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A Tuberculous Meningitis International Research Consortium conducted a systematic review using PICO questions spanning diagnosis, anti-tuberculosis chemotherapy, adjunctive anti-inflammatory therapy, and neurocritical/neurosurgical care. Using GRADE, the review produced evidence-based recommendations plus expert opinion, identifying major evidence gaps and current research priorities for children and adults, including people living with HIV.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-clinical-practice-guideline-for-tuberculous-meningitis/374031/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-clinical-practice-guideline-for-tuberculous-meningitis/374031.png","ImageObject",300,407,{"name":92,"@type":93},"Aria Callaghan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are new international guidelines needed for tuberculous meningitis?","Question",{"text":112,"@type":113},"No up-to-date international clinical practice guideline existed, and older national guidance had not been updated. Existing WHO and ATS/CDC/IDSA tuberculosis guidance included only limited recommendations for CNS tuberculosis management.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What diagnostic tests are strongly recommended?",{"text":117,"@type":113},"Xpert Ultra or Xpert PCR tests are strongly recommended as diagnostic tests, alongside mycobacterial culture. The guideline notes that diagnosing tuberculous meningitis is difficult and no single test can exclude it.",{"name":119,"@type":110,"acceptedAnswer":120},"What is recommended regarding adjunctive corticosteroid therapy?",{"text":121,"@type":113},"Corticosteroids reduce mortality in tuberculous meningitis without HIV co-infection and are strongly recommended. For HIV-associated tuberculous meningitis, corticosteroids are recommended on a case-by-case basis due to safety and potential effectiveness when no effective alternative adjunctive therapy exists.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},374031,1790494492,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":36},962084926284,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Review  \nA clinical practice guideline for tuberculous meningitis  \nJoseph Donovan*, Fiona VCresswell*, Elizabeth W Tucker*, Angharad G Davis*, Ursula KRohlwink*, Julie Huynh*, Regan Solomons*, James A Seddon*, Nathan C Bahr, Arjan van Laarhoven, Suzanne T Anderson, Sanjay K Jain, Felicia C Chow, Sophie Pattison, James EScriven, Gabriela Singh, Rob E Aarnoutse, Jan-Willem CAlffenaar, Sofiati Dian, Abi Manesh, Robin Basu Roy, Varinder Singh, Ronald van Toorn, Caryn M Upton, Reinout van Crevel, Kelly E Dooley, Diana Gibb, David Meya, Robert J Wilkinson, Ewelina Rogozińska, Usha K Misra, Anthony Figaji, Guy EThwaites  \nTuberculous meningitis is the most severe form of tuberculosis, causing death or disability in around half of those affected. There are no up-to-date international guidelines defining its optimal management. Therefore, the Tuberculous Meningitis International Research Consortium conducted a systematic review of available evidence to address key management questions and to develop practice guidance. The consortium includes representatives from India, Indonesia, South Africa, Uganda, Viet Nam, Australia, the Netherlands, the UK, and the USA. Questions were developed using the Population, Intervention, Comparator, Outcome (PICO) format for tuberculous meningitis diagnosis, anti-tuberculosis chemotherapy, adjunctive anti-inflammatory therapy, and neurocritical and neurosurgical care. A Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty (or quality) of evidence and establish the direction and strength of recommendations for each PICO-based question. We provide evidence-based recommendations for the optimal treatment and diagnosis of tuberculous meningitis, alongside expert opinion. We expose substantial knowledge and evidence gaps, thereby highlighting current research priorities.  \nIntroduction  \nAn estimated 10·8 million people develop tuberculosis globally each year,1 of whom 2–5% have tuberculous meningitis.2–4 Young children and people who are immunosuppressed, including those living with HIV, are at a particularly high risk of the disease and the associated poor outcomes.5  \nTuberculous meningitis develops following dissemination of Mycobacterium tuberculosis from the lungs to the brain and has a clinical course that is usually insidious, with typical features of headache, neck stiffness, and fever, that develops in days to weeks. In untreated cases, neurological deficits develop, consciousness declines, which results in death.5 Even with the best available treatment, 20–50% of patients die.6–10 Early diagnosis and treatment, before the onset of coma, substantially reduces death and disability,11 yet the best diagnostics and most effective treatments are not well defined. Therefore, we conducted a systematic review of the available evidence to address a series of predefined, crucial clinical questions, to produce authoritative international practice guidelines for the management of tuberculous meningitis.  \nNo international clinical practice guideline exists for tuberculous meningitis. Previous national guidelines by the United Kingdom British Infection Society for CNS tuberculosis in adults and children, published in 2009, have not been updated.12 Tuberculosis treatment guidelines from WHO13–15 and jointly from the American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA)16,17 include limited recommendations on CNS tuberculosis management. Up to date, evidence based practice guidelines are required to help physicians globally provide the best care to adults and children with tuberculous meningitis.  \nWe provide guidance for the diagnosis and management of tuberculous meningitis in children and adults, including people living with HIV. We provide some review of other CNS tuberculous complications, including isolated brain tuberculomas, spinal cord tuberculosis, and tuberculous brain","cbCair9q7aYoqXIm","https://ap.wps.com/l/cbCair9q7aYoqXIm","pdf",492177,16,"English","# Introduction\n# Key messages","[{\"question\":\"Why are new international guidelines needed for tuberculous meningitis?\",\"answer\":\"No up-to-date international clinical practice guideline existed, and older national guidance had not been updated. Existing WHO and ATS/CDC/IDSA tuberculosis guidance included only limited recommendations for CNS tuberculosis management.\"},{\"question\":\"What diagnostic tests are strongly recommended?\",\"answer\":\"Xpert Ultra or Xpert PCR tests are strongly recommended as diagnostic tests, alongside mycobacterial culture. The guideline notes that diagnosing tuberculous meningitis is difficult and no single test can exclude it.\"},{\"question\":\"What is recommended regarding adjunctive corticosteroid therapy?\",\"answer\":\"Corticosteroids reduce mortality in tuberculous meningitis without HIV co-infection and are strongly recommended. For HIV-associated tuberculous meningitis, corticosteroids are recommended on a case-by-case basis due to safety and potential effectiveness when no effective alternative adjunctive therapy exists.\"}]","A clinical practice guideline for tuberculous meningitis | PDF",1790201048]