Treatment of Central Nervous System Tuberculosis Infections and Neurological Complications of Tuberculosis Treatment

J.      J. van der Harst; G.      J. Luijckx

Abstract

Tuberculosis (TB) with central nervous system (CNS) manifestation is a form of TB with a high mortality and morbidity. Tuberculous meningitis (TM) is the most common form of CNS-TB. Although diagnosis of CNS-TB can be challenging, early treatment of CNS-TB is related to a better outcome. If CNS-TB is suspected, even though the clinical picture is not specific, it should be immediately treated.

For the treatment of CNS-TB, knowledge of the penetration across the blood-brain barrier of the various antituberculosis agents used in TB treatment is important. These will be described here in order to serve as a guide in choosing a treatment for CNS-TB. Corticosteroids have an evidence-based value in the treatment of TM and so are recommended. As for thalidomide use in CNS-TB, sound evidence is still lacking. We will also include a description of the adverse neurotoxic effects of the various other agents including their psychiatric, ototoxic and ophthalmic adverse effects.

Keywords: Tuberculosis, central nervous system, tuberculous meningitis, antituberculosis agents, blood-brain barrier, corticosteroids, thalidomide, adverse neurotoxic effects, HIV infection, enzyme-linked immunospot assay (ELISpot assay)