CEREBROSPINAL FLUID ANALYSIS IN TUBERCULOUS MENINGITIS: DIAGNOSTIC, PROGNOSTIC, AND MONITORING PERSPECTIVES

Kiky Monica Soesanto; Ni Made Susilawathi; A.A. Raka Sudewi

Kiky Monica Soesanto Neurology Specialist Program, Medical of Faculty, Universitas Udayana, Bali, Indonesia
Ni Made Susilawathi Neurology Department, Medical of Faculty, Universitas Udayana, Bali, Indonesia http://orcid.org/0000-0002-3166-2440
A.A. Raka Sudewi Neurology Department, Medical of Faculty, Universitas Udayana, Bali, Indonesia http://orcid.org/0000-0002-4669-2669

Abstract

Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis, associated with high morbidity and mortality. This review aims to evaluate the role of cerebrospinal fluid (CSF) analysis in the diagnosis and prognosis, particularly in relation to mortality, as well as in therapeutic monitoring of TBM. A narrative literature review was conducted using studies published between 2010 and 2025 on CSF parameters in TBM. Studies reporting associations between CSF biomarkers and clinical outcomes were included. Eighteen eligible studies were analyzed qualitatively. CSF analysis plays a critical role in classifying TBM as definite, probable, or possible according to the Lancet criteria. Elevated CSF protein (≥2 g/L) and reduced glucose (<2.2 mmol/L) levels are strongly associated with mortality, reflecting severe inflammation and blood-brain barrier dysfunction. Additional markers such as CSF lactate, inflammatory cytokines, and CRP further support prognostication. Serial measurements of CSF parameters aid in monitoring treatment response, especially in cases with atypical clinical progress. This review also highlights the diagnostic and monitoring roles of CSF parameters throughout the course of TBM. CSF biomarkers, especially protein and glucose levels, are key to assessing disease severity, predicting outcomes, and guiding treatment strategies in TBM. These findings support the integration of CSF analysis into routine clinical algorithms for managing this life-threatening condition.

Keywords: cerebrospinal fluid, diagnosis, monitoring, prognosis, tuberculous meningitis

DOI: 10.35990/mk.v9n1.p104-114

Author Biographies

Ni Made Susilawathi, Neurology Department, Medical of Faculty, Universitas Udayana, Bali, Indonesia

Current Position:

Lecturer, Department of Neurology, Faculty of Medicine, Universitas Udayana
Neurologist, Universitas Udayana Hospital

Educational Background:

MD, Universitas Udayana, 2000
Specialist in Neurology, Universitas Udayana, 2011
PhD in Biomedical Sciences, Universitas Udayana, 2021

Research Interests:

Neuroinfectious diseases
Neuroimmunology
Rabies
Neurocysticercosis
Streptococcus suis meningitis
Neuro-AIDS

Scientific Output:

Publications: 52 articles
Citations: >300
Reads: >20,000

International Collaborations:

University of Bern, Switzerland
Santé Publique France

A.A. Raka Sudewi, Neurology Department, Medical of Faculty, Universitas Udayana, Bali, Indonesia

Educational History :

SMA Negeri 1 Denpasar – Graduated in 1977

Bachelor of Medicine (dr.) – Udayana University, completed 1985

Neurology Specialist (Sp.S) – Airlangga University, completed 1993

Master of Health (S2) – Airlangga University, completed 1993

Doctor of Medical Science (S3) – Airlangga University, completed 2004

Neurology Consultant Specialist (Sp.S(K)) – University of Indonesia, completed 2006)

Academic & Functional Position:

Young Lecturer – Faculty of Medicine, University Udayana (1995)

Associate Lecturer – Faculty of Medicine, Udayana University (1999)

Lecturer – Faculty of Medicine, Udayana University (2001)

Professor (Professor) – Faculty of Medicine, Udayana University (2008 and 2021)

Structural Experience:

Head of Neurology Study Program – Faculty of Medicine, Udayana University

Secretary of Doctoral Study Program in Medicine – Postgraduate Program, Udayana University

Head of Doctoral Study Program in Medicine – Postgraduate Program, Udayana University (2009–2010)

Head of Research and Development Unit (R&D) – Faculty of Medicine, Udayana University (2010–2012)

Director of Postgraduate Program – Udayana University (2010–2017)

Rector of Udayana University – Period 2017–2021

Scientific Publications

Total Publications:

International Journals: 96 articles

National Journals: 724 articles

Scopus Indexed Journals: 21 articles

Citation Index (as of June 2025):

Google Scholar: 2,888 citations

h-Index: 15

i10-Index: 22

Awards & Achievements:

First Female Rector – Udayana University

University Accreditation Improvement – Under her leadership, Udayana University achieved Excellent accreditation with an Accredited A rating

International Program Development – Initiated a postgraduate double degree program with universities from Japan and France

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