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Kulkarni S, Arunachala S, Chaya SK, ShankaraSetty RV, Karnik M, Bansal N, Ravindran S, Lokesh KS, Mohan M, Kaleem Ullah M, Siddaiah JB, Mahesh PA. The Assessment of Serum Fibronectin Levels as a Potential Biomarker for the Severity of Drug-Sensitive Pulmonary Tuberculosis: A Pilot Study. Diagnostics (Basel) 2023; 14:50. [PMID: 38201359 PMCID: PMC10804257 DOI: 10.3390/diagnostics14010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a global health burden caused by Mycobacterium tuberculosis (Mtb) infection. Fibronectin (Fn) facilitates Mtb attachment to host cells. We studied the Fn levels in smear-positive TB patients to assess its correlation with disease severity based on sputum smears and chest X-rays. METHODS Newly detected consecutive sputum AFB-positive pulmonary TB patients (n = 78) and healthy control subjects (n = 11) were included. The mycobacterial load in the sputum smear was assessed by IUATLD classification, ranging from 0 to 3. The severity of pulmonary involvement was assessed radiologically in terms of both the number of zones involved (0-6) and as localized (up to 2 zones), moderate (3-4 zones), or extensive (5-6 zones). The serum human fibronectin levels were measured by using a commercially available enzyme-linked immunosorbent assay (ELISA) kit (Catalogue No: CK-bio-11486, Shanghai Coon Koon Biotech Co., Ltd., Shanghai, China). RESULTS The PTB patients showed lower Fn levels (102.4 ± 26.7) compared with the controls (108.8 ± 6.8), but they were not statistically significant. Higher AFB smear grades had lower Fn levels. The chest X-ray zones involved were inversely correlated with Fn levels. The Fn levels, adjusted for age and gender, decreased with increased mycobacterial load and the number of chest radiograph zones affected. A Fn level <109.39 g/mL predicted greater TB severity (sensitivity of 67.57% and specificity of 90.38%), while a level <99.32 pg/mL predicted severity based on the chest radiology (sensitivity of 84.21% and specificity of 100%). CONCLUSIONS The Fn levels are lower in tuberculosis patients and are negatively correlated with severity based on sputum mycobacterial load and chest radiographs. The Fn levels may serve as a potential biomarker for assessing TB severity, which could have implications for early diagnosis and treatment monitoring.
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Affiliation(s)
- Shreedhar Kulkarni
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Sumalatha Arunachala
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
- Public Health Research Institute of India, Mysore 570020, India
- Department of Critical Care Medicine, Adichunchanagiri Institute of Medical Sciences, Bellur 571448, India
| | - Sindaghatta Krishnarao Chaya
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Rekha Vaddarahalli ShankaraSetty
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Medha Karnik
- Centre for Excellence in Molecular Biology and Regenerative Medicine (A DST-FIST Supported Center), Department of Biochemistry (A DST-FIST Supported Department), JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India; (M.K.)
| | - Nidhi Bansal
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Sukanya Ravindran
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Komarla Sundararaja Lokesh
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Mikash Mohan
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Mohammed Kaleem Ullah
- Centre for Excellence in Molecular Biology and Regenerative Medicine (A DST-FIST Supported Center), Department of Biochemistry (A DST-FIST Supported Department), JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India; (M.K.)
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Jayaraj Biligere Siddaiah
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
| | - Padukudru Anand Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore 570015, India (S.A.); (R.V.S.); (S.R.)
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Kamal AF, Oktari PR, Kurniawan A, Kodrat E, Mumpuni NA. Clinical Outcomes of Delayed Osteoarticular Tuberculosis: A Review of 30 Cases. Orthop Res Rev 2022; 14:351-363. [PMID: 36299465 PMCID: PMC9590347 DOI: 10.2147/orr.s366294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The lack of knowledge regarding osteoarticular tuberculosis (TB) cases in Indonesia leads to delayed and chronic conditions. This study aims to evaluate clinical outcomes of patients with osteoarticular TB. Materials and Methods Thirty osteoarticular cases were retrospectively analyzed, with a focus on non-immunocompromised patients without spine involvement. Chemotherapy length, operative treatment method, and infection recurrence were evaluated. Results The majority (60%) of patients were aged between 19 to 49 years. The most common complaint was painful swelling, particularly during physical activity. Weight-bearing joints, such as the hips, knees, and ankles, were the most affected. Laboratory results showed over half of the patients had anemia, 96% had elevated erythrocyte sedimentation rate (ESR), and 76% had elevated C-reactive protein (CRP) levels. Radiological findings varied, with lytic lesions, abscesses, and joint destruction observed. All patients presented with pathognomonic histological tubercle appearances, with caseous necrosis, lymphocytes, and Langhans giant cells present. Twenty-nine cases were treated with anti-TB drugs for 12 months, while one recurrent case received the drugs for 24 months. All patients underwent surgery to gain local infection control. Conclusion Osteoarticular TB is a common manifestation of extrapulmonary TB and must not be overlooked. Early detection of osteoarticular TB may prevent limb morbidity. Although anti-TB drugs are the primary treatment for osteoarticular TB, in some cases, surgery is required to establish a diagnosis and gain local infection control.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Prima Rizky Oktari
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia,Correspondence: Prima Rizky Oktari, Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jl Diponegoro No. 71, Central of Jakarta, Jakarta, Indonesia, Email
| | - Aryadi Kurniawan
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Evelina Kodrat
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Dasaradhan T, Koneti J, Kalluru R, Gadde S, Cherukuri SP, Chikatimalla R. Tuberculosis-Associated Anemia: A Narrative Review. Cureus 2022; 14:e27746. [PMID: 36106202 PMCID: PMC9447415 DOI: 10.7759/cureus.27746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) is an airborne illness that induces systemic inflammation. It often affects the lungs causing cough, fever, and chest pain. A commonly associated comorbid condition in TB is anemia. This review article has summarized various studies with an aim to gain a better understanding of pathogenesis and the role of cytokines that contribute to the development of anemia in TB. The study has gathered risk factors that enhance the likelihood of TB patients acquiring anemia. It has reviewed therapeutic modalities such as antitubercular therapy and iron therapy in an attempt to find which of them are effective in reducing the severity of anemia. This review article has also emphasized the importance of measuring hepcidin and ferritin and has touched upon the investigations that can be easily implemented.
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Laghari M, Sulaiman SAS, Khan AH, Memon N. A prospective study of socio-demographic, clinical characteristics and treatment outcomes of children with tuberculosis in Sindh, Pakistan. BMC Infect Dis 2019; 19:82. [PMID: 30678656 PMCID: PMC6345030 DOI: 10.1186/s12879-019-3702-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 01/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Understanding the explanations behind unsuccessful treatment outcomes in tuberculosis (TB) patients is important to improve treatment success. Treatment completion for TB is the mainstay of TB prevention and control. The study was aimed to assess the treatment outcomes and predictors for unsuccessful outcomes among children with TB. METHODS This was a prospective multicenter study conducted in Sindh. Children aged ≤14 years enrolled from June to November 2016 were included. A structured data collection tool was used to gather information with respect to patients' socio-demographic, clinical and microbiological data. Additionally, to collect the information related to socio-economic and education level of caregivers, validated questionnaire was administered to the caregivers. Treatment outcomes were assessed according to the World Health Organization (WHO) guidelines. The relationship of unsuccessful treatment outcome with socio-demographic and clinical attributes of TB patients was analyzed using logistic regression model. RESULTS Childhood TB represented 19.3% (508/2634) of all TB cases in selected hospitals. Of these, 268/508 (52.8%) were females and one third of the children were aged ≤2 years (34.3%). In multivariate analysis, pulmonary smear positive TB (PTB+) (AOR = 5.910, 95%CI = 1.64-21.29), those with adverse drug reactions (AOR = 11.601, 95%CI = 4.06-33.12) and those who had known TB contacts (AOR = 3.128, 95%CI = 1.21-8.06) showed statistically significant association with unsuccessful treatment outcomes. CONCLUSIONS The high proportion of childhood TB cases (19.3%) demonstrates the continuation of TB transmission in the study setting. Furthermore, an increased focus on PTB+ patients, those with adverse drug reactions and household contact with TB is warranted.
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Affiliation(s)
- Madeeha Laghari
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden Penang, Malaysia.
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden Penang, Malaysia
| | - Amer Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden Penang, Malaysia
| | - Naheed Memon
- College of Pharmacy, Liaquat University of Medical and Health Sciences, Jamshoro, 76090, Pakistan
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Rathish D, Siribaddana S. Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to find out common clinical presentations, investigation findings and the treatment options. Allergy Asthma Clin Immunol 2018; 14:11. [PMID: 29599802 PMCID: PMC5868065 DOI: 10.1186/s13223-018-0236-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation findings and treatment options through a systematic review of published reports. Methods PubMed, Trip, Google Scholar, Science Direct, Cochrane Library, Open-Grey, Grey literature report and the reference lists of the selected articles were searched for case reports in English on tuberculosis induced auto-immune haemolytic anaemia. PRISMA statement was used for systematic review. Quality assessment of the selected reports was done using the CARE guidelines. Results Twenty-one articles out of 135 search results were included. Thirty-three percent of patients were reported from India. More than half had fever and pallor. The mean haemoglobin was 5.77 g/dl (SD 2.2). Positive direct coombs test was seen in all patients. Pulmonary tuberculosis (43%) was most prevalent. Twenty-nine percent of patients needed a combination of anti-tuberculosis medicines, blood transfusion and steroids. Higher percentage of disseminated TB induced AIHA (67%) needed steroids in comparison to the other types of TB induced AIHA (13%). Conclusions Rarer complications of tuberculosis such as auto-immune haemolytic anaemia should be looked for especially in disease-endemic areas. Blood transfusion and steroids are additional treatment options along with the anti-tuberculosis medicines. Electronic supplementary material The online version of this article (10.1186/s13223-018-0236-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devarajan Rathish
- 1Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Sisira Siribaddana
- 2Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
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Abstract
Tuberculosis (TB) affects the production and life span of all hematologic cellular components. In addition, plasma coagulation factors may be affected, resulting in sometimes life-threatening complications. Iron, folate, and vitamin B12 metabolism is derailed. The pharmacological agents used for TB therapy may also cause hematologic changes. There are some uncommon manifestations of TB in nontuberculous hematologic patients. There have been some exciting developments in the field of imaging to screen for TB, TB pathophysiology at the cellular level, and our understanding of immune response in TB. Advances have been made in pharmacologic therapeutic options, including discovery of new drugs in the fight against drug-resistant TB, bearing in mind their hematologic effects. This chapter reviews and updates known hematologic effects of TB and its therapy and some lesser known effects of TB in patients with nontuberculous hematologic conditions.
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Kolla G, Acharya V, Balanthimogru P, Mani A, Ruman S. Rare Offshoot of a Common Malady Anaemia and Tuberculosis. J Clin Diagn Res 2016; 10:OD05-6. [PMID: 27656489 DOI: 10.7860/jcdr/2016/20773.8269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/15/2016] [Indexed: 11/24/2022]
Abstract
Haematological manifestations are one of the rarer presentations of tuberculosis and are usually of normocytic normochromic type. An association of Autoimmune Haemolytic Anaemia (AIHA) with active pulmonary tuberculosis is an exceeding rare entity, though anaemia and tuberculosis commonly co-exist. We report a patient with sputum negative pulmonary tuberculosis with associated Coomb's positive AIHA. The patient responded well to Anti- Tubercular Therapy (ATT) and low dose steroids tapered over a month.
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Affiliation(s)
- Gautham Kolla
- Junior Resident, Department of Internal Medicine, Kasturba Medical College (KMC) , Mangalore, Karnataka, India
| | - Vishak Acharya
- Professor and Head, Department of Pulmonary Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - Prashantha Balanthimogru
- Senior Resident, Department of Medicine, Consultant; Department of Hematology, Kasturba Medical College , Mangalore, Karnataka, India
| | - Arun Mani
- Senior Resident, Department of Pulmonary Medicine, Kasturba Medical College , Mangalore, Karnataka, India
| | - Shehzad Ruman
- Junior Resident, Department of Internal Medicine, Kasturba Medical College , Mangalore, Karnataka, India
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Safe IP. Tuberculosis associated with transient hemolytic anemia responsive to tuberculosis chemotherapy: a case report. Braz J Infect Dis 2013; 17:110-1. [PMID: 23290474 PMCID: PMC9427378 DOI: 10.1016/j.bjid.2012.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 04/14/2012] [Accepted: 04/14/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Izabella Picinin Safe
- Corresponding author at: Fundação de Medicina Tropical – Dr. Heitor Vieira Dourado (FMT-HVD), Avenida Pedro Teixeira 25, Dom Pedro, Manaus, 69040-000, AM, Brazil. Tel.: +55 92 21273442.
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