Essential and toxic metals in serum of individuals with active pulmonary tuberculosis in an endemic region

Characterization of Potential Virulence, Resistance to Antibiotics and Heavy Metals, and Biofilm-Forming Capabilities of Soil Lignocellulolytic Bacteria

Soil bacteria participate in self-immobilization processes for survival, persistence, and production of virulence factors in some niches or hosts through their capacities for autoaggregation, cell surface hydrophobicity, biofilm formation, and antibiotic and heavy metal resistance. This study investigated potential virulence, antibiotic and heavy metal resistance, solvent adhesion, and biofilm-forming capabilities of six cellulolytic bacteria isolated from soil samples: Paenarthrobacter sp. MKAL1, Hymenobacter sp. MKAL2, Mycobacterium sp. MKAL3, Stenotrophomonas sp. MKAL4, Chryseobacterium sp. MKAL5, and Bacillus sp. MKAL6. Strains were subjected to phenotypic methods, including heavy metal and antibiotic susceptibility and virulence factors (protease, lipase, capsule production, autoaggregation, hydrophobicity, and biofilm formation). The effect of ciprofloxacin was also investigated on bacterial susceptibility over time, cell membrane, and biofilm formation. Strains MKAL2, MKAL5, and MKAL6 exhibited protease and lipase activities, while only MKAL6 produced capsules. All strains were capable of aggregating, forming biofilm, and adhering to solvents. Strains tolerated high amounts of chromium, lead, zinc, nickel, and manganese and were resistant to lincomycin. Ciprofloxacin exhibited bactericidal activity against these strains. Although the phenotypic evaluation of virulence factors of bacteria can indicate their pathogenic nature, an in-depth genetic study of virulence, antibiotic and heavy metal resistance genes is required.

Essential metals, vitamins and antioxidant enzyme activities in COVID-19 patients and their potential associations with the disease severity

The role of micronutrient deficiency in the pathogenesis of COVID-19 has been reviewed in the literature; however, the data are limited and conflicting. This study investigated the association between the status of essential metals, vitamins, and antioxidant enzyme activities in COVID-19 patients and disease severity. We recruited 155 patients, who were grouped into four classes based on the Adults guideline for the Management of Coronavirus Disease 2019 at King Faisal Specialist & Research Centre (KFSH&RC): asymptomatic (N = 16), mild (N = 49), moderate (N = 68), and severe (N = 22). We measured serum levels of copper (Cu), zinc (Zn), selenium (Se), vitamin D₃, vitamin A, vitamin E, total antioxidant capacity, and superoxide dismutase (SOD). Among the patients, 30%, 25%, 37%, and 68% were deficient in Se (< 70.08 µg/L), Zn (< 0.693 µg/mL), vitamin A (< 0.343 µg/mL), and vitamin D₃ (< 20.05 µg/L), respectively, and SOD activity was low. Among the patients, 28% had elevated Cu levels (> 1.401 µg/mL, KFSH&RC upper reference limit). Multiple regression analysis revealed an 18% decrease in Se levels in patients with severe symptoms, which increased to 30% after adjusting the model for inflammatory markers. Regardless of inflammation, Se was independently associated with COVID-19 severity. In contrast, a 50% increase in Cu levels was associated with disease severity only after adjusting for C-reactive protein, reflecting its possible inflammatory and pro-oxidant role in COVID-19 pathogenesis. We noted an imbalance in the ratio between Cu and Zn, with ~ 83% of patients having a Cu/Zn ratio > 1, which is an indicator of inflammation. Cu-to-Zn ratio increased to 45% in patients with mild symptoms and 34%–36% in patients with moderate symptoms compared to asymptomatic patients. These relationships were only obtained when one of the laboratory parameters (lymphocyte or monocyte) or inflammatory markers (neutrophil-to-lymphocyte ratio) was included in the regression model. These findings suggest that Cu/Zn might further exacerbate inflammation in COVID-19 patients and might be synergistically associated with disease severity. A 23% decrease in vitamin A was seen in patients with severe symptoms, which disappeared after adjusting for inflammatory markers. This finding may highlight the potential role of inflammation in mediating the relationship between COVID-19 severity and vitamin A levels. Despite our patients’ low status of Zn, vitamin D₃, and antioxidant enzyme (SOD), there is no evidence of their role in COVID-19 progression. Our findings reinforce that deficiency or excess of certain micronutrients plays a role in the pathogenesis of COVID-19. More studies are required to support our results.

Serum zinc levels in patients with phlegmons as a marker of the severity of infection and the potential of zinc supplementation to reduce the risk of recurrence

We analyzed the serum zinc levels of 37 patients with 40 phlegmon lesions. The mean serum zinc level was 52.1 ± 16.4 μg/dL. The serum zinc level was negatively correlated with the C-reactive protein (CRP) level (r = -0.66) and white blood cell (WBC) count (r = -0.56). It was also positively correlated with the serum levels of albumin, hemoglobin, and hematocrit (r = 0.57, 0.50, and 0.50, respectively). Patients with serum zinc levels of <60 μg/dL had higher CRP levels and WBC counts (p < 0.005 and p < 0.05, respectively) and lower albumin, hemoglobin, and hematocrit levels (p < 0.001, p < 0.01, and p < 0.01, respectively), and were more likely to be hospitalized (p < 0.05) than those with serum zinc levels of ≥60 μg/dL. Patients with low serum zinc levels were given zinc tablets. Three of the seven patients who developed recurrent phlegmons did not develop any further lesions after taking zinc tablets for >10 months. Of the remaining patients, one only developed a minimal lesion, and another two experienced recurrence twice but did not have any further lesions for 10 and 15 months, respectively. These findings indicate that in patients with phlegmons the serum zinc level is a suitable marker of the severity of infection, and zinc supplementation reduces the risk of further recurrence in patients whose lesions relapse.

Oxidative Stress and Trace Elements in Pulmonary Tuberculosis Patients During 6 Months Anti-tuberculosis Treatment

Pulmonary tuberculosis (TB) is a well-known cause of imbalance in oxidative stress (OS) status and trace element levels. However, little information is available for targeting the correlation between OS and trace elements in pulmonary TB patients. The aim of our study was to analyze the OS status and its correlation with trace elements in patients initially and during 6 months anti-TB treatment. Eighty-six newly diagnosed pulmonary TB patients were consecutively recruited, and 112 age- and sex-matched healthy controls participated in the study. Serum markers of OS and trace elements levels were tested and analyzed in all subjects during 6 months anti-TB treatment. Compared with healthy controls, significantly increased level of malondialdehyde (MDA), decreased glutathione (GSH) level, superoxide dismutase (SOD), and catalase (CAT) activities were found in TB patients. The activities of SOD and CAT and GSH level recovered till normal range at treatment final. Zinc (Zn), selenium (Se), and copper (Cu) concentrations were significantly lower in TB patients in comparison with healthy controls, whereas Zn, Cu, and Se concentrations rise during 6 months anti-TB treatment. Zn was positively correlated with Cu, Se, and GSH, while MDA was negatively correlated with Zn, Se, SOD, and CAT, and SOD was positively correlated with Cu, Zn, and CAT. Our findings indicate that anti-TB treatment could reduce the status of OS and increase the levels of trace elements. The routine assessment of OS markers and element traces may guarantee improved monitoring the anti-TB treatment.

Assessment of 7 trace elements in serum of patients with nontuberculous mycobacterial lung disease

Nontuberculous mycobacterial (NTM) lung diseases are an emerging cause of pulmonary infection, becoming more common in the clinical setting as incidence of NTM lung diseases steadily increases worldwide. Trace elements are essential micronutrients and are known to play many important roles in infectious diseases. We investigated the concentrations of trace elements in patients with NTM lung disease and compared these values to patients with pulmonary tuberculosis and healthy controls. A case-control study was conducted to evaluate the serum trace element concentrations in 95 patients with NTM lung disease, 97 patients with pulmonary tuberculosis, and 99 healthy control subjects. The serum concentrations of 7 trace elements (cobalt, copper, chromium, manganese, molybdenum, selenium, and zinc) were measured using inductively coupled plasma-mass spectrometry. We also analyzed demographic data, clinical outcomes, and other biochemical parameters. The median serum concentrations of copper and molybdenum were higher in patients with NTM lung disease (109 vs. 91 μg/dL, p < 0.001 and 1.70 vs. 0.96 μg/L, p < 0.001). In contrast, the median serum concentrations of selenium and zinc were significantly lower in patients with NTM lung disease than in healthy controls (105 vs. 115 μg/L, p < 0.001 and 94 vs. 102 μg/dL, p < 0.001). Compared to patients with pulmonary tuberculosis, the serum concentrations of molybdenum and zinc were higher in patients with NTM lung disease, while cobalt and copper concentrations were lower (p < 0.001). Correlations among trace element concentrations were observed (copper and zinc, r = -0.367; cobalt and molybdenum, r = -0.360; selenium and zinc, r = 0.335; and manganese and zinc, r = 0.327, respectively). None of the 7 trace elements were associated with treatment outcomes. Patients with NTM lung disease showed different serum trace element concentrations. Our study indicates that altered trace element status is associated with mycobacterial disease. Further study investigating the clinical significance of individual trace elements and their association with nutritional status in patients with NTM lung disease would be required.

Changes in serum level of trace elements in pulmonary tuberculosis patients during anti-tuberculosis treatment

INTRODUCTIONS

Tuberculosis is spreading throughout the globe, while it is a crucial cause of death in developing countries. In this study, trace elements concentrations and their alterations were determined in TB patients during anti-tuberculosis treatment period.

MATERIALS AND METHODS

We have collected blood samples from a total of 180 TB patients with pulmonary Tuberculosis, and 180 healthy controls in Sistan, Iran. The serum iron, copper, lead, calcium, arsenic and selenium concentrations were detected at the beginning of anti-TB chemotherapy, at the end of 2nd, 4th and 6th month after treatment initiation. Data were then analyzed using SPSS version 20.

RESULTS AND DISCUSSIONS

Although Ca, Pb, and As levels did not change during the treatment period, serum concentrations of Fe, Zn, Cu, and Se were diminished in TB patients significantly during treatment in comparison with controls (P < 0.001).We also found that there was a significant difference in the ^Cu/_Se and ^Cu/_Zn ratios in tuberculosis patients in comparison with healthy individuals (P < 0.001).

CONCLUSIONS

Trace elements serum concentrations are affected by TB infection and anti-TB therapy. Their serum levels were strongly perturbed during infection as well as anti-TB treatment.

Serum selenium levels in tuberculosis patients: A systematic review and meta-analysis

INTRODUCTION

Tuberculosis (TB) is associated with increased mortality. The high risk of micronutrients deficiency, including selenium, in TB patients is of great concern because it increases the risk of death. However, it is not clear whether selenium supplementation could improve the treatment outcomes in TB patients. We conducted a systematic review and meta-analysis to provide an update on the existing evidence about low selenium levels in TB patients.

METHODS

In this systematic review and meta-analysis, EMBASE, Medline and the International Journal of Tuberculosis and Lung Disease were searched to identify observational studies on selenium and TB published up until April 2018. Studies comparing blood selenium levels in TB patients to controls were included. Data extraction was performed by two investigators. The quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Random effects analysis was performed to calculate the pooled effect size and 95% confidence interval (CI).

RESULTS

Of the 605 studies initially identified, only six were eligible. Of them, four were carried out in Asia, and one each in Africa and South America. The random pooled effect size was 1.6 (CI: 0.9, 2.4). This means that the probability is 160% for an individual with TB to have low levels of selenium as compared to an individual without TB. Heterogeneity across the studies was substantial (I² = 95.1%). Potential sources of heterogeneity included study design and selenium measurement methods.

CONCLUSION

Our review provides compelling evidence that serum selenium is lower in TB patients as compared with controls. Therefore, it is advisable to individually assess selenium status in TB patients and decide whether selenium supplement is needed or not.

Vitamin A and zinc deficiencies among tuberculosis patients in Ethiopia

BACKGROUND

The link between tuberculosis (TB) and malnutrition has long been recognized. Vitamin A and zinc deficiencies may reduce the host defenses and increase the risk for diseases.

OBJECTIVE

The aim of the present study was to estimate the difference in vitamin A and zinc deficiencies together with dietary intakes among pulmonary TB patients and controls.

MATERIALS AND METHODS

A case-control study design was employed to undertake this study in North Shewa, Ethiopia. Sputum smear examination, high-performance liquid chromatography (HPLC), flame atomic absorption spectrometry (FAAS), and enzyme-linked immunosorbent assay (ELISA) were used to analyse acid fast bacilli (AFB), vitamin A, zinc, and C-reactive protein (CRP), respectively. Dietary intake was assessed using a 24-h recall questionnaire. Mann-Whitney U test, Kruskal-Wallis test, Chi-square, odds ratio (OR), Spearman correlation, and multinomial logistic regression model were computed for data analyses.

RESULTS

In this study, 62 TB cases and 59 controls were included. The proportions of vitamin A deficiency among TB cases and controls were 56.4% and 39.0%, respectively. All TB cases and 92.5% controls were zinc deficient. The odds of TB cases with deficiencies of vitamin A and zinc was 2.3 (95% CI: 1.1 to 4.8)times more likely as compared to the controls. More than 80% of all participants had below average fulfilment of energy and vitamin A intakes.

CONCLUSION

Vitamin A and zinc deficiencies are severe problems among TB patients. Moreover, undernutrition determines the development of TB. Therefore, the management programs of TB need to address the problems of vitamin A and zinc deficiencies together with protein-energy malnutrition.