Association Between Tuberculosis and Neuromyelitis Optica Spectrum Disorder (NMOSD): A Systematic Review
Milagros Pascual-Guevara1, Miguel Cabanillas Lazo1, Carlos Alva-Diaz2
1Sociedad Científica de San Fernando, Lima, Perú. Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Perú, 2Universidad Señor de Sipán, Chiclayo, Perú. Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú. Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Perú.
Objective:
To summarize the evidence between tuberculosis and neuromyelitis optica spectrum disorder (NMOSD)
Background:
NMOSD is a rare autoimmune disease of the central nervous system characterized by inflammation of the optic nerve and the spinal cord. Although its etiology is uncertain, there is an hypothesis of molecular mimicry which states that microorganisms, such as mycobacterium tuberculosis, could have proteins similar to AQP4 that would trigger an immune response that causes NMOSD. Numerous reports and case series described the presence of Tuberculosis in NMOSD; however an association between both conditions has not been conclusively demonstrated.
Design/Methods:
A systematic search was performed in PubMed, Embase, Scopus, Google Scholar, Web of Science and Scielo Citation Index until September 2023. We included observational studies and case series or case reports. The evidence was synthesized narratively and the quality of studies was evaluated according to study designs. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to narrative results.
Results:
We screened 28 studies for full-text review from 3672 in the initial search. We selected 2 studies for qualitative synthesis with a total of 116 NMOSD patients and 15 case series or case reports. The first study reported 1(1.1%) NMOSD patient and 3(0.8%) control patients with a preceding diagnosis of TB while the second study reported an OR 4.6 (95%CI 1.71-15.49) for the presence of TB in both groups. In relation to the certainty of the evidence, we initiated with low certainty because both studies were case-control. Additionally, we downgraded two levels for inconsistency due to a large confidence interval and for heterogeneity among the reported results
Conclusions:
With very low certainty of evidence, we found an association between tuberculosis and NMOSD. However, we recommend further studies, especially prospective cohorts in different populations and classifying NMOSD into +/- AQP4, because different pathophysiology could affect the relationship.