Comparison of clinical features of tuberculous meningitis and cryptococcus neoformans meningitis in patients with acquired immunodeficiency syndrome
Objective To explore the early differential diagnosis method by comparing the clinical characteristics of acquired immunodeficiency syndrome(AIDS)patients complicated with tuberculous meningitis(TBM)and cryptococcus neoformans meningitis(CNM).Methods The AIDS patients admitted to Guangzhou Eighth People's Hospital,Guangzhou Medical University from January 2011 to February 2022 and diagnosed with combined TBM and CNM after discharge respectively were included.A retrospective study was performed to analyze the clinical features of 21 AIDS patients complicated with TBM(TBM group)and 54 AIDS patients with CNM(CNM group)(all cases were confirmed by etiology).The data of meningitis-related symptoms and signs,blood routine test,CD4+T lymphocyte counts,imaging characteristics and cerebrospinal fluid examination at admission were collected and analyzed.Statistical analysis was performed by using independent sample t test,rank sum test or chi-square test.Results The age of patients in the TBM group was(44.6±12.9)years old,which was older than that of patients in the CNM((37.6±12.6)years old),the difference was statistically significant(t=-2.15,P=0.035).Forty-eight cases(88.89％)and seven cases(12.96％)in the CNM group experienced headaches and consciousness disorders respectively,with statistically significant differences compared to those in the TBM group(13 cases(61.90％)and nine cases(42.86％),respectively)(X2=7.25,P=0.007 andx2=8.05,P=0.005,respectively).The proportion of leukopenia was 27.78％(15/54),and proportion of thrombocytopenia was 16.67％(9/54)in the CNM group,which were higher than those in the TBM group(4.76％(1/21)and 0(0/21),respectively),and the differences were statistically significant(x2=4.77,P=0.029 and x2=3.98,P=0.042,respectively).The CD4+T lymphocyte count in the TBM group was 74.0(92.0)/μL,which was higher than 19.5(56.5)/µL in the CNM group,and the difference was statistically significant(Z=-2.87,P=0.009).The CNM group had 46 cases(85.19％)with cerebrospinal fluid pressure＞180 mmH2O(1 mmH2O=0.009 8 kPa)and 24 cases(44.44％)with cerebrospinal fluid pressure＞330 mmH2O,which were significantly higher than those in the TBM group with seven cases(33.33％)and four cases(19.05％),respectively,and the differences were statistically significant(x2=19.61,P＜0.001 and x2=4.17,P=0.041,respectively).Fifty-two point three eight percent(11/21)of patients in the TBM group had a white blood cell counts＞200 × 106/L in the cerebrospinal fluid,which was higher than that in the CNM group(1.85％(1/54)),with a statistically significant difference(x2=27.23,P＜0.001).The white blood cell counts,protein and adenosine deaminase levels in the cerebrospinal fluid of TBM group were significantly higher than those in the CNM group(200.00(579.50)× 106/L vs 17.50(66.25)× 106/L,1 863(2 858)mg/L vs 672(513)mg/Land 6.60(8.55)U/L vs 1.95(2.60)U/L,respectively),and the cerebrospinal fluid chloride level was lower than that in the CNM group((107.71±8.22)mmol/L vs(115.99±6.55)mmol/L),and all the differences were statistically significant(Z=4.11,P＜0.001,Z=21.23,P=0.008,Z=2.09,P=0.040 and t=4.57,P＜0.001,respectively).There was no significant difference in cerebrospinal fluid glucose between the TBM group and the CNM group((1.86±1.22)mmol/L vs(2.34±1.05)mmol/L,t=-1.72,P=0.090).The proportion of patients with bilateral lung lesions in the TBM group was higher than that in the CNM group,and the difference was statistically significant(100.00％(21/21)vs 40.74％(22/54),x2=-6.53,P=0.011).Conclusions Patients with AIDS complicated with TBM are more likely to have consciousness disorders,inflammatory response in the cerebrospinal fluid,and more bilateral lung lesions.In contrast,patients with AIDS complicated with CNM are more frequently to experience severe headache and significant elevation of cerebrospinal fluid pressure,leukopenia and thrombocytopenia,and lower peripheral blood CD4+T lymphocyte counts.
Acquired immunodeficiency syndromeTuberculosis,meningealCryptococcus neoformans meningitisClinical features
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