1
|
Demitto FO, Araújo-Pereira M, Schmaltz CA, Sant'Anna FM, Arriaga MB, Andrade BB, Rolla VC. Impact of Persistent Anemia on Systemic Inflammation and Tuberculosis Outcomes in Persons Living With HIV. Front Immunol 2020; 11:588405. [PMID: 33072136 PMCID: PMC7541849 DOI: 10.3389/fimmu.2020.588405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis (TB) is associated with systemic inflammation and anemia, which are aggravated in persons living with HIV (PLWH). Here, we characterized the dynamics of hemoglobin levels in PLWH coinfected with TB undergoing antitubercular therapy (ATT). We also examined the relationships between anemia and systemic inflammatory disturbance as well as the association between persistent anemia and unfavorable clinical outcomes. Data on several blood biochemical parameters and on blood cell counts were retrospectively analyzed in a cohort of 256 TB/HIV patients from Brazil during 180 days of ATT. Multidimensional statistical analyses were employed to profile systemic inflammation of patients stratified by anemia status (hemoglobin levels <12 g/dL for female and <13.5 g/dL for male individuals) prior to treatment and to perform prediction of unfavorable outcomes, such as treatment failure, loss to follow up and death. We found that 101 (63.63%) of patients with anemia at pre-ATT persisted with such condition until day 180. Such individuals exhibited heightened degree of inflammatory perturbation (DIP), which in turn was inversely correlated with hemoglobin levels. Recovery from anemia was associated with increased pre-ATT albumin levels whereas persistent anemia was related to higher total protein levels in serum. Multivariable regression analysis revealed that lower baseline hemoglobin levels was the major determinant of the unfavorable outcomes. Our findings demonstrate that persistent anemia in PLWH during the course of ATT is closely related with chronic inflammatory perturbation. Early intervention to promote recovery from anemia may improve ATT outcomes.
Collapse
Affiliation(s)
- Fernanda O Demitto
- Programa de Pós-Graduação em Pesquisa Clínica em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Mariana Araújo-Pereira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Carolina A Schmaltz
- Laboratório de Pesquisa Clínica em Micobacterioses (LAPCLIN-TB), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Flávia M Sant'Anna
- Laboratório de Pesquisa Clínica em Micobacterioses (LAPCLIN-TB), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - María B Arriaga
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil.,Universidade Salvador (UNIFACS), Laureate International Universities, Salvador, Brazil.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Valeria C Rolla
- Programa de Pós-Graduação em Pesquisa Clínica em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Laboratório de Pesquisa Clínica em Micobacterioses (LAPCLIN-TB), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Metanat M, Mashhadi MA, Alavi-Naini R, Rezaie-Kahkhaie L, Sepehri-Rad N, Afshari M. The Prevalence of Absolute and Functional Iron Deficiency Anemia in New Cases of Smear-positive Pulmonary Tuberculosis and Their Sputum Conversion Rate at the End of Intensive Tuberculosis Treatment Phase. Prague Med Rep 2020; 121:35-41. [PMID: 32191618 DOI: 10.14712/23362936.2020.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
About one third of the population is infected with tuberculosis (TB). On the other hand, iron deficiency is the most common micronutrient deficiency in the world. A number of studies have documented anemia in patients with TB, however, this study aimed to assess the prevalence of iron deficiency anemia (IDA) in patients with acid-fast bacilli (AFB) sputum smear-positive, and sputum conversion in these two groups of patients with absolute and functional IDA at the end of the second month of anti-TB therapy in Zahedan, Iran. The results of this study revealed that 91 out of 198 (45.9%) sputum positive pulmonary TB patients were anemic, and among those 72 (79.1%) had iron deficiency anemia. The overall prevalence of IDA in this study was 36.3%. In 72 patients with IDA, 54 (75%) had functional while the remainder had absolute IDA 18 (25%). Twenty-one out of 72 (29.2%) of patients with IDA remained sputum positive and among 126 non IDA patients 47 (37.3%) had positive sputum smear at the end of intensive TB treatment phase (p=0.278). Approximately, less than half of patients with tuberculosis had anemia among them 79% had iron deficiency anemia. The frequency of functional IDA was three times more than absolute IDA. There was no statistically significant difference in sputum conversion between two groups of IDA and non-IDA patients after intensive phase of anti-TB therapy.
Collapse
Affiliation(s)
- Maliheh Metanat
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mohammad Ali Mashhadi
- Department of Internal Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Roya Alavi-Naini
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Leli Rezaie-Kahkhaie
- Department of Infectious Diseases, Zabol University of Medical Sciences, Zabol, Iran
| | - Nahid Sepehri-Rad
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| |
Collapse
|
3
|
Hematological Abnormalities of Pulmonary Tuberculosis Patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia: A Comparative Cross-Sectional Study. Tuberc Res Treat 2018; 2018:5740951. [PMID: 30693104 PMCID: PMC6332918 DOI: 10.1155/2018/5740951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/06/2018] [Indexed: 12/02/2022] Open
Abstract
Background Hematological abnormalities are common in pulmonary tuberculosis (PTB) patients, which is one of the major public health problems worldwide. However, there is paucity of information about the hematological profile of PTB patients with and without HIV in the study area. Therefore, this study aimed to assess hematological abnormalities of pulmonary tuberculosis patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia. Methods A comparative cross-sectional study was conducted at the University of Gondar Hospital. Sociodemographic data was collected using a pretested, structured questionnaire. Five milliliters of venous blood sample was collected and divided into a 3 ml EDTA tube for complete blood count with the Cell Dyn 1800 hematological analyzer and a 2 ml citrated tube for erythrocyte sedimentation rate determination. Data were entered into Epi Info version 3.5.3 and then transferred to SPSS 20 for analysis. The independent samples t-test was used to compare the mean values of hematological parameters between PTB patients and PTB-HIV coinfected patients. Result A total of 100 study subjects (50 PTB and 50 PTB-HIV coinfected) were included with a mean age of 31.3 ± 10.3 years for PTB patients and 32.1 ± 9.2 years for PTB-HIV coinfected patients. In this study, there were significantly lower mean values of Hgb (P = 0.049), platelet count (P < 0.001), and neutrophils counts (P = 0.007) among PTB-HIV coinfected patients when compared with PTB patients. Of the PTB infected patients 46% were anemic, 6% leukopenic, 22% neutropenic, 8% lymphopenic, and 8% thrombocytopenic. On the other hand, of the PTB-HIV coinfected patients 60% were anemic, 14% leukopenic, 66% neutropenic, 12% lymphopenic, and 20% thrombocytopenic. ESR value was increased in all patients. Conclusion This study demonstrated high prevalence of neutropenia, anemia, and thrombocytopenia among PTB-HIV coinfected patients. HIV coinfection worsens hematological abnormalities of PTB patients. Assessment of hematological parameters can be used as an indicator in the diagnosis and follow-up of PTB patients coinfected with HIV. We recommended assessment of PTB patients with or without HIV for various hematological disorders such as neutropenia, anemia, and thrombocytopenia.
Collapse
|
4
|
Kutiyal AS, Gupta N, Garg S, Hira HS. A Study of Haematological and Haemostasis Parameters and Hypercoagulable State in Tuberculosis Patients in Northern India and the Outcome with Anti-Tubercular Therapy. J Clin Diagn Res 2017; 11:OC09-OC13. [PMID: 28384907 DOI: 10.7860/jcdr/2017/24022.9249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/19/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Tuberculosis is one of the leading infectious diseases with high morbidity and mortality in the developing countries. Tuberculosis is also rarely associated with hypercoagulable state and very limited literature is available on this association. AIM To study the haematological and haemostasis laboratory parameters, to correlate the abnormalities for a hypercoagulable state and to study the outcome with anti-tubercular therapy. MATERIALS AND METHODS The study population included 128 patients with newly diagnosed tuberculosis. Anti-tubercular therapy naïve patients were studied for haemostasis parameters like Prothrombin time, Activated Partial Thromboplastin time, Factor VIII, Fibrinogen and D-dimer and haematological parameters like Haemoglobin, White Blood Cells, Platelet count, Erythrocyte Sedimentation Rate (ESR), Lactate Dehydrogenase, C-reactive protein and albumin. At the end of the second month of anti-tubercular therapy, results were compared and analysed using statistical package for the social sciences software (SPSS). RESULTS Prothrombin levels were deranged in 50%. Activated Partial Thromboplastin time levels were deranged in 18%. Deranged Factor VIII levels were found in 35.15%. Fibrinogen levels were deranged in 57%. D-Dimer positivity was found in 57.8% patients. Anaemia was found in 75.78%, Leukocytosis in 49.21%, Thrombocytopenia in 37.5% and Hypoalbuminaemia in 75%. ESR levels were raised in 98.43%. Follow up comparison analysis revealed significant p-value for all the parameters except Factor VIII and Activated Partial Thromboplastin time. Similar trend was also observed within different groups of Tuberculosis patients. CONCLUSION Tuberculosis does favour a hypercoagulable state with increased risk of developing thrombosis and significant improvement with the anti-tubercular treatment alone.
Collapse
Affiliation(s)
- Aditya Singh Kutiyal
- Senior Resident, Department of Internal Medicine, Maulana Azad Medical College , New Delhi, India
| | - Naresh Gupta
- Director- Professor, Department of Internal Medicine, Maulana Azad Medical College , New Delhi, India
| | - Sandeep Garg
- Professor, Department of Internal Medicine, Maulana Azad Medical College , New Delhi, India
| | - Harmanjit Singh Hira
- Director- Professor, Department of Internal Medicine, Maulana Azad Medical College , New Delhi, India
| |
Collapse
|
5
|
Deng W, Yu M, Ma H, Hu LA, Chen G, Wang Y, Deng J, Li C, Tong J, Wang DX. Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: a retrospective study in Chongqing, China. BMC Infect Dis 2012; 12:121. [PMID: 22607610 PMCID: PMC3407496 DOI: 10.1186/1471-2334-12-121] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/20/2012] [Indexed: 01/01/2023] Open
Abstract
Background Miliary tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS) with a high mortality. The aim of the present study was to evaluate the clinical characteristics, predictors and outcome of patients with ARDS caused by miliary TB. Methods A retrospective study was conducted among patients with a diagnosis of ARDS with miliary TB in four hospitals from 2006 to 2010. Medical records and laboratory examinations of these patients were taken during the first 24 h of admission. Results Eighty-five patients with miliary TB developed ARDS, 45 of whom survived (52.9%). The median age was 36.6 ± 12.5 years with 38 males (44.7%). Diabetes mellitus (DM) was the most common underlying disease (18.8%).ICU mortality was 47.1%. The time from admission to anti-tuberculosis therapy was 4.5 ± 2.0 days. Mean duration of mechanical ventilation was 8.5 ± 3.0 days in all patients. Duration of time to diagnosis, time from diagnosis to mechanical ventilation, and time to anti-tuberculosis therapy were significantly shorter in survivors than those in non-survivors. Diabetes mellitus (OR 5.431, 95%CI 1.471-20.049; P = 0.005), ALT (70-100U/L, OR 10.029, 95%CI 2.764-36.389; P = 0.001), AST (>94U/L,OR 8.034, 95%CI 2.200-29.341; P = 0.002), D-dimer (>1.6mg/L, OR 3.167, 95%CI 0.896-11.187; P = 0.042), hemoglobin (<90g/L, OR 14.824, 95%CI 3.713-59.179; P = 0.001), albumin (<25g/L, OR 15.896, 95%CI 3.975-63.566; P = 0.001) were independent predictors of ARDS development in the setting of miliary TB. Conclusions Accurate diagnosis, early initiation of anti-tuberculosis therapy and mechanical ventilation are important for the outcome of patients with ARDS caused by miliary TB. DM, ALT, AST, D-dimer, hemoglobin, and albumin are independent predictors of ARDS development in patients with miliary TB.
Collapse
Affiliation(s)
- Wang Deng
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Semba RD, Darnton-Hill I, de Pee S. Addressing Tuberculosis in the Context of Malnutrition and HIV Coinfection. Food Nutr Bull 2010. [DOI: 10.1177/15648265100314s404] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Tuberculosis is the second leading cause of infectious disease mortality (1.8 million/year), after HIV/AIDS. There are more than 9 million new cases each year. One-third of the world's population, and 50% of adults in sub-Saharan Africa, South Asia, and South-East Asia, are infected, representing an enormous pool of individuals at risk for developing the disease. The situation is complicated by the HIV/AIDS pandemic, widespread undernutrition, smoking, diabetes, increased mobility, and emergence of multi- and extensively drug-resistant tuberculosis. Objective To review the scientific evidence about the interactions among tuberculosis, nutrition, and HIV coinfection. Results HIV infection and malnutrition lower immunity, increasing the risk of reactivation tuberculosis and primary progressive disease. Having either tuberculosis or HIV infection causes weight loss. Malnutrition markedly increases mortality among both tuberculosis and HIV/AIDS patients and should be treated concurrently with treatment of the infections. Tuberculosis treatment is a prerequisite for nutritional recovery, in addition to intake of nutrients required for rebuilding tissues, which is constrained in food-insecure households. Additional pharmaceutical treatment to reduce the catabolic impact of inflammation or promote growth may be needed. Specific nutrients can contribute to faster sputum smear clearance, which is important for reducing transmission, as well as faster weight gain when combined with an adequate diet. Adequate nutrition and weight gain in undernourished populations might reduce the incidence of tuberculosis. Conclusions The many risk factors for the development of tuberculosis need to be addressed simultaneously, especially HIV/AIDS and food insecurity and undernutrition. For stronger evidence-based guidelines, existing recommendations and clinical applications need to be more widely applied and evaluated.
Collapse
|
7
|
Lee SW, Kang YA, Yoon YS, Um SW, Lee SM, Yoo CG, Kim YW, Han SK, Shim YS, Yim JJ. The prevalence and evolution of anemia associated with tuberculosis. J Korean Med Sci 2006; 21:1028-32. [PMID: 17179681 PMCID: PMC2721923 DOI: 10.3346/jkms.2006.21.6.1028] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis (TB) may produce abnormalities in the peripheral blood, including anemia. However, the evolution of TB-associated anemia with short-term combination anti-TB chemotherapy has not been well elucidated. The aim of this study was to characterize TB-associated anemia by clarifying its prevalence, characteristics, and evolution, through involving large numbers of patients with TB. The medical records of adult patients with TB diagnosed between June 2000 and May 2001 were reviewed. Among 880 patients with TB, 281 (31.9%) had anemia on diagnosis of TB, however, the hemoglobin concentration was less than 10 g/dL in only 45 patients (5.0%). Anemia was more frequently associated with the female and old age. Good treatment response, young age (< or =65 yr-old) and initial high hemoglobin were the predictive factor for resolution of anemia. In 202 patients with anemia (71.9%), anemia was normocytic and normochromic. During or after anti-TB treatment, anemia was resolved in 175 (64.6%) out of 271 patients without iron intake. The mean duration of resolution from the initiation of anti-TB treatment was 118.8+/-113.2 days. In conclusion, anemia is a common hematological abnormality in patients with TB and close observation is sufficient for patients with TB-associated anemia, because TB-associated anemia is usually mild and resolves with anti-TB treatment.
Collapse
Affiliation(s)
- Sei Won Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Soon Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Soo Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
van Lettow M, Harries AD, Kumwenda JJ, Zijlstra EE, Clark TD, Taha TE, Semba RD. Micronutrient malnutrition and wasting in adults with pulmonary tuberculosis with and without HIV co-infection in Malawi. BMC Infect Dis 2004; 4:61. [PMID: 15613232 PMCID: PMC544350 DOI: 10.1186/1471-2334-4-61] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 12/21/2004] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Wasting and micronutrient malnutrition have not been well characterized in adults with pulmonary tuberculosis. We hypothesized that micronutrient malnutrition is associated with wasting and higher plasma human immunodeficiency virus (HIV) load in adults with pulmonary tuberculosis. METHODS In a cross-sectional study involving 579 HIV-positive and 222 HIV-negative adults with pulmonary tuberculosis in Zomba, Malawi, anthropometry, plasma HIV load and plasma micronutrient concentrations (retinol, alpha-tocopherol, carotenoids, zinc, and selenium) were measured. The risk of micronutrient deficiencies was examined at different severity levels of wasting. RESULTS Body mass index (BMI), plasma retinol, carotenoid and selenium concentrations significantly decreased by increasing tertile of plasma HIV load. There were no significant differences in plasma micronutrient concentrations between HIV-negative individuals and HIV-positive individuals who were in the lowest tertile of plasma HIV load. Plasma vitamin A concentrations <0.70 micromol/L occurred in 61%, and zinc and selenium deficiency occurred in 85% and 87% respectively. Wasting, defined as BMI<18.5 was present in 59% of study participants and was independently associated with a higher risk of low carotenoids, and vitamin A and selenium deficiency. Severe wasting, defined as BMI<16.0 showed the strongest associations with deficiencies in vitamin A, selenium and plasma carotenoids. CONCLUSIONS These data demonstrate that wasting and higher HIV load in pulmonary tuberculosis are associated with micronutrient malnutrition.
Collapse
Affiliation(s)
| | | | | | | | - Tamara D Clark
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Taha E Taha
- Johns Hopkins University School of Public Health, Baltimore, USA
| | | |
Collapse
|
9
|
|
10
|
Henderson A. Ferritin levels in patients with microcytic anaemia complicating pulmonary tuberculosis. TUBERCLE 1984; 65:185-9. [PMID: 6485114 DOI: 10.1016/0041-3879(84)90073-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In a sample of 33 Nepali patients with microcytic, hypochromic anaemia complicating pulmonary tuberculosis, only 15% were iron deficient as judged by absence of stainable bone marrow iron. Individual ferritin levels in the iron deficient subjects were all within the normal range, although as a group their mean ferritin was significantly lower than in the non-iron deficient patients (104 micrograms/l v 349 micrograms/l p less than 0.05). It is suggested that in pulmonary tuberculosis ferritin synthesis is stimulated by the inflammatory process regardless of iron status and that the level of ferritin below which iron deficiency may be diagnosed is much higher than the accepted level of 15 micrograms/l.
Collapse
|
11
|
Monie RD, Hunter AM, Rocchiccioli KM, White JP, Campbell IA, Kilpatrick GS. Retrospective survey of the management of miliary tuberculosis in South and West Wales, 1976-8. Thorax 1983; 38:369-72. [PMID: 6879486 PMCID: PMC459560 DOI: 10.1136/thx.38.5.369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In a survey of 1000 patients with tuberculosis 28 were found to have miliary disease. Half of these patients were over 60 years old. Anorexia and weight loss were present in 19 (70%) and pyrexia in 17 (63%). A factor predisposing to tuberculosis or a history of recent contact was found in 12 (43%), and 21 (75%) had positive cultures. Seventeen (61%) had classical miliary shadowing while four (14%) had cryptic miliary tuberculosis with no radiological evidence of tuberculosis. The remaining seven patients (25%) had radiological changes consistent with pulmonary tuberculosis, but no miliary shadows. Of those who completed chemotherapy, only five (42%) received 18 months' treatment. Nine patients (32%) died from their miliary tuberculosis. Failure to consider the diagnosis, leading to a delay in starting chemotherapy, appeared to be a major problem.
Collapse
|
12
|
MESH Headings
- Aged
- Anemia/etiology
- Anemia, Aplastic/diagnosis
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/etiology
- Anemia, Sideroblastic/diagnosis
- Antitubercular Agents/adverse effects
- Diagnosis, Differential
- Female
- Folic Acid Deficiency/etiology
- Hematologic Diseases/chemically induced
- Hematologic Diseases/etiology
- Hematopoiesis
- Humans
- Hypersensitivity, Delayed
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/etiology
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/etiology
- Male
- Middle Aged
- Multiple Myeloma/diagnosis
- Multiple Myeloma/etiology
- Thrombocytopenia/diagnosis
- Thrombocytopenia/etiology
- Tuberculosis/blood
- Tuberculosis/complications
- Tuberculosis/immunology
- Tuberculosis, Miliary/diagnosis
- Tuberculosis, Pulmonary/diagnosis
Collapse
|
13
|
Evans DI, Attock B. Folate deficiency in pulmonary tuberculosis: relationship to treatment and to serum vitamin A and beta-carotene. TUBERCLE 1971; 52:288-94. [PMID: 5143924 DOI: 10.1016/0041-3879(71)90005-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|