Association between gut microbiota and white matter microstructural damage in tuberculous meningitis patients

BACKGROUND: Tuberculous meningitis (TBM), the most severe form of tuberculosis, may involve the gut-brain axis. This study investigated the link between TBM, brain white matter integrity measured by diffusion tensor imaging (DTI), and the gut microbiome. METHODS: 22 TBM patients and 31 healthy controls underwent MRI and provided fecal samples. Gut microbiota (16S rRNA sequencing), fecal metabolites (metabolomics), and DTI metrics (FA, MD, RD, AD) were analyzed. Tract-based spatial statistics and correlation analyses were employed. RESULTS: TBM patients showed lower gut microbiota α-diversity. The abundance of the Escherichia genus correlated negatively with FA and positively with MD in specific white matter tracts. Metabolomics revealed elevated acetic acid in TBM patients, which correlated with both Escherichia abundance and DTI metrics. KEGG analysis indicated altered arginine and proline metabolism pathways. CONCLUSION: TBM is associated with differences in gut microbiota composition. Higher relative abundance of Escherichia is linked to white matter microstructural damage, potentially mediated by specific bacterial metabolites.