Advancing Diagnosis and Treatment in People Living with HIV and Tuberculosis Meningitis.

Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Inadequate diagnostic testing and treatment regimens adapted from pulmonary tuberculosis without consideration of the unique nature of TBM are among the potential drivers. This review focuses on the progress being made in relation to both diagnosis and treatment of TBM, emphasizing promising future directions. The molecular assay GeneXpert MTB/Rif Ultra has improved sensitivity but has inadequate negative predictive value to “rule-out” TBM. Evaluations of tests focused on the host response and bacterial components are ongoing. Clinical trials are in progress to explore the roles of rifampin, fluoroquinolones, linezolid, and adjunctive aspirin. Though diagnosis has improved, novel modalities are being explored to improve the rapid diagnosis of TBM. Multiple ongoing clinical trials may change current therapies for TBM in the near future.

结核性脑膜炎（TBM）是结核病最严重的形式。潜在的驱动因素包括诊断检测不充分以及在未考虑结核性脑膜炎独特性质的情况下采用适用于肺结核的治疗方案。这篇综述重点关注结核性脑膜炎在诊断和治疗方面取得的进展，强调有前景的未来方向。 分子检测GeneXpert MTB/Rif Ultra提高了检测灵敏度，但其阴性预测值不足以“排除”结核性脑膜炎。针对宿主反应和细菌成分的检测评估正在进行中。探索利福平、氟喹诺酮类药物、利奈唑胺和辅助性阿司匹林作用的临床试验正在进行。 尽管诊断水平有所提高，但正在探索新的方法以提高结核性脑膜炎的快速诊断能力。多项正在进行的临床试验可能在不久的将来改变结核性脑膜炎的现行治疗方法。