Effect of Malnutrition on Radiographic Findings and Mycobacterial Burden in Pulmonary Tuberculosis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Mar 28

PMID 30917170

Citations 30

Authors

Kacie J Hoyt

Sonali Sarkar

Laura White

Noyal Mariya Joseph

Padmini Salgame

Subitha Lakshminarayanan

Muthuraj Muthaiah

Saka Vinod Kumar

Jerrold J Ellner

Gautam Roy

C Robert Horsburgh Jr

Natasha S Hochberg

Affiliations

Soon will be listed here.

Abstract

Background: The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden.

Methods: Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2.

Results: Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP.

Conclusion: We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.

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References

Paton N, Chua Y, Earnest A, Chee C . Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Am J Clin Nutr. 2004; 80(2):460-5. DOI: 10.1093/ajcn/80.2.460. View

Santha T, Garg R, Frieden T, Chandrasekaran V, Subramani R, Gopi P . Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis. 2002; 6(9):780-8. View

Lin H, Wu C, Wang C, Fu H, Lonnroth K, Chang Y . Association of Obesity, Diabetes, and Risk of Tuberculosis: Two Population-Based Cohorts. Clin Infect Dis. 2017; 66(5):699-705. PMC: 5850624. DOI: 10.1093/cid/cix852. View

van Lettow M, Kumwenda J, Harries A, Whalen C, Taha T, Kumwenda N . Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 2004; 8(2):211-7. View

Bhargava A . Undernutrition, nutritionally acquired immunodeficiency, and tuberculosis control. BMJ. 2016; 355:i5407. DOI: 10.1136/bmj.i5407. View

Hochberg N, Sarkar S, Horsburgh Jr C, Knudsen S, Pleskunas J, Sahu S . Comorbidities in pulmonary tuberculosis cases in Puducherry and Tamil Nadu, India: Opportunities for intervention. PLoS One. 2017; 12(8):e0183195. PMC: 5568341. DOI: 10.1371/journal.pone.0183195. View

Madebo T, Nysaeter G, Lindtjorn B . HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis. Scand J Infect Dis. 1997; 29(4):355-9. DOI: 10.3109/00365549709011830. View

Podewils L, Holtz T, Riekstina V, Skripconoka V, Zarovska E, Kirvelaite G . Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients. Epidemiol Infect. 2010; 139(1):113-20. DOI: 10.1017/S0950268810000907. View

Najera O, Gonzalez C, Toledo G, Lopez L, Cortes E, Betancourt M . CD45RA and CD45RO isoforms in infected malnourished and infected well-nourished children. Clin Exp Immunol. 2001; 126(3):461-5. PMC: 1906241. DOI: 10.1046/j.1365-2249.2001.01694.x. View

10.

Willcox P, Ferguson A . Chronic obstructive airways disease following treated pulmonary tuberculosis. Respir Med. 1989; 83(3):195-8. DOI: 10.1016/s0954-6111(89)80031-9. View

11.

Gonzalez-Torres C, Gonzalez-Martinez H, Miliar A, Najera O, Graniel J, Firo V . Effect of malnutrition on the expression of cytokines involved in Th1 cell differentiation. Nutrients. 2013; 5(2):579-93. PMC: 3635214. DOI: 10.3390/nu5020579. View

12.

Cooper A . Cell-mediated immune responses in tuberculosis. Annu Rev Immunol. 2009; 27:393-422. PMC: 4298253. DOI: 10.1146/annurev.immunol.021908.132703. View

13.

Potian J, Rafi W, Bhatt K, McBride A, Gause W, Salgame P . Preexisting helminth infection induces inhibition of innate pulmonary anti-tuberculosis defense by engaging the IL-4 receptor pathway. J Exp Med. 2011; 208(9):1863-74. PMC: 3171086. DOI: 10.1084/jem.20091473. View

14.

Lee S, Kim Y, Kim D, Oh Y, Lee S . The risk of obstructive lung disease by previous pulmonary tuberculosis in a country with intermediate burden of tuberculosis. J Korean Med Sci. 2011; 26(2):268-73. PMC: 3031013. DOI: 10.3346/jkms.2011.26.2.268. View

15.

Lohmann E, Koster B, le Cessie S, Kamst-van Agterveld M, van Soolingen D, Arend S . Grading of a positive sputum smear and the risk of Mycobacterium tuberculosis transmission. Int J Tuberc Lung Dis. 2012; 16(11):1477-84. DOI: 10.5588/ijtld.12.0129. View

16.

Bush K, Kivlahan D, McDonell M, Fihn S, Bradley K . The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998; 158(16):1789-95. DOI: 10.1001/archinte.158.16.1789. View

17.

Lonnroth K, Williams B, Cegielski P, Dye C . A consistent log-linear relationship between tuberculosis incidence and body mass index. Int J Epidemiol. 2009; 39(1):149-55. DOI: 10.1093/ije/dyp308. View

18.

Weaver R . Unusual radiographic presentation of pulmonary tuberculosis in diabetic patients. Am Rev Respir Dis. 1974; 109(1):162-3. DOI: 10.1164/arrd.1974.109.1.162. View

19.

Abe M, Akbar F, Matsuura B, Horiike N, Onji M . Defective antigen-presenting capacity of murine dendritic cells during starvation. Nutrition. 2003; 19(3):265-9. DOI: 10.1016/s0899-9007(02)00854-7. View

20.

Cegielski J, Arab L, Cornoni-Huntley J . Nutritional risk factors for tuberculosis among adults in the United States, 1971-1992. Am J Epidemiol. 2012; 176(5):409-22. PMC: 5788452. DOI: 10.1093/aje/kws007. View