Tuberculous meningitis in Asia

Tuberculous meningitis is an important global medical problem which gives rise to high morbidity and mortality. It is the most severe form of extrapulmonary Mycobacterium tuberculosis. Comprehensive prevention effort, prompt diagnosis and rational treatment are all keys to improving treatment outcomes; yet many unsolved problems remain. On the other hand, the new problems, such as HIV co-infection and drug-resistance are posing important challenges. This review outlines the epidemiology, pathogenesis, diagnosis, management and prognosis of tuberculous meningitis. We mainly focus on research carried out in the recent decades, giving special attention to the work done among the Asian populations. Neurology Asia 2015; 20(1) : 1 – 6 Address correspondence to: Dr. Gang Zhao, Department of Neurology, Xijing Hospital, Forth Military Medical University.No.15 Changle-Xi Road, Xi’an, Shaanxi province, China. Email: [email protected] INTRODUCTION Tuberculous meningitis (TBM) is a common and the most severe form of extrapulmonary tuberculosis (TB) whose mortality and morbidity is close to half of the patients affected. TB has been a challenge worldwide for many years. Although the spread of TB is already partially controlled sometime in the past history, the incidence of severe and drug resistant TB has been shown to increase in the last 20 years, partly due to the population mobility, the spread of HIV infection, and the wide use of immunosuppressive agents, resulting also in the increase in the number of TBM patients. Children and adults co-infected with HIV are particularly vulnerable to TBM. Since the clinical manifestations of TB infection are non-specific, and diagnostic methods are insensitive, these often result in the delay of diagnosis, affecting the outcome of treatment and prognosis. Consequently for TBM, we still encounter many challenges. In this paper, we mainly focus on the burden of TBM among Asians, to draw attention to researchers and physicians practicing in the region.