Tuberculous Meningitis — New Approaches Needed

The clinical effects of infectious diseases are determined by a complex interplay between pathogen and immune response, a dynamic exemplified by tuberculous meningitis. Despite being paucibacillary, tuberculous meningitis causes permanent neurologic injury and death in a high proportion of affected persons through local inflammatory complications and stroke. The maladaptive inflammatory response in tuberculous meningitis has not been fully characterized but may be amenable to modulation by glucocorticoids. A trial conducted 20 years ago changed practice by showing that dexamethasone reduced mortality among patients with tuberculous meningitis in Vietnam.1 This is the only intervention for tuberculous meningitis supported by strong evidence . . .