Diagnosis and treatment of tuberculous meningitis

Although the overall incidence and mortality of tuberculous meningitis (TBM) have decreased over the past decades, the disease still remains a leading cause of bacterial meningitis in some developing countries, and its incidence has increased in consequence of the AIDS pandemic. Mortality is closely related to the rapidness, with which the diagnosis is made, and especially in European countries the diagnosis is often delayed due to a lack of awareness of the disease. New diagnostic tools such as polymerase chain reaction (PCR) for M. tuberculosis DNA can assist diagnosis before results of culture specimens are available, but new methods, and growing awareness of alternative diagnoses such as neurosarcoidosis have created new diagnostic pitfalls and may result in delayed treatment. We discuss two recent cases of TBM from our department, and provide an overview of present diagnostic strategies and treatment regimens from a clinical point of view.