On the Horizon for Tuberculosis of the Central Nervous System in Children
Animal models: The development of animal models to understand the basic neuropathogenesis of M. tuberculosis is ongoing (17).
Rapid identification of drug-resistant strains: This work and the identification of virulent strains of M. tuberculosis could profoundly reduce the delay in adequate therapy for those with CNS TB due to resistant isolates.
Development of better antibiotics: Work to develop antibiotics with a better ability to cross the blood-brain barrier to achieve therapeutic concentrations in the CSF for treatment of CNS TB is ongoing (69).
New vaccine or improving existing BCG vaccine: The BCG vaccine has limitations, and research to develop new TB vaccines is ongoing. A number of potential candidates are currently in phase I and II clinical trials. Two main approaches are being used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines. MVA85A, an example of a subunit vaccine, currently in trials in South Africa, is based on a genetically modified vaccinia virus (39). Vaccines are hoped to play a significant role in treatment of both latent and active disease.