Differential Diagnosis of Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy and Tuberculous Meningitis: A Multi-Center Observational Study Based on a Non-HIV Population

• DOI: 10.2139/ssrn.4533584
• Publication Date: 2023-08-08T17:43:00Z
• Authors: Ding Liu; Pei-Hao Lin; Zhanhang Wang; Huilu Li; Jie Yang; Yong You; Xiao Yang; Jing Li; Li-Hong Jiang; Jia-Jia Yue; Chun Lian; Lu-Fen Xu; Sha Liao; Zhi-Ke Lan; Jin-Long Ye; Cai-Yu Ma; Yu-Ying Lu; Yin Liu; Qing-Xia Zhang; Han Chen; Wei Qiu; Yaqing Shu; Ling Long; Hui-Ming Xu; Yong-Xiang Fan; Hai-Yang Wang; Hong-Li Liu; Yue Wang; Chun-Mei Duan; Huan Yang; Xiu-Ling Wu; Lu Zhang; Hui-Yu Feng; Huan Chen; Hou-Shi Zhou; Xiu-Jun Zheng; Qian-Hui Xu; Gui-Xian Zhao; Teng-Fei Ou; Jin-Liang Wang; Yu-Hua Lu; Zhi-Feng Mao; Jun Guo; Hong-Ya Zhang; Sheng Chen; Yan Xu; Cong Gao; You-Ming Long
• Keywords: Tuberculous Meningitis; Center (category theory)

Background: In clinical practice, autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) and tuberculous meningitis (TBM) are difficult to discriminate. Many GFAP-A patients have been misdiagnosed as TBM unnecessarily administered antituberculosis therapy. This study aimed establish a diagnostic model that could distinguish between TBM.Methods: We conducted an observational on multi-center data from 396 73 control patients. randomly divided our dataset into validation training sets. used both univariate multivariate logistic regression develop for disease discrimination.Findings: Cohort A, 91 of were identified possible cases. Of these patients, 25 accepted therapy before immunotherapy, but only 2 confirmed be The remaining did not accept therapy, with one them TBM. B, 19 tested positive tissue-based assay (TBA). 11 presented other autoantibodies 8 GFAP-IgG. Compared TBM, more focal neurological deficits except cranial nerve palsies, lower multinuclear cell proportion, higher lymphocyte proportion in cerebrospinal fluid (CSF), longitudinal radial perivascular enhancement, spinal cord lesion MRI, viral content the CSF recorded by next-generation sequencing (NGS). Three characteristics predictive diagnosis GFAP-A: CSF≥80%, presence detected NGS, excluding palsies. validated internal external datasets.Interpretation: Our model, which is based combination three relevant indicators, helps differentiating or without Following further future prospective studies, it may guide treatment decisions clinic.Funding: was supported National Natural Science Foundation China (81771302), Multi-center Project Second Affiliated Hospital Guangzhou Medical University (2020-LCYJ-XJS-03, 2022-LCYJ-YYDZX-04) Wisdom Accumulation Talent Cultivation Third Xiangya Central South (YX202205).Declaration Interest: authors declare no competing interests exist.Ethical Approval: protocol (No. 2022-hs-56-02, 2020-hs-54) approved Ethics Committee (Guangzhou China). Participants gave informed consent participate taking part.