Bourgi Kassem, Fiske Christina, Sterling Timothy R
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Tuberculosis Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Curr Infect Dis Rep. 2017 Sep 11;19(11):39. doi: 10.1007/s11908-017-0595-4.
As the most severe form of tuberculosis (TB), TB meningitis disproportionately affects developing countries and results in significant morbidity and mortality. In this report, we review recent updates in the epidemiology, diagnosis, and management of TB meningitis.
Young children and people living with HIV continue to be at highest risk for TB meningitis. Early diagnosis remains challenging, especially since conventional diagnostic tests have sub-optimal sensitivity and specificity. Recently, nucleic acid amplification testing emerged as the preferred diagnostic modality due to its rapid turnaround time and high specificity. Several recent studies have assessed the optimal treatment for TB meningitis. While the benefit of treatment intensification, by increasing rifampin dosing or adding a fluoroquinolone, is unclear, a growing body of evidence suggests that steroids confer a survival advantage, particularly in patients with mild disease. Additionally, TB meningitis management is further complicated by high rates of HIV co-infection. Recent data suggest that unlike other forms of TB, early initiation of antiretroviral therapy in patients with TB meningitis is associated with higher rates of adverse reactions, without improved survival. TB meningitis continues to be a significant problem worldwide. Despite recent advances, more studies are warranted to improve early disease detection and optimize therapy.
结核性脑膜炎作为结核病最严重的形式，在发展中国家的影响尤为严重，会导致显著的发病率和死亡率。在本报告中，我们回顾了结核性脑膜炎在流行病学、诊断和治疗方面的最新进展。
幼儿和艾滋病毒感染者仍然是患结核性脑膜炎风险最高的人群。早期诊断仍然具有挑战性，尤其是因为传统诊断测试的敏感性和特异性欠佳。最近，核酸扩增检测因其快速周转时间和高特异性而成为首选的诊断方式。最近的几项研究评估了结核性脑膜炎的最佳治疗方法。虽然通过增加利福平剂量或添加氟喹诺酮来强化治疗的益处尚不清楚，但越来越多的证据表明，类固醇具有生存优势，特别是在轻症患者中。此外，艾滋病毒合并感染率高使结核性脑膜炎的治疗更加复杂。最近的数据表明，与其他形式的结核病不同，结核性脑膜炎患者早期开始抗逆转录病毒治疗会导致更高的不良反应发生率，且生存率并未提高。结核性脑膜炎在全球范围内仍然是一个重大问题。尽管最近取得了进展，但仍需要更多研究来改善疾病的早期检测并优化治疗。
