- 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.
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