Reduction of blood C-reactive protein concentration complements the resolution of sputum bacillary load in patients on anti-tuberculosis therapy.
| Autor: | Azam K; Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Vila de Marracuene, Moçambique.; Center for International Health - CIHLMU, Munich, Germany.; Southern Africa TB and Health System Support Project, East, Central and Southern Africa Health Community (ECSA-HC), Arusha, Tanzania., Khosa C; Center for International Health - CIHLMU, Munich, Germany.; Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde (INS), Cidade de Maputo, Moçambique., Viegas S; Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Vila de Marracuene, Moçambique., Massango I; Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde (INS), Cidade de Maputo, Moçambique., Bhatt N; Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde (INS), Cidade de Maputo, Moçambique., Jani I; Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Vila de Marracuene, Moçambique., Heinrich N; Center for International Health - CIHLMU, Munich, Germany.; Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians Universität München (LMU) Munich, Munich, Germany.; Partner Site Munich, German Centre for Infection Research (DZIF), Munich, Germany., Hoelscher M; Center for International Health - CIHLMU, Munich, Germany.; Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians Universität München (LMU) Munich, Munich, Germany.; Partner Site Munich, German Centre for Infection Research (DZIF), Munich, Germany., Gillespie SH; Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom., Rachow A; Center for International Health - CIHLMU, Munich, Germany.; Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians Universität München (LMU) Munich, Munich, Germany.; Partner Site Munich, German Centre for Infection Research (DZIF), Munich, Germany., Sabiiti W; Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom. |
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| Jazyk: | angličtina |
| Zdroj: | Frontiers in immunology [Front Immunol] 2022 Sep 16; Vol. 13, pp. 1005692. Date of Electronic Publication: 2022 Sep 16 (Print Publication: 2022). |
| DOI: | 10.3389/fimmu.2022.1005692 |
| Abstrakt: | Background: Tuberculosis (TB) is a difficult-to-treat disease requiring the combination of four antibiotics for a minimum of 6 months. Rapid and quantitative biomarkers to monitor treatment response are urgently needed for individual patient management and clinical trials. C-reactive protein (CRP) is often used clinically as a rapid marker of inflammation caused by infection. We assessed the relationship of TB bacillary load and CRP as biomarkers of treatment response. Methods: Xpert MTB/RIF-confirmed pulmonary TB cases were enrolled for treatment response assessment in Mozambique. Treatment response was measured using the Tuberculosis Molecular Bacterial Load Assay (TB-MBLA) in comparison with standard-of-care Mycobacterium Growth Indicator Tube (MGIT) culture at baseline and at weeks 1, 2, 4, 8, 12, 17, and 26 of treatment. Blood CRP concentration was measured at baseline, week 8, and week 26. Treatment response was defined as increase in MGIT culture time to positivity (TTP), and reduction in TB-MBLA-measured bacillary load and blood CRP concentration. Results: Out of the 81 screened presumptive TB cases, 69 were enrolled for 6-month treatment follow-up resulting in 94% treatment completion rate. Four participants did not complete TB treatment and 22 participants had missing CRP or TB-MBLA results and were excluded from TB-MBLA-CRP analysis. The remaining 43 participants-median age, 31 years old [interquartile range (IQR): 18-56]; 70% (30/43) male; and 70% (30/43) infected with HIV-were considered for analysis. Culture TTP and bacillary load were inversely correlated, Spearman's r = -0.67, p < 0.0001. Resolution of sputum bacillary load concurred with reduction of blood CRP, r = 0.70, p < 0.0001. At baseline, bacillary load had a median (IQR) of 6.4 (5.5-7.2), which reduced to 2.4 (0.0-2.9) and 0.0 (0.0-0.0) log Conclusion: TB-MBLA-measured bacillary load and blood CRP complement each other in response to anti-TB therapy. Slow CRP reduction probably reflects residual TB bacilli in the lung not expectorated in sputum. Combining both measures can improve the accuracy of these biomarkers for monitoring TB treatment response and shorten turnaround time since the results of both assays could be available in 24 h. Competing Interests: WS and SG provide pro bono services to LifeArc, a commercial charity with a contract to commercialize TB-MBLA. This work was performed before University of St Andrews engagement with LifeArc, and the company has had no role in the writing of or the decision to publish this manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Azam, Khosa, Viegas, Massango, Bhatt, Jani, Heinrich, Hoelscher, Gillespie, Rachow and Sabiiti.) |
| Databáze: | MEDLINE |
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