medigraphic.com
Instituto Nacional de Salud Pública

2010, Number 3

salud publica mex 2010; 52 (3)

Adjunctive micronutrient supplementation for pulmonary tuberculosis

Armijos RX, Weigel MM, Chacon R, Flores L, Campos A

Language: Spanish
References: 13
Page: 185-189
PDF size: 118.81 Kb.


ABSTRACT

Objective. To assess the effect of micronutrient supplementation on tuberculosis (TB) patient outcomes. Material and Methods. The randomized, double-blinded, placebocontrolled study was conducted in pulmonary TB patients undergoing directly observed treatment short course/ tratamiento acortado estrictamente supervisado (TAES/ DOTS) at IMSS in Ciudad Juarez, Chihuahua, Mexico, who were recruited during August 2005-July 2006. Consecutive patients received zinc and vitamin A supplements or matched placebo for four months. Dietary intake, blood zinc and vitamin A, immune response (IFN-γ, TNF-α, and IL-10 mRNA), and sputum smear conversion were measured. Results. The proportion of micronutrient compared to placebo group subjects with a negative sputum smear by month 3 was significantly increased (p= 0.03). This occurred subsequent to increased TNF-α and IFN-γ and decreased IL-10 observed at month 2. Micronutrient supplementation appeared to accelerate the beneficial therapeutic effect of chemotherapy. Conclusions. The earlier elimination of bacilli from sputum was associated with improved zinc status and Th1 immune response. The therapeutic effect of vitamin A was less evident.


REFERENCES

  1. Karyadi E, Schultink W, Nelwan RHH, Gross R, Amin Z, Dolmans WMV,et al. Poor Micronutrient Status of Active Pulmonary Tuberculosis Patients in Indonesia. J Nutr 2002;130:2953-2958.

  2. van Lettow M, West CE, van der Meer JW, Wieringa FT, Semba RD. Low plasma selenium concentrations, high plasma human immunodeficiencyvirus load and high interleukin-6 concentrations are risk factors associated with anemia in adults presenting with pulmonary tuberculosis in Zomba district, Malawi. Eur J Clin Nutr 2005; 59(4):526-532.

  3. McMurray DN, Bartow RA, Mintzer CL, Hernandez-Frontera E.Micronutrient status and immune function in tuberculosis. Ann N Y Acad Sci 1990;587:59-69.

  4. Karyadi E, West CE, Schultink W, Nelwan WH, Gross R, Amin Z, et al. A double-blind, placebo-controlled study of vitamin A and zinc supplementation in persons with tuberculosis in Indonesia: effects on clinical response and nutritional status. Am J Clin Nutr 2002;75(4):720-727.

  5. Flynn J,Chan J. Immunology of tuberculosis. Ann Rev Immunol 2001;19:93-129.

  6. Boussiotis VA, Tsai EY, Yumis EJ, Thim S, Delgado JC, Dascher CC, et al. IL-10 producing T cells suppress immune response in anergic tuberculosis patients. J Clin Invest 2000;105:1317-1325.

  7. Geffner L, Yokobori N, Basile J, Schierloh P, Balboa L, Romero M, et al. Patients with multidrug tuberculosis display impaired Th1 responses and enhanced regulatory T-cell levels in response to an outbreak of multidrugresistant Mycobacterium tuberculosis M and Ra strains. Infection and Immunity 2009;77:5025-5034.

  8. Karyadi E, Dolmans WM,West CE,Van Crevel R, Nelwan RH,Amin Z, et al. Cytokines related to nutritional status in patients with untreated pulmonary tuberculosis in Indonesia. Asia Pac J Clin Nutr 2007; 16(2):218-226.

  9. Range N, Andersen AB, Magnussen P, Mugomela A, Friis H.The effect of micronutrient supplementation on treatment outcome in patients with pulmonary tuberculosis: a randomized controlled trial in Mwanza, Tanzania. Trop Med Int Health 2005;10(9):826-32.

  10. Chandra RK. Nutrient supplementation as adjunct therapy in pulmonary tuberculosis. Int J Vitam Nutr Res 2004;74(2):144-146.

  11. Mathur M. Role of vitamin A supplementation in the treatment of tuberculosis. Nat Med J India 2007;20: 16-21.

  12. Hernandez-Pando R, Orosco H, Aguilar D. Factors that deregulate the protective immune response in tuberculosis. Arch Immunol Ther Exp 2009;57:355-367.

  13. Hirsch C, Toossi Z, Othieno C, Johnson J, Schwander S, Robertson S et al. Depressed T-Cell Interferon-g Responses in Pulmonary Tuberculosis: Analysis of Underlying Mechanisms and Modulation with Therapy. J Infect Dis 1999;180:2069-2073.




2020     |     www.medigraphic.com