Tuberculous Meningitis: an Update on the Pathogenesis and Neuroimmunology

Tuberculosis meningitis (TBM) carries the highest morbidity and mortality of any type of tuberculosis infection, yet the definitive mechanism(s) that result in TBM are largely unknown.

Microglia as a bridge between the immune and nervous systems and its role in age related physiological changes that may lend some insight into why TBM is prevalent in pediatrics.

There are various hypotheses on how Mycobacterium tuberculosis, the etiological agent of tuberculosis, disseminates from the lungs to the central nervous system but these routes have been unobserved in existing animal models. This review aims to highlight the neuroimmunology of TBM, highlights the importance of age-dependent physiological changes, and recommends techniques commonly used in neurobiology to generate a more complete picture of TBM pathogenesis. We argue that age is an important consideration because TBM typically presents in children less than 5 years old. We hope that increasing the prevalence of longitudinal studies in TBM research with respect to age will aid in identifying definitive mechanism(s) that result in TBM and improve clinical outcomes.