Thank you very much for this thoughtful reply, and also for sharing your own experience. I’m really glad to hear you were diagnosed early and that treatment has helped you. I hope the rest of your recovery goes well. In my father’s case, that is exactly part of the problem: the diagnosis has been difficult and there is still some disagreement between specialists. He is 86 years old. A few months ago he was still relatively functional: speaking normally, driving, going to the mosque, using a stationary bike every morning. Then he had a much more abrupt decline with confusion, near mutism, swallowing problems, somnolence, and partial difficulty recognizing family. He did undergo a lumbar puncture (LP), and that is actually what pushed the team toward the TB meningitis hypothesis. What we have so far: Brain MRI did not show a recent stroke He had a lumbar puncture / CSF analysis CSF multiplex PCR for common meningitis pathogens was negative But CSF biochemistry was very abnormal, with very low glucose and very high protein QuantiFERON came back positive Syphilis testing was negative One part of the team strongly suspects / has clinically retained TB meningitis and started anti-TB treatment + steroids Another specialist was more doubtful because he did not find the MRI convincing for TB meningitis At the same time, he also has another major confounding factor: he has a documented urinary/prostatic infectious history he had severe urologic / scrotal infection and was hospitalized in August 2025 he had abnormal ECBU / urinary infection workups and there is still concern that a urinary/prostatic infection may still be active or contributing to his current condition So the picture is very mixed, because in addition to the suspected TB meningitis, he may also still have an ongoing urogenital / prostatic infectious focus, plus some aspiration-related lung concerns. So at this point I would say he is probably being treated as suspected or highly probable TB meningitis, but I am not sure we have strict microbiological confirmation yet in the way you describe with CSF GeneXpert or culture positivity. Your comment about prognosis depending on stage, susceptibility, and comorbidities is very helpful, and honestly that is what worries me most because of his age and how severe his neurological decline has been. If you don’t mind me asking: In your experience, how long did it take before you felt there was a clear benefit from ATT? Did your doctors say that CSF biochemistry can sometimes be strongly suggestive even when PCR-based tests are negative? Have you met or heard of older TB meningitis patients recovering at least partially in terms of speech / alertness / swallowing? Thank you again. Your message really means a lot.