Publication highlights

Tuberculosis is most commonly thought of an encountered as a lung disease. However it may also enter the brain to cause meningitis (TBM) which causes death or disability in approximately 50% of those affected and kills approximately 78200 adults every year. Antibiotic treatment is based on that used for lung disease which overlooks important differences in the ability of drugs to reach the brain. TBM has a profound inflammatory component which also requires treatment, yet only steroid have shown benefit. There is now an active pipeline of new anti-TB drugs, and the increasing availability of better and more specific anti-inflammatory therapies could bring a a new era of improved TBM treatment and outcomes. Yet, to date, TBM studies have been relatively few, progress is slow, and a new approach is required. In this article the views of a global consortium of TBM researchers are articulated towards a coordinated, definitive way ahead via globally conducted clinical trials of novel drugs and regimens to advance treatment and improve outcomes from this life-threatening infection.

The microbiome has been recognised as an essential element in the body's protection against infectious agents. Microorganisms enter the body through different routes, including the oral one, making it an important niche for potential pathogens. An imbalance in the composition of the oropharyngeal microbiome can lead to increase risks of respiratory tract infections, which still represent a major public health problem worldwide, particularly in developing countries. Characterising the microbiome of this ecological niche in developing countries is essential for identifying biomarkers of infections. This manuscript presents the results of the first study on the link between the oropharyngeal microbiome and symptomatic upper respiratory tract infections in children in Côte d'Ivoire. It provides a description of the microbiota as well as an understanding of potential microbial markers of infection for pathogens such as Streptococcus pneumonia, Haemophilus influenza and Sars-Cov2. The results of this study add to the knowledge on the microbiome in diverse and understudied settings.

Researchers from the University of Cape Town and the Crick worked together to investigate vitamin D supplementation and growth in children. Results from a clinical trial, conducted in a large number of African schoolchildren in Cape Town, South Africa, showed that a 3-year course of weekly vitamin D supplementation was effective in elevating vitamin D levels, however this was not associated with any effect on growth, body composition, pubertal development or lung volumes. There has been a lot of interest in the links between vitamin D deficiency in childhood and slower linear growth, reduced lean mass, obesity and precocious puberty, but this study suggests that vitamin D supplementation wouldn't be a useful intervention.

Researchers at the Francis Crick Institute have shown in lab-based experiments that variants of SARS-CoV-2, the virus that causes COVID-19, can affect the blood-brain barrier and damage brain cells in different ways. This work gives clues as to how the virus could enter the brain, but doesn’t take into account the protection that people have acquired through vaccination. Brain cells and a 3D model of a blood-brain barrier were exposed to different strains of SARS-CoV-2: wild-type (the original variant from Wuhan), Alpha, Beta, Delta, Eta and Omicron. The brain cells investigated were pericytes, astrocytes, endothelial cells and microglia – cells that support nerve cells and control how permissible the blood-brain barrier is to allowing molecules and cells to cross. The researchers showed that all variants caused stress to brain cells, stopping them from working as well, but exactly which cells were affected depended on the variant.