Cerebrospinal fluid analysis in tuberculous meningitis: A literature review

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Abstract
Background: Tuberculous meningitis (TBM) is the most common central nervous system infection of Mycobacterium tuberculosis (M.tb). The infection will cause focal neurological deficits and can be fatal, so that it will increase the morbidity and mortality rates. Adequate treatment is needed so that the drug can reach the center of infection. Not all anti-tuberculosis (TB) drugs can effectively cross the blood–brain and blood-cerebrospinal fluid barriers. The use of higher doses is expected to be able to work on the center of infection effectively. However, the use of higher doses will also increase the risk of drug-induced liver injury, which requires temporary discontinuation of the suspected drug. Methods: This scientific work aims to determine the penetration rate of first-line anti-TB drugs that are often used in patients infected with M.tb, especially TBM. Journal searches were performed on PubMed/PMC and BioMed Central/BMC search engines with the appropriate keywords. Critical appraisal analysis was carried out in selected journals. CSF sampling can be done to establish the diagnosis of TBM. CSF characteristics in TBM include lymphocyte pleocytosis, increased protein levels, and decreased glucose levels. Results: The results of CSF analysis depend on the volume of CSF used, the delivery of the sample, and the technical expertise of the clinician. If clinically, a patient is suspected of having TBM even though the results of CSF analysis show negative results for M.tb bacteria, a drug regimen can be given immediately to prevent worsening of the patient’s condition. Bacterial cultures may be performed as treatment progresses. Based on the penetration rate of anti-TB drugs in the CSF, isoniazid (INH), pyrazinamide, and fluoroquinolones, especially levofloxacin, are drugs with fairly good CSF penetration. Conclusion: The use of INH is beneficial because it has high bactericidal activity. Gatifloxacin and ciprofloxacin, which are included in the fluoroquinolone class of drugs, are safe to use even though their CSF penetration is not as good as levofloxacin.

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