Priyanka Changmai¹ and Amrit Kumar Saikia²*

¹Department of Pulmonary Medicine, Jorhat Christian Medical Center, India
²Department of Neurosurgery, Jorhat Medical College and Hospital, India

*Corresponding Author: Kenneth Blum, Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, USA

Received: June 24, 2025; Published: August 12, 2025

Abstract

Introduction: Tuberculous meningitis (TBM) poses a significant diagnostic challenge due to its non-specific clinical presentation and the lack of a universally accepted case definition. This variability often delays treatment, contributing to high mortality and morbidity rates, particularly in resource-limited settings. A standardized diagnostic framework is essential to improve early detection and outcomes. This systematic review aims to evaluate the development and application of uniform case definition criteria for TBM diagnosis, identifying gaps and proposing pathways for global consensus.

Methods: We conducted a systematic review following PRISMA guidelines, searching PubMed, Scopus, and Web of Science for studies published between 1990 and 2024. Keywords included “tuberculous meningitis,” “diagnostic criteria,” and “case definition.” Inclusion criteria encompassed studies proposing or evaluating TBM diagnostic criteria, scoring systems, or consensus guidelines in English. Two reviewers independently screened and extracted data, assessing study quality using the QUADAS-2 tool.

Results: Thirty-two studies were included, highlighting heterogeneity in diagnostic approaches. The Marais criteria (2010) were most widely adopted (20 studies), followed by earlier frameworks like Ahuja’s clinical criteria (1994). Sensitivity for Marais criteria ranged from 80-95%, but specificity varied, particularly in HIV-positive cohorts. Validation studies were limited for pediatric and immunocompromised populations.

Conclusion: This systematic review underscores the need for standardized criteria integrating clinical, laboratory, and imaging parameters to enhance diagnostic accuracy. Gaps in validation across diverse populations persist, necessitating a global consensus framework to improve early TBM detection and reduce associated mortality and morbidity.

Keywords: Uniform; Tuberculous Meningitis; Diagnosis

References

1. Ahuja GK., et al. “Diagnostic criteria for tuberculous meningitis and their validation”. Tubercle and Lung Disease 2 (1994): 149-152.
2. Marais S., et al. “Tuberculous meningitis: a uniform case definition for use in clinical research”. The Lancet Infectious Diseases 11 (2010): 803-812.
3. Thwaites GE., et al. “Improving the bacteriological diagnosis of tuberculous meningitis”. Journal of Clinical Microbiology 1 (2004): 378-379.
4. Solomons RS., et al. “Uniform research case definition criteria differentiate tuberculous and bacterial meningitis in children”. Clinical Infectious Diseases 11 (2014): 1574-1578.
5. Solomons RS., et al. “Diagnostic accuracy of a uniform research case definition for TBM in children: a prospective study”. The International Journal of Tuberculosis and Lung Disease 7 (2016): 903-908.
6. Kim MC., et al. “Validation of the uniform case definition criteria for differentiating tuberculous meningitis, viral meningitis, and bacterial meningitis in adults”. Journal of Infection and Chemotherapy 2 (2019): 188-190.
7. Wen A., et al. “A new scoring system to differentially diagnose and distinguish tuberculous meningitis and bacterial meningitis in South China”. Frontiers in Neurology 13 (2022): 830969.
8. Handryastuti S., et al. “Development of clinical-based scoring system to diagnose tuberculous meningitis in children”. Archives of Disease in Childhood 11 (2023): 884-888.
9. Youssef FG., et al. “Differentiation of tuberculous meningitis from acute bacterial meningitis using simple clinical and laboratory parameters”. Diagnostic Microbiology and Infectious Disease 4 (2006): 275-278.
10. van Well GTJ., et al. “Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa”. Pediatrics1 (2009): e1-e8.
11. He H., et al. “A diagnostic scoring system for distinguishing between tuberculous and bacterial meningitis based on clinical and laboratory findings”. Journal of Clinical Laboratory Analysis 5 (2020): e23185.
12. Mai NTH and Thwaites GE. “Recent advances in the diagnosis and management of tuberculous meningitis”. Current Opinion in Infectious Diseases 1 (2017): 123-128.
13. Marais BJ., et al. “Standardized methods for enhanced quality and comparability of tuberculous meningitis studies”. Clinical Infectious Diseases 4 (2017): 501-509.
14. Wilkinson RJ., et al. “Tuberculous meningitis”. Nature Reviews Neurology 10 (2017): 581-598.
15. Tuon FF., et al. “Adenosine deaminase and tuberculous meningitis-a systematic review with meta-analysis”. Scandinavian Journal of Infectious Diseases 3 (2010): 198-207.
16. Saitoh A., et al. “Prediction of neurologic sequelae in childhood tuberculous meningitis: a review of 20 cases and proposal of a novel scoring system”. The Pediatric Infectious Disease Journal 3 (2004): 207-212.
17. Pehlivanoglu F., et al. “Tuberculous meningitis in adults: a review of 160 cases”. Scientific World Journal 2012 (2012): 169028.
18. Chen X., et al. “MRI advances in the imaging diagnosis of tuberculous meningitis: opportunities and innovations”. Frontiers in Neurology 14 (2023): 1129043.
19. Bharath RD., et al. “Correlation of MRI findings with clinical outcome in tuberculous meningitis”. Neuroradiology12 (2010): 1099-1106.
20. Kalita J., et al. “Predictors of long-term neurological sequelae of tuberculous meningitis: a multivariate analysis”. European Journal of Neurology 1 (2007): 33-37.
21. Mishra OP., et al. “Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis in children”. Annals of Tropical Paediatrics 4 (2003): 287-290.
22. Sharma SK., et al. “Extrapulmonary tuberculosis”. Expert Review of Respiratory Medicine 7 (2021): 931-948.
23. Ramachandran PS., et al. “Integrating central nervous system metagenomics and host response for diagnosis of tuberculosis meningitis and its mimics”. Nature Communications 1 (2022): 1675.
24. Rohlwink UK., et al. “Tuberculous meningitis in children: advances in diagnosis and treatment”. Seminars in Pediatric Neurology 1 (2014): 12-18.
25. Guo Y., et al. “Systemic inflammation predicts neurological functional outcome in patients with tuberculous meningitis: a multicenter retrospective cohort study in China”. Journal of Inflammation Research 17 (2024): 7561-7571.
26. Pormohammad A., et al. “Human immunodeficiency virus in patients with tuberculous meningitis: systematic review and meta-analysis”. Tropical Medicine and International Health 6 (2018): 589-595.
27. Qu J., et al. “Comparison of clinical features and prognostic factors in HIV-negative adults with cryptococcal meningitis and tuberculous meningitis: a retrospective study”. BMC Infectious Diseases 1 (2017): 51.
28. Chiang SS., et al. “Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis”. Lancet Infectious Diseases 10 (2014): 947-957.
29. van Toorn R and Solomons R. “Update on the diagnosis and management of tuberculous meningitis in children”. Seminars in Pediatric Neurology 1 (2014): 12-18.
30. Ashizawa N., et al. “Efficacy of intrathecal isoniazid and steroid therapy in refractory tuberculous meningitis”. Internal Medicine 4 (2024): 583-586.
31. Huynh J., et al. “Tuberculosis treatment in children: the changing landscape”. Paediatric Respiratory Reviews 36 (2020): 33-43.
32. Manyelo CM., et al. “Tuberculous Meningitis: Pathogenesis, Immune Responses, Diagnostic Challenges, and the Potential of Biomarker-Based Approaches”. Journal of Clinical Microbiology 3 (2021): e01771-e01772.

Citation

Citation: Priyanka Changmai and Amrit Kumar Saikia. “Uniform Case Definitions in Tuberculous Meningitis: A Systematic Review".Acta Scientific Neurology 8.9 (2025): 41-51.

Copyright

Copyright: © 2025 Priyanka Changmai and Amrit Kumar Saikia. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.