Advances in management and treatment of tubercular meningitis – a narrative review

Abstract

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to be a major global health issue, particularly due to its potential to cause severe complications such as tubercular meningitis (TBM), which is a fatal condition that proves difficult to diagnose and treat effectively and often results in poor outcomes, especially in children, due to delayed diagnosis, drug resistance, and limited diagnostic techniques. Methods: This review provides a comprehensive overview of recent advancements in TBM management and treatment. A systematic search was performed across major databases, including PubMed, Google Scholar, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and the ISRCTN Registry. The search strategy used terms like (“tubercular meningitis” OR “TBM” OR “TB meningitis”) AND (“diagnosis” OR “treatment” OR “clinical trials”). Inclusion criteria focused on studies published from January 2014 to September 2024, highlighting novel diagnostics, therapeutic advances, and clinical trials for TBM. Exclusion criteria involved studies unrelated to TBM or older than 10 years. Results: Diagnostic methods for TBM, such as microbiological and molecular techniques (Fig. 1), vary in sensitivity, with polymerase chain reaction assays being the most sensitive. While anti-TB drugs are available, drug resistance and poor cerebrospinal fluid penetration limit effectiveness. New molecular diagnostics and therapies, including anti-TNF agents, anti-inflammatory drugs, and antibiotics, show promise for improving outcomes. JOURNAL/amsur/04.03/01845215-202506000-00069/figure1/v/2025-06-12T194953Z/r/image-jpeg Conclusion: Despite recent advancements in TBM diagnostics and treatment, substantial challenges remain, particularly in addressing drug resistance and improving drug efficacy in the central nervous system. Continued innovation in molecular diagnostics and treatment approaches is essential to enhance TBM care and mitigate its devastating consequences.