Children with tuberculosis meningitis - a brain and spinal cord
infection that can lead to disability and death - have a biological
fingerprint that can be used to assess the severity of the
condition, help decide the best course of treatment, and provide
clues for novel treatments, scientists at the Francis Crick
Institute, Imperial College London and the University of Cape Town
reveal.
By comparing the blood and spinal cord fluid of 44 children with
tuberculosis meningitis (TBM) and 20 patients with other spinal
cord disorders, the team identified a set of biological markers
elevated in TBM. The most common markers indicate damage of neurons
and neuron-supporting cells, and their presence in the bloodstream
and spinal cord can help to determine disease progression. The
research, funded by Wellcome, is published in the journal ofClinical Infectious Diseases.
In the study, the children that developed severe disabilities or
died from TBM had the highest levels of these biological markers,
and the levels increased over time, suggesting that this
information could be used to help predict disease outcome.
"This is the first time that anyone has found a set of
biological markers for TBM," says Robert Wilkinson, Group Leader at
the Crick and Imperial College London, and Director of the Wellcome
Centre for Infectious Diseases Research in Africa at the University
of Cape Town.
TBM is caused by a bacterium known as Mycobacterium
tuberculosis. Infection normally begins in the lungs as TB and
can spread to the brain and spinal cord, causing swelling and
restricting blood flow. Several thousand young children die of TBM
every year, and many more are left severely disabled.
Whilst the immune response to TBM sets up some of the damage,
this new research suggests that markers of ongoing neuronal injury
are more predictive of disease severity than markers of immune
response.
"In the future, doctors could test their patients for these
markers and use them to make better prognoses and decide on the
right treatment strategy for the individual," says Robert. "In
addition, we have greater knowledge of this historically neglected
condition."
The paper 'Biomarkers of cerebral injury and inflammation in
pediatric tuberculous meningitis' is published in Clinical Infectious Diseases.