Faculty: Health Sciences And Technology
Department: Medical Laboratory Science
Tuberculosis (TB) is a major chronic infectious disease usually marked by a high level of inflammatory response with up and down-regulation of various cytokines. Haemostasis and inflammation are closely linked both in health and disease in such a way that inflammation leads to activation of the haemostatic system that in turn influences inflammatory activity. This prospective follow-up study was therefore designed to assess the levels of haemostatic and inflammatory markers in Mycobacterium tuberculosis infected individuals before and during treatment. A total of 60 TB-infected individuals, aged 18-80 years participated in the study. The individuals were recruited before initiation of therapy and followed up to 6 month into treatment. Tuberculosis was diagnosed using Ziehl Neelsen acid-fast bacilli test and GeneXpert MTB/RIF assay. Whole blood was used for malaria screening, parasite density, total white cell counts (TWBC), neutrophil (NEUT), lymphocyte (LYM), monocyte (MONO), eosinophil (EOS) and platelet (PLT) counts. Plasma samples were used for assay of P-selectin (P-SEL), platelet activating factor (PAF), platelet factor-4 (PF-4) and GP IIb/IIIa complex using ELISA test kits, while serum samples were used for HIV screening, analysis of tumor necrosis factor-alpha (TNF-α), IL-10, IL-6, IL-2, transforming growth factor-beta (TGF-β), thrombopoietin (TPO) by ELISA method. The height and weight of the subjects were measured and the body mass index (BMI) was calculated. Also the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte-ratio were calculated. These parameters except those for diagnosis were analysed at pre-treatment, 2 month and 6 month into treatment. Data were analyzed using SPSS version 22. The results showed that the median values of TNF-α, IL-6, IL-2, P-SEL, GP IIb/IIIa and TPO were significantly increased at 2 month into treatment compared to pre-treatment values (86.54 vs 1.55 pg/ml, 172.90 vs 66.12 pg/ml, 16.98 vs 11.36 pg/ml, 23.22 vs 22.12 ng/ml, 6.63 vs 4.87 ng/ml and 3966.04 vs 3603.03 pg/ml respectively) (p= <0.001, <0.001, <0.001, 0.015, 0.035 and 0.017 respectively) and decreased at 6 month into treatment. Also at 6 month into treatment in comparison to 2-month into treatment, there were significant increase in IL-10 (4.46 vs 2.77 pg/ml) and TGF-β (173.83 vs 23.83 pg/ml) (p=0.020 and 0.001 respectively) as well as a significant decline in PF-4 (0.35 vs 0.38 ng/ml) (p=0.030). There were significant positive correlations between GP IIb/IIIa and TNF-α (r=0.372; p=0.031), IL-6 and PSEL (r=0.413; p=0.027), IL-6 and TPO (r=0.335; p=0.046), PF4 and TGF-β (r=0.463; P=0.006), while PAF correlated negatively with TGF-β (r=-0.368; p=0.032). Moreover, there was a significant increase in PLT at 2 month into treatment (281.92 ± 93.22) and a higher increase at 6 months into treatment (340.69 ± 71.00) compared to the pre-treatment value (209.02 ± 103.55) (p<0.001). The median parasite count correlated positively with PF4 (r=0.480; p=0.046) and PSEL (r=0.589; P=0.008) and negatively with PLT (r=-0.599; p=0.022). P-selectin was significantly higher in males compared to the female TB individuals at pre-treatment, 2 month and 6 month into treatment (p<0.05). Conclusively, the levels of pro-inflammatory cytokines in TB individuals were highest at 2 month into treatment, while the anti-inflammatory cytokines levels were highest at 6 month into treatment. The changes in the pro- inflammatory cytokines aligned with changes in the levels of P-selectin, GP IIb/IIIa, PF-4 and TPO suggesting that inflammation affects the levels of these haemostatic parameters in TB individuals.