thealthЗдравоохранение ТаджикистанаHealth care of Tajikistan0514-2415Редакция журнала «Здравоохранение Таджикистана»10.52888/0514-2515-2024-363-4-115-120thealth-615Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWСовременные подходы к диагностике туберкулёзного менингитаModern approaches to diagnosis of tuberculous meningitisЗиёзодаЗ. К.ZiezodaZ. K.

Зиёзода Зубайдулло Кароматулло – заочный аспирант

Ziyozoda Zubaidullo Karomatullo - extramural postgraduate student

Dushanbe

doktorziyo@gmail.comЗакироваК. А.ZakirovaK. A.

Dushanbe

ЮсупджановДж. М.YusupjanovaJ. M.

Dushanbe

ПировК. И.PirovQ. I.

Dushanbe

Кафедра фтизиопульмонологии, ГОУ “Институт последипломного образования в сфере здравоохранения Республики Таджикистан”ТаджикистанDepartment of Phthisiopulmonology, SEI “Institute of Postgraduate Education in Health Care”TajikistanГУ “Центр по защите населения от туберкулёза”ТаджикистанSI “Center on protected of population from tuberculosis”Tajikistan20240702202504115120Copyright © Зиёзода З.К., Закирова К.А., Юсупджанов Д.М., Пиров К.И., 20252025Зиёзода З.К., Закирова К.А., Юсупджанов Д.М., Пиров К.И.Ziezoda Z.K., Zakirova K.A., Yusupjanova J.M., Pirov Q.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zdrav.tj/jour/article/view/615

В статье проведен обзор публикаций последних лет о туберкулезном менингите. Описаны патоморфология изменений, клинические отличия от других видов менингитов, диагностические особенности исследования спиномозговой жидкости, нейрорадиологические нарушения выявляемые проведением МРТ сканирования.

Заключение. Туберкулезный менингит чаще встречается в странах с высоким бременем туберкулеза, чаще у детей, не вакцинированных вакциной БЦЖ, лиц, инфицированных ВИЧ и при диссеминации M. tuberculosis у нелеченных больных с туберкулезом легких. Продолжительность проявления симптомов может варьировать от 1 дня до 9 месяцев, а продромальный период обычно неспецифичен. Диагностика туберкулезного менингита сложна и часто запаздывает, в связи с чем при подозрении на туберкулезный менингит необходимо использовать весь доступный комплекс диагностических мер, включая клинико-рентгенологические методы, МРТ и исследование спиномозговой жидкости.

This article reviews recent publications on tuberculous meningitis. The pathomorphology of the changes, clinical differences from other types of meningitis, diagnostic features of CSF examination and neuroradiological disorders detected by MRI are described.

Conclusions. Tuberculous meningitis is more common in countries with a high burden of tuberculosis, in children who have not received BCG vaccination, in HIV-infected individuals, and in patients with untreated pulmonary tuberculosis. The duration of symptoms may vary from 1 day to 9 months and the prodrome is usually non-specific. Diagnosis of tuberculous meningitis is complex and often delayed, and it is therefore necessary to use the full range of diagnostic tools available when tuberculous meningitis is suspected, including clinical and radiological methods, MRI and examination of cerebrospinal fluid.

Туберкулезный менингитепатоморфологияклинические отличияисследование спиномозговой жидкостинейрорадиологические нарушенияМРТ сканированиеtuberculous meningitispathomorphologyclinical differencescerebrospinal fluid examinationneuroradiological abnormalitiesMRI scanningReferencesГончарова С.Н. Особенности клинического течения туберкулезного менингита у ВИЧ-инфицированных пациентов / С.Н. Гончарова, Н.М. Корецкая, В.Ф. Элярт // Медицинский альянс. – 2019. – №1. – С. 20-23.Goncharova S.N., Koretskaya N.M., Elyart V.F. Osobennosti klinicheskogo techeniya tuberkuleznogo meningita u VICH-infitsirovannykh patsientov [Characteristics of the clinical course of tuberculous meningitis in HIV-infected patients]. Meditsinskiy alyans - Medical Alliance, 2019, No. 1, pp. 20-23.Корж Е.В. Туберкулезный менингит у больных с сочетанием туберкулеза и ВИЧ-инфекции, начавших антиретровирусную терапию: особенности течения и прогноз / Е.В. Корж, Н.А. Подчос // Туберкулёз и болезни лёгких. – 2019. – №9 (97). – С. 5-10.Korzh E.V., Podchos N.A. Tuberkuleznyy meningit u bolnykh s sochetaniem tuberkuleza i VICH-infektsii, nachavshikh antiretrovirusnuyu terapiyu: osobennosti techeniya i prognoz [Tuberculous meningitis in patients with a combination of tuberculosis and HIV infection who have started antiretroviral therapy: progression features and prognosis]. Tuberkulyoz i bolezni lyogkikh - Tuberculosis and Lung Diseases, 2019, No. 9 (97), pp. 5-10.Ракишева А.С. Туберкулезный менингит в современных условиях (обзор литературы) / А.С. Ракишева, Е.В. Арбузова // Вестник КазНМУ. – 2020. – №4. – С. 301-305.Rakisheva A.S., Arbuzova E.V. Tuberkuleznyy meningit v sovremennykh usloviyakh (obzor literatury) [Tuberculous meningitis in modern conditions (review of the literature)]. Vestnik KaZNMU, 2020, No. 4, pp. 301-305.Чугаев Ю.П. Туберкулез мозговых оболочек у детей и взрослых / Ю.П. Чугаев. Учебное пособие. – М.: 2019. – 71 с.Chugaev Yu.P. Tuberkulez mozgovykh obolochek u detey i vzroslykh. Uchebnoe posobie [Tuberculosis of the cerebral membranes in children and adults]. Moscow, 2019. 71 p.Amicosante M., D’Ambrosio L., Munoz M. TB Diagnostic Survey Working Group. Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey. Jornal Brasileiro de Pneumologia, 2017, No. 43, pp. 380-392.Amicosante M., D’Ambrosio L., Munoz M. TB Diagnostic Survey Working Group. Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey. Jornal Brasileiro de Pneumologia, 2017, No. 43, pp. 380-392.Bahr N.C., Meintjes G., Boulware D.R. Inadequate diagnostics: the case to move beyond the bacilli for detection of meningitis due to Mycobacterium tuberculosis. Journal of Medical Microbiology, 2019, No. 68, pp. 755-760.Bahr N.C., Meintjes G., Boulware D.R. Inadequate diagnostics: the case to move beyond the bacilli for detection of meningitis due to Mycobacterium tuberculosis. Journal of Medical Microbiology, 2019, No. 68, pp. 755-760.Bahr N.C., Nuwagira E., Evans E.E. ASTRO-CM Trial Team. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study. Lancet Infectious Diseases, 2018, No. 18, pp. 68 – 75.Bahr N.C., Nuwagira E., Evans E.E. ASTRO-CM Trial Team. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study. Lancet Infectious Diseases, 2018, No. 18, pp. 68 – 75.Cresswell F.V., Davis A.G., Sharma K. Tuberculous Meningitis International Research Consortium. Recent developments in tuberculous meningitis pathogenesis and diagnostics. Wellcome Open Research, 2020, No. 4, pp. 164.Cresswell F.V., Davis A.G., Sharma K. Tuberculous Meningitis International Research Consortium. Recent developments in tuberculous meningitis pathogenesis and diagnostics. Wellcome Open Research, 2020, No. 4, pp. 164.Daniel B.D., Grace G.A., Natrajan M. Tuberculous meningitis in children: clinical management and outcome. Indian Journal of Medical Research, 2019, No. 150, pp. 117-130.Daniel B.D., Grace G.A., Natrajan M. Tuberculous meningitis in children: clinical management and outcome. Indian Journal of Medical Research, 2019, No. 150, pp. 117-130.Davis A.G., Rohlwink U.K., Proust A. The pathogenesis of tuberculous meningitis. Journal of Leukocyte Biology, 2019, No. 105, pp. 267-280.Davis A.G., Rohlwink U.K., Proust A. The pathogenesis of tuberculous meningitis. Journal of Leukocyte Biology, 2019, No. 105, pp. 267-280.Dosenbach N.U.F, Koller J.M., Earl E.A. Real-time motion analytics during brain MRI improve data quality and reduce costs. NeuroImage, 2017, No. 161, pp. 80-93.Dosenbach N.U.F, Koller J.M., Earl E.A. Real-time motion analytics during brain MRI improve data quality and reduce costs. NeuroImage, 2017, No. 161, pp. 80-93.Ekermans P., Dusé A., George J. The dubious value of cerebrospinal fluid adenosine deaminase measurement for the diagnosis of tuberculous meningitis. BMC Infectious Diseases, 2017, No. 17, pp. 104.Ekermans P., Dusé A., George J. The dubious value of cerebrospinal fluid adenosine deaminase measurement for the diagnosis of tuberculous meningitis. BMC Infectious Diseases, 2017, No. 17, pp. 104.Hu X., Liao S., Bai H. Integrating exosomal microRNAs and electronic health data improved tuberculosis diagnosis. EBioMedicine, 2019, No. 40, pp. 564-573.Hu X., Liao S., Bai H. Integrating exosomal microRNAs and electronic health data improved tuberculosis diagnosis. EBioMedicine, 2019, No. 40, pp. 564-573.Liu Q., Gao Y., Zhang B. Cytokine profiles in cerebrospinal fluid of patients with meningitis at a tertiary general hospital in China. Journal of Microbiology, Immunology and Infection, 2020, No. 53, pp. 216-224.Liu Q., Gao Y., Zhang B. Cytokine profiles in cerebrospinal fluid of patients with meningitis at a tertiary general hospital in China. Journal of Microbiology, Immunology and Infection, 2020, No. 53, pp. 216-224.Li Y.J., Wilkinson K.A., Wilkinson R.J. Elevated matrix metalloproteinase concentrations offer novel insight into their role in pediatric tuberculous meningitis. Journal of the Pediatric Infectious Diseases Society, 2020, No. 9, pp. 82-86.Li Y.J., Wilkinson K.A., Wilkinson R.J. Elevated matrix metalloproteinase concentrations offer novel insight into their role in pediatric tuberculous meningitis. Journal of the Pediatric Infectious Diseases Society, 2020, No. 9, pp. 82-86.Li Z., Du B., Li J. Cerebrospinal fluid metabolomic profiling in tuberculous and viral meningitis: screening potential markers for differential diagnosis. Clinica Chimica Acta, 2017, No. 466, pp. 38-45.Li Z., Du B., Li J. Cerebrospinal fluid metabolomic profiling in tuberculous and viral meningitis: screening potential markers for differential diagnosis. Clinica Chimica Acta, 2017, No. 466, pp. 38-45.Manyelo C.M., Solomons R.S., Walzl G., Chegou N.N. Tuberculous meningitis: pathogenesis, immune responses, diagnostic challenges, and the potential of biomarker-based approaches. Journal of Clinical Microbiology Journal, 2021, No. 59, pp. 20.Manyelo C.M., Solomons R.S., Walzl G., Chegou N.N. Tuberculous meningitis: pathogenesis, immune responses, diagnostic challenges, and the potential of biomarker-based approaches. Journal of Clinical Microbiology Journal, 2021, No. 59, pp. 20.Manyelo C.M., Solomons R.S., Snyders C.I. Potential of host serum protein biomarkers in the diagnosis of tuberculous meningitis in children. Frontiers in Pediatrics, 2019, No. 7, pp. 376.Manyelo C.M., Solomons R.S., Snyders C.I. Potential of host serum protein biomarkers in the diagnosis of tuberculous meningitis in children. Frontiers in Pediatrics, 2019, No. 7, pp. 376.Mason S., Reinecke C.J., Solomons R. Cerebrospinal fluid amino acid profiling of pediatric cases with tuberculous meningitis. Frontiers in Neuroscience, 2017, No. 11, pp. 534-534.Mason S., Reinecke C.J., Solomons R. Cerebrospinal fluid amino acid profiling of pediatric cases with tuberculous meningitis. Frontiers in Neuroscience, 2017, No. 11, pp. 534-534.Mechai F., Bouchaud O. Tuberculous meningitis: challenges in diagnosis and management. Revue Neurologique (Paris), 2019, No. 175, pp. 451-457.Mechai F., Bouchaud O. Tuberculous meningitis: challenges in diagnosis and management. Revue Neurologique (Paris), 2019, No. 175, pp. 451-457.Pan L., Liu F., Zhang J. Genome-wide miRNA analysis identifies potential biomarkers in distinguishing tuberculous and viral meningitis. Frontiers in Cellular and Infection Microbiology, 2019, No. 9, pp. 323.Pan L., Liu F., Zhang J. Genome-wide miRNA analysis identifies potential biomarkers in distinguishing tuberculous and viral meningitis. Frontiers in Cellular and Infection Microbiology, 2019, No. 9, pp. 323.Pan D., Pan M., Xu Y-M. Mir - 29a expressions in peripheral blood mononuclear cell and cerebrospinal fluid: diagnostic value in patients with pediatric tuberculous meningitis. Brain Research Bulletin, 2017, No. 130, pp. 231-235.Pan D., Pan M., Xu Y-M. Mir - 29a expressions in peripheral blood mononuclear cell and cerebrospinal fluid: diagnostic value in patients with pediatric tuberculous meningitis. Brain Research Bulletin, 2017, No. 130, pp. 231-235.Poplin V., Boulware D.R., Bahr N.C. Methods for rapid diagnosis of meningitis etiology in adults. Biomarkers in Medicine, 2020, No. 14, pp. 459-479.Poplin V., Boulware D.R., Bahr N.C. Methods for rapid diagnosis of meningitis etiology in adults. Biomarkers in Medicine, 2020, No. 14, pp. 459-479.Pormohammad A., Riahi S-M., Nasiri M.J. Diagnostic test accuracy of adenosine deaminase for tuberculous meningitis: a systematic review and meta-analysis. Journal of Infection, 2017, No. 74, pp. 545-554.Pormohammad A., Riahi S-M., Nasiri M.J. Diagnostic test accuracy of adenosine deaminase for tuberculous meningitis: a systematic review and meta-analysis. Journal of Infection, 2017, No. 74, pp. 545-554.Rohlwink U.K., Figaji A., Wilkinson K.A. Tuberculous meningitis in children is characterized by compartmentalized immune responses and neural excitotoxicity. Nature Communications, 2019, No. 10, pp. 37-67.Rohlwink U.K., Figaji A., Wilkinson K.A. Tuberculous meningitis in children is characterized by compartmentalized immune responses and neural excitotoxicity. Nature Communications, 2019, No. 10, pp. 37-67.Sabir N., Hussain T., Shah S.Z.A. miRNAs in tuberculosis: new avenues for diagnosis and hostdirected therapy. Frontiers in Microbiology, 2018, No. 9, pp. 602602.Sabir N., Hussain T., Shah S.Z.A. miRNAs in tuberculosis: new avenues for diagnosis and hostdirected therapy. Frontiers in Microbiology, 2018, No. 9, pp. 602602.Seddon J.A., Tugume L., Solomons R. Tuberculous Meningitis International Research Consortium. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Research, 2019, No. 4, pp. 167.Seddon J.A., Tugume L., Solomons R. Tuberculous Meningitis International Research Consortium. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Research, 2019, No. 4, pp. 167.Tai M.S., Nor H.M., Rahmat K. Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis. Neurology Asia, 2017, No. 22 (1), pp. 15-23.Tai M.S., Nor H.M., Rahmat K. Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis. Neurology Asia, 2017, No. 22 (1), pp. 15-23.Thompson E.G., Du Y., Malherbe S.T. Catalysis TB–Biomarker Consortium. Host blood RNA signatures predict the outcome of tuberculosis treatment. Tuberculosis (Edinburgh, Scotland), 2017, No. 107, pp. 48-58.Thompson E.G., Du Y., Malherbe S.T. Catalysis TB–Biomarker Consortium. Host blood RNA signatures predict the outcome of tuberculosis treatment. Tuberculosis (Edinburgh, Scotland), 2017, No. 107, pp. 48-58.Van Laarhoven A., Dian S., Ruesen C. Clinical Parameters, Routine Inflammatory Markers, and LTA4H Genotype as Predictors of Mortality Among 608 Patients with Tuberculous Meningitis in Indonesia. Journal of Infectious Diseases, 2017, No. 215 (7), pp. 1029-1039.Van Laarhoven A., Dian S., Ruesen C. Clinical Parameters, Routine Inflammatory Markers, and LTA4H Genotype as Predictors of Mortality Among 608 Patients with Tuberculous Meningitis in Indonesia. Journal of Infectious Diseases, 2017, No. 215 (7), pp. 1029-1039.Wei Z., Zhang X., Wei C. Diagnostic accuracy of in-house real-time PCR assay for Mycobacterium tuberculosis: a systematic review and metaanalysis. BMC Infectious Diseases, 2019, No. 19, pp. 701.Wei Z., Zhang X., Wei C. Diagnostic accuracy of in-house real-time PCR assay for Mycobacterium tuberculosis: a systematic review and metaanalysis. BMC Infectious Diseases, 2019, No. 19, pp. 701.Wilkinson R.J., Rohlwink U., Misra U.K. On behalf of the Tuberculous Meningitis International Research Consortium. Tuberculous meningitis. Nature Reviews Neurology, 2017, No. 13 (10), pp. 581-598.Wilkinson R.J., Rohlwink U., Misra U.K. On behalf of the Tuberculous Meningitis International Research Consortium. Tuberculous meningitis. Nature Reviews Neurology, 2017, No. 13 (10), pp. 581-598.

The authors declare that there are no conflicts of interest present.