AUTHOR=Ssebambulidde Kenneth , Gakuru Jane , Ellis Jayne , Cresswell Fiona V. , Bahr Nathan C. 

TITLE=Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet?

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.892224

DOI=10.3389/fneur.2022.892224

ISSN=1664-2295

ABSTRACT=Diagnosis of tuberculous meningitis (TBM) remains challenging due to a paucity of high-performance diagnostics. Even those which have reasonable sensitivity are not adequate to ‘rule-out’ TBM. Therefore, a combination of clinical factors alongside microbiological, molecular and radiological investigations are utilized, depending on availability. A low threshold to start empiric therapy in the appropriate clinical scenario remains crucial for good outcomes in many cases.
Herein we review the current TBM diagnostics landscape with a focus on limitations frequently encountered such as diagnostic test performance, cost, laboratory infrastructure and clinical expertise. Though molecular technologies, particularly GeneXpert MTB/Rif Ultra, have been a step forward, diagnosis of TBM remains difficult. We also provide an overview of promising technologies including cerebrospinal fluid (CSF) lactate, a new lipoarabinomannan test (FujiLAM), metagenomics next generation sequencing and transcriptomics that may further improve our TBM diagnostic capacity and lead to better outcomes.