Central nervous system tuberculosis (CNS-TB) is one of the most serious and complicated forms of extrapulmonary tuberculosis (EP-TB) and has a high mortality rate, neurological disability and delayed diagnosis, especially in developing countries. In resource limited settings, the challenges in the diagnosis and treatment of CNS-TB are significant because of the lack of adequate healthcare infrastructure, lab capacity, access to advanced neuro-imaging techniques, and trained medical personnel. Common laboratory tests like smear microscopy and culture of the cerebrospinal fluid (CSF) have low sensitivity and are time-consuming, and molecular testing is not available in many rural and impoverished areas. In addition, vague symptoms, overlapping clinical features, co-infection with HIV, malnutrition and a late seeking of care make the diagnosis difficult in the early stages. The critical diagnostic problems of CNS tuberculosis in the developing world are critically discussed and the role of socioeconomic, infrastructural, and technological barriers on the outcome of the disease is explained. The review also includes discussion of some of the new diagnostic options that are emerging and the need for complex health strategies to enhance early detection and minimize the morbidity and mortality associated with CNS-TB.
Central nervous system tuberculosis, tuberculous meningitis, developing countries, diagnostic challenges, resource-limited settings, molecular diagnostics, neuroimaging