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2009 ; 9
(2
): 94-9
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Pathogenesis of central nervous system tuberculosis
#MMPMID19275620
Be NA
; Kim KS
; Bishai WR
; Jain SK
Curr Mol Med
2009[Mar]; 9
(2
): 94-9
PMID19275620
show ga
Central Nervous System (CNS) tuberculosis is a serious, often fatal form of
tuberculosis, predominantly affecting young children. HIV co-infection and drug
resistant strains of Mycobacterium tuberculosis are making the diagnosis and
treatment of CNS tuberculosis more complicated. Current concepts about the
pathogenesis of CNS tuberculosis are based on necropsy studies done in 1933,
which suggest that tuberculous meningitis develops subsequent to the rupture into
the cerebrospinal fluid of tuberculomas that form around M. tuberculosis
deposited in the brain parenchyma and meninges during the initial hematogenous
dissemination. Foreign antigens including pathogens deposited in the brain
parenchyma are not detected efficiently by the immune system in the CNS. These
experimental data may explain the clinical observation of delayed "paradoxical"
enlargement or development of intracranial tuberculomas, observed several weeks
to months in patients receiving anti-tuberculous therapy. Since severe sequelae
are observed even when CNS tuberculosis is treated effectively, it is important
to develop preventive strategies for this disease. Recent data utilizing animal
models suggests that, in addition to host factors, M. tuberculosis genes and
their encoded proteins may contribute specifically to bacterial invasion and
survival in the CNS. Understanding how these microbial factors affect CNS disease
would be essential to developing such preventive strategies.
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