Infectious disease Unit, Avicenne Hospital, Université Paris 13, IAME, Inserm, 125, route de Stalingrad, 93017, Bobigny, France.
Infectious disease Unit, Avicenne Hospital, Université Paris 13, IAME, Inserm, 125, route de Stalingrad, 93017, Bobigny, France.
Rev Neurol (Paris). 2019 Sep-Oct;175(7-8):451-457. doi: 10.1016/j.neurol.2019.07.007. Epub 2019 Aug 2.
Tuberculous meningitis (TBM) is the most lethal and disabling form of tuberculosis. In 2017, approximately 10 million people developed TB worldwide, of whom more than 100,000 new cases of TBM are estimated to occur per year. In patients who are co-infected with HIV-1, TBM has a mortality approaching 50%. Diagnosis of TBM is often delayed by the insensitive and lengthy culture technique required for disease confirmation. GeneXpert represents the most significant advance in TBM diagnostics over the past decade, but it lacks sensitivity and cannot be used to rule out the diagnosis. Higher volume of cerebrospinal fluid (CSF) seems to be interesting to improve the diagnosis performances. New rapid and accurate diagnostic tools are necessary. Better advances have been made concerning the anti-tuberculosis chemotherapy of TBM, with the publication of clinical trials and pharmacokinetic studies exploring the use of higher rifampicin doses and fluoroquinolones. The rise of drug-resistant TBM is another challenge for management because TBM caused by multidrug resistant organisms results in death or severe disability in almost all sufferers.
结核性脑膜炎（TBM）是最致命和致残的结核病形式。2017 年，全球约有 1000 万人罹患结核病，据估计，每年约有 10 万例新的 TBM 病例发生。在合并感染 HIV-1 的患者中，TBM 的死亡率接近 50%。由于用于确认疾病的培养技术不够敏感且耗时较长，TBM 的诊断往往会被延误。GeneXpert 是过去十年中 TBM 诊断方面的重大进展，但它的灵敏度不足，不能用于排除诊断。增加脑脊液（CSF）量似乎有助于提高诊断性能。需要新的快速而准确的诊断工具。关于 TBM 的抗结核化疗已经取得了更好的进展，临床试验和药代动力学研究的发表探索了使用更高剂量的利福平及氟喹诺酮类药物。耐多药 TBM 的出现是管理方面的另一个挑战，因为由多药耐药菌引起的 TBM 几乎会导致所有患者死亡或严重残疾。
