Tuberculous meningitis: more questions, still too few answers

Thwaites, Guy E; van Toorn, Ronald; Schoeman, Johan

doi:10.1016/s1474-4422(13)70168-6

Cited by 482Infectious Diseases and TuberculosisBacterial Infections and VaccinesTuberculosis Research and Epidemiology

Tuberculous meningitis: more questions, still too few answers

Thwaites, Guy E, van Toorn, Ronald, Schoeman, Johan·2013·The Lancet Neurology

DOI 10.1016/s1474-4422(13)70168-6

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Abstract

Tuberculous meningitis is especially common in young children and people with untreated HIV infection, and it kills or disables roughly half of everyone affected. Childhood disease can be prevented by vaccination and by giving prophylactic isoniazid to children exposed to infectious adults, although improvements in worldwide tuberculosis control would lead to more effective prevention. Diagnosis is difficult because clinical features are non-specific and laboratory tests are insensitive, and treatment delay is the strongest risk factor for death. Large doses of rifampicin and fluoroquinolones might improve outcome, and the beneficial effect of adjunctive corticosteroids on survival might be augmented by aspirin and could be predicted by screening for a polymorphism in LTA4H, which encodes an enzyme involved in eicosanoid synthesis. However, these advances are insufficient in the face of drug-resistant tuberculosis and HIV co-infection. Many questions remain about the best approaches to prevent, diagnose, and treat tuberculous meningitis, and there are still too few answers.

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Around 50% of those affected by tuberculous meningitis die or experience disabling consequences.
“Around 50% of those affected die or experience disabling consequences (Thwaites 2013).”
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Authors: Thwaites, G. E., van Toorn, R., & Schoeman, J.
Affiliations: Guy's Hospital (GB)
Stellenbosch University (ZA)
Corresponding author: Thwaites, Guy E
ORCID: Thwaites, Guy E
Venue: The Lancet Neurology
Publisher: Elsevier BV
Published: 2013-10
Volume: 12
Issue: 10
Pages: 999-1010
ISSN: 1474-4422 (ISSN-L)
DOI: 10.1016/s1474-4422(13)70168-6
OpenAlex: W2110728266
Cited by: 482
References: 138
Citations by year: 2026: 42 · 2025: 33 · 2024: 46 · 2023: 44 · 2022: 38 · 2021: 38 · 2020: 38 · 2019: 45 · 2018: 32 · 2017: 37 · 2016: 40 · 2015: 25 · 2014: 23 · 2013: 1
FWCI: 5.25
Type: journal article
Language: en
Open access: closed
Locations: The Lancet Neurology (publishedVersion)
PubMed (publishedVersion)
SUNScholar (Stellenbosch University) (submittedVersion)
Funders: Wellcome Trust (089276)
Topics: Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
Keywords: tuberculous meningitis, HIV coinfection, pediatric tuberculosis, isoniazid preventive therapy, tuberculosis vaccination, diagnosis, treatment delay, rifampicin, fluoroquinolones, adjunctive corticosteroid therapy, aspirin, drug-resistant tuberculosis, tuberculosis control
MeSH terms: Adult, Child, Humans, Tuberculosis, Meningeal

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Tuberculous meningitis: more questions, still too few answers

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