doi: 10.1097/QCO.0000000000000331.
Tuberculous meningitis is a devastating infection that is hard to diagnose and treat. We have reviewed tuberculous meningitis original research published within the past 18 months, selecting studies which we consider have most advanced knowledge.
We review advances in diagnostic methods, anti-tuberculosis chemotherapy, and the common complications of tuberculous meningitis. New commercial molecular diagnostic tests, such as GeneXpert MTB/RIF, have an important role in tuberculous meningitis diagnosis, but as with all other available tests, they lack sensitivity and cannot rule out the disease. Recent trials and pharmacokinetic studies have advanced understanding of the best anti-tuberculosis drug regimens for tuberculous meningitis, although optimal doses and duration remain uncertain, especially for young children. Good outcomes depend upon the careful management of the common complications (brain infarcts, tuberculomas, hydrocephalus and hyponatraemia) and controlling intracranial pressure. New tools, such as point-of-care ultrasound, may assist in the management, especially in the assessment of intravascular volume and raised intracranial pressure.
Disability-free survival from tuberculous meningitis depends upon rapid diagnosis, starting anti-tuberculosis drugs before the onset of coma and managing complications. Progress is slow and threatened by emerging drug-resistant bacteria, but new drugs and diagnostic technologies offer hope to future patients.
结核性脑膜炎是一种极具破坏性的感染性疾病，难以诊断和治疗。我们回顾了过去18个月内发表的结核性脑膜炎原创研究，选取了我们认为最具前沿知识的研究。
我们回顾了诊断方法、抗结核化疗以及结核性脑膜炎常见并发症方面的进展。新型商业分子诊断检测，如GeneXpert MTB/RIF，在结核性脑膜炎诊断中发挥着重要作用，但与所有其他现有检测一样，它们缺乏敏感性，无法排除该病。近期的试验和药代动力学研究增进了对结核性脑膜炎最佳抗结核药物方案的理解，尽管最佳剂量和疗程仍不确定，尤其是对于幼儿。良好的预后取决于对常见并发症（脑梗死、结核瘤、脑积水和低钠血症）的精心管理以及控制颅内压。新工具，如即时超声，可能有助于管理，尤其是在评估血管内容量和颅内压升高方面。
结核性脑膜炎实现无残疾生存取决于快速诊断、在昏迷发作前开始抗结核药物治疗以及处理并发症。进展缓慢且受到新出现的耐药细菌的威胁，但新药和诊断技术为未来患者带来了希望。
