CNS Tuberculosis in India: A Systematic Review

Abstract Central nervous system tuberculosis (CNS TB), a severe manifestation of Mycobacterium tuberculosis infection, remains one of the most challenging public health problems in India. Despite significant advances in diagnostic modalities and treatment protocols, CNS TB continues to result in high morbidity and mortality, particularly among vulnerable populations in resource-limited settings. This systematic review synthesizes the epidemiological trends, clinical presentations, diagnostic barriers, treatment strategies, and outcomes of CNS TB in India. Emphasis is placed on two major clinical manifestations: tuberculoma and tuberculous meningitis (TBM). By integrating international diagnostic frameworks—such as the Marais Uniform Case Definition—with locally adapted strategies like the Ahuja criteria, along with emerging molecular diagnostics, advanced neuroimaging, and biomarker innovations, we propose a multi-tiered approach tailored to the Indian healthcare landscape. The review also discusses policy interventions and research priorities necessary to bridge existing diagnostic gaps and improve patient outcomes. Our findings underscore the urgent need for coordinated efforts to enhance early detection, optimize treatment regimens, and ultimately reduce the burden of CNS TB in India.