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Clinical Microbiology Reviews, April 2008, p. 243-261, Vol. 21, No. 2
0893-8512/08/$08.00+0     doi:10.1128/CMR.00042-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

R. Bryan Rock,* Michael Olin, Cristina A. Baker, Thomas W. Molitor, and Phillip K. Peterson

Center for Infectious Diseases and Microbiology Translational Research, and Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota

Summary: Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.

* Corresponding author. Mailing address: Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota Medical School, McGuire Translational Research Facility, 2001 6th Street SE, no. 3-218, Minneapolis, MN 55455. Phone: (612) 624-9996. Fax: (612) 904-4299. E-mail: rockx012{at}umn.edu

Clinical Microbiology Reviews, April 2008, p. 243-261, Vol. 21, No. 2
0893-8512/08/$08.00+0     doi:10.1128/CMR.00042-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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