Advances in Tuberculous Meningitis: Research, Challenges, and Future Perspectives

Tuberculous meningitis (TBM) is the most lethal form of tuberculosis (TB), with reported short-term mortality of 20–69% for patients on treatment and five-year deaths exceeding 58%. The World Health Organization has reported a new record of approximately 8.3 million new cases of TB diagnosed worldwide, with TBM accounting for 1–5% of these cases in 2024. Heterogeneous clinical manifestations, as well as difficulties in identifying TBM at onset, will delay timely therapy. Drug-resistant TB (DRTB) represents a real threat to public health and is evolving rapidly. Although new drugs have emerged to overcome DRTB, their role in TBM is limited. Our first objective was to update knowledge about the pathogenic mechanisms, clinical manifestations, diagnosis, therapy, and prevention of TBM. Another goal was to highlight advances in nanomedicine and medical imaging in terms of timely diagnosis of TBM and rapid initiation of targeted treatment, including overcoming DRTBM. The last aim was to bring to the attention of infectious disease specialists, neurologists, pediatricians, healthcare professionals, and information technology (IT) specialists the results of clinical trials on TBM published in the last two years. Technological innovation has integrated next-generation sequencing, and IT and artificial intelligence (AI) will develop new applications for precision medicine in TBM and vaccine optimization.