Burden of disease

Tuberculosis (TB) is one of the most important infectious diseases and one of ten most common causes of death globally,1 with almost 10 million new cases per year and 1.5 million deaths (WHO report 2011).2 It is estimated that a third of the world's population is infected with TB of whom approximately 10% will develop clinically apparent disease. TB is also in the top 15 of causes of disease burden worldwide in the rank of disability-adjusted life years.3 The WHO estimates that five countries India, China, South Africa, Indonesia and Pakistan account for over 70% of the global burden of disease.2 Southern and eastern sub-Saharan Africa is the most affected region by the HIV/AIDS-TB combination.3 But the reality is that in all low-income and middle-income countries and increasingly in high-income countries, TB remains a major public health problem.

Tuberculous meningitis (TBM) is the most severe form of TB with a high mortality and many of the survivors are left with chronic neurological sequelae, which affect their daily lives and those of their family and community. The impact of this disease is even more severe in those coinfected with HIV. Patients coinfected with HIV are at more than 20 times higher risk of developing TB, compared with non-infected individuals.2 In a recent studies from Vietnam, the mortality rate in the 1st year following diagnosis of TBM in HIV and non-HIV infected adult patients was approximately 65% and 30%, respectively, and over 50% of survivors suffer from long-term disability.4 In countries with the greatest burden of TB, TBM is most commonly seen in children while in lower TB transmission settings, most cases of TBM occur in adults. It is now the third most common cause of bacterial meningitis in the UK. Several aspects of TBM …