Cao Wen-Feng, Leng Er-Ling, Liu Shi-Min, Zhou Yong-Liang, Luo Chao-Qun, Xiang Zheng-Bing, Cai Wen, Rao Wei, Hu Fan, Zhang Ping, Wen An
Department of Neurology, Jiangxi Provincial People's Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China.
Department of neurology, Xiangya Hospital, Central South University, Jiangxi Hospital, National Regional Center for Neurological Diseases, Nanchang, Jiangxi, China.
Front Microbiol. 2023 Aug 28;14:1202752. doi: 10.3389/fmicb.2023.1202752. eCollection 2023.
Tuberculous meningitis (TBM) is the most common type of central nervous system tuberculosis (TB) and has the highest mortality and disability rate. Early diagnosis is key to improving the prognosis and survival rate of patients. However, laboratory diagnosis of TBM is often difficult due to its paucibacillary nature and sub optimal sensitivity of conventional microbiology and molecular tools which often fails to detect the pathogen. The gold standard for TBM diagnosis is the presence of MTB in the CSF. The recognised methods for the identification of MTB are acid-fast bacilli (AFB) detected under CSF smear microscopy, MTB cultured in CSF, and MTB detected by polymerase chain reaction (PCR). Currently, many studies consider that all diagnostic techniques for TBM are not perfect, and no single technique is considered simple, fast, cheap, and efficient. A definite diagnosis of TBM is still difficult in current clinical practice. In this review, we summarise the current state of microbiological and molecular biological diagnostics for TBM, the latest advances in research, and discuss the advantages of these techniques, as well as the issues and challenges faced in terms of diagnostic effectiveness, laboratory infrastructure, testing costs, and clinical expertise, for clinicians to select appropriate testing methods.
结核性脑膜炎（TBM）是中枢神经系统结核病（TB）最常见的类型，死亡率和致残率最高。早期诊断是改善患者预后和生存率的关键。然而，由于TBM菌量少，以及传统微生物学和分子检测工具的敏感性欠佳，常常无法检测到病原体，TBM的实验室诊断往往很困难。TBM诊断的金标准是脑脊液（CSF）中存在结核分枝杆菌（MTB）。公认的MTB鉴定方法包括CSF涂片显微镜检查下检测到的抗酸杆菌（AFB）、CSF中培养出的MTB以及通过聚合酶链反应（PCR）检测到的MTB。目前，许多研究认为，所有TBM诊断技术都不完善，没有一种技术被认为是简单、快速、廉价且高效的。在当前临床实践中，TBM的明确诊断仍然困难。在本综述中，我们总结了TBM微生物学和分子生物学诊断的现状、最新研究进展，并讨论了这些技术的优势，以及在诊断有效性、实验室基础设施、检测成本和临床专业知识方面面临的问题和挑战，以便临床医生选择合适的检测方法。
