Advancements in the identification and utilization of cerebrospinal fluid immunological biomarkers for the diagnosis of tuberculous meningitis.

Tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, poses a major global health challenge due to its high morbidity and mortality, affecting over 100,000 individuals annually. Diagnosing TBM is challenging due to its clinical resemblance to other forms of meningitis and the slow, often inadequate, traditional diagnostic methods like CSF smear and culture. Despite advancements such as the Xpert MTB/RIF assay, which has enhanced the speed and sensitivity of diagnostics, significant challenges persist due to variability in test performance and sample handling. This review explores the potential of CSF immunological biomarkers to improve the diagnosis of TBM by reflecting the complex immune responses to Mycobacterium tuberculosis. Focusing on immune-related cytokines, chemokines, inflammatory mediators, and specific immune cells, the review proposes these biomarkers as more precise and rapid alternatives to conventional diagnostic methods. The review suggests that future research should prioritize the development of a composite biomarker panel to enhance diagnostic specificity and sensitivity. Additionally, integrating biomarker data with clinical outcomes to create a reliable biomarker-based diagnostic framework will ultimately improve patient management and outcomes in TBM.