Mezochow Alyssa, Thakur Kiran, Vinnard Christopher
Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Curr Neurol Neurosci Rep. 2017 Sep 20;17(11):85. doi: 10.1007/s11910-017-0796-0.
Tuberculous meningitis is the most devastating manifestation of infection with Mycobacterium tuberculosis and represents a medical emergency. Approximately one half of tuberculous meningitis patients die or suffer severe neurologic disability. The goal of this review will be to review the pathogenic, clinical, and radiologic features of tuberculous meningitis and to highlight recent advancements in translational and clinical science.
Pharmacologic therapy includes combination anti-tuberculosis drug regimens and adjunctive corticosteroids. It is becoming clear that a successful treatment outcome depends on an immune response that is neither too weak nor overly robust, and genetic determinants of this immune response may identify which patients will benefit from adjunctive corticosteroids. Recent clinical trials of intensified anti-tuberculosis treatment regimens conducted in Indonesia and Vietnam, motivated by the pharmacologic challenges of treating M. tuberculosis infections of the central nervous system, have yielded conflicting results regarding the survival benefit of intensified treatment regimens. More consistent findings have been observed regarding the relationship between initial anti-tuberculosis drug resistance and mortality among tuberculous meningitis patients. Prompt initiation of anti-tuberculosis treatment for all suspected cases remains a key aspect of management. Priorities for research include the improvement of diagnostic testing strategies and the optimization of host-directed and anti-tuberculosis therapies.
结核性脑膜炎是结核分枝杆菌感染最具破坏性的表现形式，属于医疗急症。约半数结核性脑膜炎患者死亡或遭受严重神经功能残疾。本综述旨在回顾结核性脑膜炎的致病、临床及影像学特征，并重点介绍转化医学和临床科学的最新进展。
药物治疗包括联合抗结核药物方案及辅助性皮质类固醇。越来越清楚的是，成功的治疗结果取决于既不太弱也不过于强烈的免疫反应，这种免疫反应的遗传决定因素可能有助于确定哪些患者将从辅助性皮质类固醇治疗中获益。受中枢神经系统结核分枝杆菌感染治疗的药理学挑战推动，印度尼西亚和越南近期开展的强化抗结核治疗方案临床试验，在强化治疗方案的生存获益方面得出了相互矛盾的结果。在结核性脑膜炎患者初始抗结核药物耐药性与死亡率之间的关系方面，观察到了更一致的结果。对所有疑似病例迅速启动抗结核治疗仍是管理的关键环节。研究重点包括改进诊断检测策略以及优化宿主导向治疗和抗结核治疗。
