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Altered protein and iron levels of patients with active tuberculosis in a Nigerian reference health facility

P.A. Akpan, I.M. Okafor, S Anakebe

 

Abstract

Backgound: Tuberculosis as a state of chronic inflammation impacts on haematologic functions of the body.

Objectives: This study aimed at assessing iron parameters and serum protein levels of ninety tuberculosis patients aged fifteen to sixty years, enrolled from Dr Lawrence Henshaw Memorial Hospital, Calabar, Nigeria. Ninety apparently healthy individuals age and gendermatched served as control subjects.

Methods: Packed cell volume, haemoglobin concentration, serum iron, total iron binding capacity, total protein, albumin and serum ferritin were determined using standard methods. Transferrin saturation, globulin concentration and albumin-globulin ratio were derived by calculation. Data were analysed using student T-test on SPSS version 20 software. Statistical significance was set at P-value less than 0.05.

Results: Packed cell volume, haemoglobin concentration, serum iron, total iron binding capacity, transferrin saturation, albumin levels and albumin-globulin ratio of tuberculosis patients were found to be significantly lower while serum ferritin and globulin were significantly increased (p<0.05) as compared with control values. Serum ferritin improved towards control values as anti-tuberculosis therapy progressed.

Conclusion: A reduction in haemoglobin, serum iron, total iron binding capacity and transferrin saturation and increase in serum ferritin as well as altered serum protein levels, occur in tuberculosis infection.

Keywords: Tuberculosis, iron, serum protein

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Altered protein and iron levels of patients with active tuberculosis in a Nigerian reference health facility

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Renal and hepatic profiles in Nigerian multidrug resistant tuberculosis patients with or without HIV co-infection

O Ige, SA Yaqub, VF Edem, OG Arinola

 

Abstract

Tuberculosis (TB) is primarily a lung disease (pulmonary tuberculosis, PTB) but the bacilli can also  develop in other places in the body, such as the bones, liver and kidney as extra pulmonary tuberculosis. Hepatic and renal involvements in PTB patients are mostly secondary to TB chemotherapy that is  potentially hepato- and nephro- toxic. In this study, the biochemical parameters that indicate renal and hepatic involvements were analyzed in the sera of MDR-TB patients with and without HIV co-infection prior to commencement of chemotherapy. Out of 115 MDR-TB patients (76 males and 39 females) recruited for the study, 22 patients (11 males and 11 females) were co-infected with HIV. Serum levels of sodium (Na+), potassium (K+), chloride (Cl-) were analyzed using Easylite (ISE technology),   bicarbonate (HCO3-) was analysed using back titration method, urea and creatinine were determined spectrophotometrically using Diacetlymonoxime (DAM) method and Jaffe’s alkaline picrate method  respectively. Total and direct bilirubin, serum glutamate oxaloacetate transferase (SGOT), serum glutamate pyruvate transferase (SGPT), alkaine phosphatase(ALP), total protein (TP) and albumin (Alb) were determined using Hitachi 912 autoanalyzer. There were no statistical significant differences in the renal and hepatic parameters of TB patients with HIV compared with TB patients without HIV. However, significantly higher proportions (89%) of MDR-TB patients had their SGOT within reference range. The mean values indicate that HIV infection did not significantly alter renal and hepatic profiles in
MDR-TB patients prior to treatment.

 

LES PROFILS RENALS ET HEPATIQUES DANS MULTIRESISTANTE PATIENTS TUBERCULEUX
NIGERIANS AVEC OU SANS CO – INFECTION PAR LE VIH.

La tuberculose est principalement une maladie du poumon (Tuberculeuse pulmonaire TBP) mais les bacilles peuvent être également se développer dans d’autres endroits dans le corps, tels que les os, le foie et les reins comme la tuberculose extra pulmonaire. L’atteinte hépatique et rénale chez les patients atteints de TBP est surtout secondaire a la chimiothérapie de la tuberculose(TB) qui est potentiellement hépato – et néphro – toxique. Dans cette étude, les paramètres biochimiques qui indiquent les  implications rénales et hépatiques ont été analyses dans les sérums des patients atteints de MDR – TB avec ou sans Co – infection par le VIH avant le commencement de la chimiothérapie. Sur les 115 patients atteints de MDR – TB (76 males et femelles), recrutés pour l’étude, 22 patients (11 males et femelles) ont été co – infectes par le VIH. Le niveau sérique de sodium (Na⁺), de potassium (K⁺), le chlorure(C1⁻) ont été analyses en utilisant Easylite(technologie ISE), le bicarbonate (HC0₃⁻) a été analyse en utilisant la méthode de titrage de retour, l’urée et de la créatinine ont été déterminés spectrophotométrie rn utilisant la méthode Diacétyle monoxime(DAM) et la méthode de picrate alcaline de Jaffer respectivement. Bilirubine totale et directe, glutamate oxaloacetate transférase sérique(SGOT), transférase sérique de glutamate pyruvate(SGPT), phosphatase alcaline(ALP), protéines totale(TP) et albumine(Alb) ont été déterminés en utilisant Hitachi 912 autoa nalyseur. Il n’ ya pas de différence statistiquement significative dans les paramètres rénales et hépatiques des patients tuberculeux vivant avec ke VIH par rapport aux patients atteints de tuberculose sans VIH. Néanmoins, les proportions significativement élevées (89%) des patients atteints de MDR – TB ont eu leurs SGOT a porté de référence. Les valeurs moyennes indiquent que l’infection par le VIH n’a pas modifié significativement les profils rénaux et hépatiques chez les patients de TB – MRD.

Mots – clés : Les reins, le foie, l’électrolyte, la tuberculose, Virus de l’immunodéficience humaine, Co – infection.

Key words: Kidney, Liver, Electrolytes, Tuberculosis, Human Immunodeficiency Virus, Co-infection.

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Renal and hepatic profiles in Nigerian multidrug resistant tuberculosis patients with or without HIV co-infection

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Prevalence of Acid-Alcohol-Fast Bacilli among Patients with Suspected Cases of Pulmonary Tuberculosis in Jos, Nigeria

EI Bigwan, MC Ohaeri, HI Okonkwo, IS Udosen, GC Markus, Z Sheyin

 

Abstract

Mycobacterium tuberculosis is a major public health problem in globally due to its high tendency of person-person transmission, morbidity, and  mortality. This study aimed at determining the prevalence of AAFB within the study area. Sputum samples were collected from three hundred and three (303) patients with suspected cases of pulmonary tuberculosis attending Plateau State Specialist Hospital and Faith Alive Foundation. The samples were examined using Ziehl Neelsen method. Structured  questionnaires were administered to obtain some demographic data from patients that consented. Results were tested statistically for significance at p < 0.05 using Chi-square test. Out of the samples examined,29(9.57.0%) were positive for AAFB .The study showed that the prevalence of smear-positive increased with age between 15 and 45 and then decreased from age groups 46 and above. The study also revealed that males had a higher prevalence with 19(12.34%)than females who had 10(6.71%  ).Marital status showed that divorced individuals had the highest  prevalence of 2(12.50%) followed by married ,singles and the widowed with 18(11.76%),8(6.34%),and 1(5.90%) respectively. Statistically the study reveals that age groups, sex, hospital (location) does not have any effects on the prevalence (p > 0.05) while marital status showed a significant  effect on the prevalence (p < 0.05).There is need for a more collaborative efforts and political will by the government and non-governmental agencies in order to fast track prevention and control measures aimed at eliminating the infection in the nearest future.

Key words: AFB, Tuberculosis, Jos, Nigeria.

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Assessment of the Diagnostic Potential of Clinotech TB Screen Test for Diagnosis of Pulmonary Tuberculosis in Nigeria

EO Ekundayo, SD Abbey, OK Achi

 

Abstract

The Clinotech TB Screen test, a 3rd generation multi-antigen rapid chromatographic immunoassay for detection of IgG antibodies in serum against recombinant protein antigens 38kDa, 16kDa and 6kDa, was assessed for its diagnostic potential for diagnosis of active pulmonary TB in routine TB control programme in Abia State, Nigeria. The overall sensitivity and specificity of Clinotech TB Screen test were 24.1% and 87.8% (95% Confidence intervals [CI]: 14.7-33.5% and 80.6-95.0%) respectively. The positive and Negative Predictive Values (PPV and NPV) were 79.2% and 37.5% respectively. The performance of the test was inferior to that of the sputum smear microscopy which had a sensitivity of 50.0% (95% CI, 39.0%-61.0%) and specificity of 92.3(95% CI: 86.4-98.2%). In 37 culture positive smear positive PTB cases, Clinotech TB Screen test was positive in 18(48.65%). The rapid test showed a very low degree of sensitivity in smear –negative culture positive PTB cases; detecting just one (2.38%) out of 42 cases. These results indicate that the diagnostic value of Clinotech TB Screen test for routine diagnosis of PTB in this setting is limited.

Key words: Tuberculosis, serological tests, immunochromatographic tests, rapid TB tests

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Assessment of the Diagnostic Potential of Clinotech TB Screen Test for Diagnosis of Pulmonary Tuberculosis in Nigeria

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HIV infection and mycobacterium tuberculosis drug-resistance among tuberculosis patients in Burkina Faso, West Africa

L Sangaré, S Diandé, G Ouédraogo, A.S Traoré

 

Abstract

The aim of this study was to compare the drug-resistance patterns of Mycobacterium tuberculosis strains among pulmonary tuberculosis patients, according to their HIV serostatus, in Burkina Faso. Tuberculosis (TB) patients were classified in new and previously treated cases by using a structured questionnaire. Susceptibility testing to isoniazid, streptomycin, rifampicin and ethambutol was done by the proportion method. Association between HIV-serostatus and drug-resistant TB was assessed with χ2 tests, and the statistical significance was set to P<0.05. Of 316 (249 new, 67 previously treated) patients included in the study, 68.7% were males and 28.8% were HIV-positive; females (36.4%) were more infected than males
(25.3%), (P=0.04). The average age of the patients was 37.24±12.76 years [11-75years]. Most of the patients infected with HIV were aged from 15 to 44 years and were females, (P=0.01). In the new cases of TB, the difference between HIV-positive and HIV-negative patients was not statistically significant neither for the MDR-TB (P=0.40), nor for the resistant-TB to any drug (P=0.26). However, the difference was significant for the resistance to isoniazid and streptomycin alone (P=0.04). Among the previously treated patients, although there was more MDR-TB and more resistance to any drug in HIV-negative patients than among HIV-positive patients, these differences also were not statistically significant (P=0.54 and P=0.63, respectively). This study found no significant difference between TB/HIV-negative and TB/HIV-positive patients according to the resistance patterns to anti-TB medications, excepted the resistance to isoniazid in new cases and to isoniazid and streptomycin in all patients took globally. These results encourage the collaboration between the programs against TB and HIV to prevent rapid diffusion of drug-resistant TB and high mortality in patients living with HIV/AIDS as recommended by the World Health Organization.

Keywords: Tuberculosis, HIV, Drug resistance, Burkina Faso

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HIV infection and mycobacterium tuberculosis drug-resistance among tuberculosis patients in Burkina Faso, West Africa

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COMPARATIVE STUDY ON SPECIFIC AND EARLY DETECTION OF PULMONARY MYCOBACTERIA COMPLEX USING SMEAR AND CULTURE METHOD AND SEROLOGICAL PATHOZYME EIA KITS

CA Enwuru, EO Idigbe, NV Ezeobi, CT Oparaugo, U Udensi Kalu, JI Onyewuche, J Ibiam

 

Abstract

The objective of this study was to compare the sensitivity and specificity of smear and culture methods with rapid serological EIA myco kits manufactured by Omega diagnostics, for the early detection of Mycobacterium tuberculosis (MTB) complex. Sera from various categories of smear and culture results were compared with the result of 38KDa, 16KDa and purified protein for IgA, IgM and IgG antibodies with sensitivity of 4%, 24% and 76%, respectively and with specificity of100% for IgG in Smear and Culture Positive (S+)C+)) category. The sensitivity of the test improved to a level of 80% for IgG + IgA without affecting the specificity. A combination of IgG + IgA and IgM further improved the sensitivity to 88% but reduced the specificity to 91%. Amongst the S–)C+) and S–)C–) 64% and 14.7% were positive for IgG respectively. The predictive value of the kit using S+)C+) subject was 96%. For all culture positivity (n=78), there was 2.6%, 33.3% and 71.8% sensitivity for IgA, IgM and IgG respectively. IgA +IgG and IgA + IgM + IgG combination gave 74.4% and 84.6% sensitivity respectively with the same level of specificity. Fifty-five percent of culture positive subjects were found to be MTB complex positive by routine biochemical tests, while 40% through PATHOZYME TB COMPLEX PLUS kit (high positive (H+)) values). When high positivity is combined with low positivity of the same kit (H+) + L+)), 65% of the isolates were found to be MTB complex. Our study showed 88% sensitivity and 91% specificity for combined IgA + IgM + IgG antibodies recorded for MTB (S+)C+) group) and 85% sensitivity and 91% specificity for all culture positives. Our study has demonstrated that the myco kits and TB complex plus kit produced by Omega Diagnostics are a good tool for specific, early and rapid identification of active tuberculosis for both diagnostic and epidemiological purposes.

Key Words: Tuberculosis, diagnosis, comparative, specificity, sensitivity, culture and serological technique.

Afr. J. Clin. Exper. Microbiol. 2004; 5(2): 182 – 188.

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PHAGE AMPLIFICATION TECHNOLOGY AND ANTI-TUBERCULOUS DRUG SUSCEPTIBILITY TESTING IN NIGERIA

E.J. Otive-Igbuzor

 

Abstract

The emergence of multi-drug resistant tuberculosis (MDR-TB) defined as combined resistance to the two most effective anti-tuberculosis drugs, rifampicin and isoniazid, threatens to create a public health hazard of unprecedented proportion. The fact that MDR-TR is more difficult and expensive to cure creates the need for prompt diagnosis. Conventionally, the proportion method on Lowenstein Jensen (L J) medium is used in most developing countries as the ‘gold standard’ in the drug susceptibility testing of Mycobacterium tuberculosis (MTB) and it takes 3-4 weeks to give results from an MTB culture. The use of phage as a diagnostic is fast gaining ground today. It involves targeting viable MTB cells from culture with a specific mycobacteriophage. After a one-hour incubation, it is treated with an antivirus to destroy the phages that are not protected with the bacilli. Upon addition of cells of growing, non-pathogenic Mycobacterium smegmatis (sensor cells), progeny phage from the MTB cells infect the sensor cells, thus amplifying the effect of the phage. When plated in an agar medium overnight, plaques occur in the cell lawn indicating the presence of viable MTB in an original sample. A comparison is made between the number of plaques produced in a drug-free control and a sample incubated in the presence of the drug. While the presence of plaques beyond a cut-of point indicates drug resistance, the absence of plaques indicates that the drug destroyed MTB cells. Overall accuracy from several trials so far conducted is put at 97-98% compared with the ‘gold standard’. With the phage amplification method, antituberculosis drug susceptibility results are obtained from MTB culture within 48 hours as opposed to the L J proportion method, which gives resulted in 3 to 4 weeks. Also, phage, as a diagnostic, is much more applicable in Nigeria laboratories than newer, rapid methods which requires specially dedicated instrumentation and are therefore very expensive. Phage amplification technology requires no special equipment and the results can be read visually.

Key words: Tuberculosis, drug susceptibility, phage, treatment, FASTPlaque-TB, rifampicin

(Af J Clinical & Exp Microbiology: 2003 4(2): 67-78)