The discrimination between autoimmune glial fibrillary acidic protein astrocytopathy and tuberculous meningitis
Yanxiang Chen1, Chongliang Luo2, Guonan Zhou3
1Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, 600# Tianhe Road, Guangzhou, Guangdong Province 510630, China; Department of Neurology, Xiaolan People's Hospital of Zhongshan, 65#, Middle Section of Jucheng Avenue, Xiaolan, Zhongshan, Guangdong Province 528400, China.
Objective:
The differential diagnosis between autoimmune glial fibrillary acidic protein astrocytopathy (AGFAPA) mimicking tuberculous meningitis and tuberculous meningitis (TBM) remains challenging in clinical practice. This study aims to identify the clinical, laboratory parameters, and clinical score systems that may be helpful in differentiating AGFAPA from TBM.
Method:
Overall 22 AGFAPA patients who were initially misdiagnosed as TBM (AGFAPA-TBM) and 30 confirmed TBM patients were included. The clinical, laboratory, imaging parameters, Thwaites systems, and Lancet consensus scoring systems (LCSS) of all patients were reviewed. Logistic regression was employed to establish a diagnostic formula to differentiate AGFAPA-TBM from TBM. The receiver operating characteristic (ROC) curve was applied to determine the best diagnostic critical point of the formula.
Results:
Urinary retention was more frequent in AGFAPA-TBM patients (72.7% vs 33.3%, p = 0.012). A significantly lower ratio of T-SPOT. TB was noted in AGFAPA-TBM patients (9.1% vs 82.1%, p < 0.001). We found the LCSS was able to differentiate AGFAPA-TBM from TBM (AUC value 0.918, 95% CI=0.897-0.924). Furthermore, we set up a new scoring system with three variables: urinary retention, T-SPOT. TB, and cerebral imaging criteria in LCSS. The proposed diagnostic score ranges from -8 to 2, and a score of ≥ 0 was suggestive of AGFAPA-TBM (AUC value 0.938, 95% CI=0.878-0.951).
Conclusions:
This study is the first to evaluate the Thwaites system and LCSS in AGFAPA-TBM and TBM. We provide an alternative diagnostic formula to differentiate AGFAPA-TBM from TBM and suggest testing for GFAP antibodies to avoid misdiagnosis when this scoring system meets AGFAPA-TBM.
Insights
Differentiating autoimmune glial fibrillary acidic protein astrocytopathy (AGFAPA) from tuberculous meningitis (TBM) is challenging. A new scoring system using urinary retention and T-SPOT. TB tests can help distinguish AGFAPA from TBM, improving diagnosis.
Area of Science:
- Neuroimmunology
- Infectious Diseases
- Neurology
Background:
- Distinguishing autoimmune glial fibrillary acidic protein astrocytopathy (AGFAPA) from tuberculous meningitis (TBM) presents diagnostic challenges.
- Accurate differentiation is crucial for appropriate patient management and treatment.
Purpose of the Study:
- To identify clinical, laboratory, and scoring system parameters for differentiating AGFAPA from TBM.
- To develop a diagnostic tool to aid in distinguishing these two conditions.
Main Methods:
- Retrospective review of 22 AGFAPA patients misdiagnosed as TBM and 30 confirmed TBM patients.
- Evaluation of clinical, laboratory, and imaging data, including Thwaites and Lancet Consensus Scoring Systems (LCSS).
- Logistic regression and ROC curve analysis to develop and validate a diagnostic formula.
Main Results:
- Urinary retention (72.7% vs 33.3%) and lower T-SPOT. TB positivity (9.1% vs 82.1%) were more frequent in AGFAPA-TBM patients.
- LCSS showed good differentiation (AUC 0.918).
- A novel scoring system incorporating urinary retention, T-SPOT. TB, and LCSS cerebral imaging criteria achieved higher differentiation (AUC 0.938).
Conclusions:
- This study introduces the first evaluation of Thwaites and LCSS for differentiating AGFAPA-TBM from TBM.
- A new diagnostic formula is proposed to improve the accuracy of differentiating AGFAPA from TBM.
- Testing for GFAP antibodies is recommended when the proposed scoring system suggests AGFAPA-TBM to prevent misdiagnosis.
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