Evaluation Of Lipids Profile In Tuberculosis (TB) Patients On Anti-Tuberculosis Therapy In General Hospital Umuguma, Owerri

Medical and Health Science Project and Seminar Material

Evaluation Of Lipids Profile In Tuberculosis (TB) Patients On Anti-Tuberculosis Therapy In General Hospital Umuguma, Owerri


Abstract


This study was carried out to evaluate the levels of serum lipids in tuberculosis (TB) subjects on anti-tuberculosis therapy. A total of 60 subjects were recruited for this study. 20 subjects were cases tuberculosis patients not on therapy, 20 were tuberculosis subjects on anti-TB therapy for at least three months, and another 20 were apparently healthy subjects used as the control. Plasma samples obtained from subjects were analyzed by enzymatic colorimetric methods and values obtained were compared statistically using statistical analysis software (SPSS version 20 for windows). Result obtained showed that the values of total cholesterol level amongst tuberculosis subjects not on therapy (150.5+ 17.42) when compared to the control subjects of apparently healthy individuals (175.1+ 26.76) had a high statistically significant decrease.

The triglyceride levels of subjects not on therapy (100.7+ 32.64) when compared with the control subjects (114.7 + 54.57) showed that there is a statistically significant decrease. The low density lipoprotein levels of subjects not on therapy (94.33+ 10.03) showed a statistically significantly decrease as with the control (103.5+ 12.39). The high density lipoprotein levels of subjects not on therapy (47.27+ 4.068) as to the values of control subjects (48.60 + 5.863), showed a statistically significant decrease. The total cholesterol level of tuberculosis subjects on therapy (171.3+ 23.86) as to the control subjects (175.1+ 26.76), showed a statistically significant decrease. The triglyceride levels of subjects on therapy (106.1+ 31.17) showed statistically significant decrease when compared with the control (114.7 + 54.57).

The low density lipoprotein levels of subjects on therapy (100.7+ 7.324) showed no statistically significant decrease when compared with the control subjects (103.5+ 12.39). The high density lipoprotein values for the control subjects (48.60 + 5.863) when compared to the levels of subjects on therapy (51.93+ 3.982), showed no statistically significant decrease. The values of total cholesterol level amongst subjects not on therapy (150.5+ 17.42) as to total cholesterol level of subjects on therapy (171.3+ 23.86), showed a statistically significant decrease. The triglyceride levels of subjects not on anti-tuberculosis therapy (100.7+ 32.64) when compared with the triglyceride levels of subjects on anti-tuberculosis therapy (106.1+ 31.17) showed no statistically significant decrease.

There was a recorded statistically non significant decrease in the low density lipoprotein levels of subjects not on therapy (94.33+10.03) when compared to the low density lipoprotein levels of subjects on therapy (100.7+ 7.324). The high density lipoprotein levels of tuberculosis subjects not on therapy (47.27+ 4.068) when compared to the levels of subjects on therapy (48.60+ 5.863), showed no statistically significant decrease. The results obtained showed there was a marked presence of hypolipidaemia amongst tuberculosis subjects especially those not on therapy also the study showed therapy affected the lipid profile levels. The findings of the study could be used to assess the severity of the disease and progress of treatment.


Chapter One


Introduction

1.1 Background of the study

Tuberculosis (TB) is an infectious disease that usually affects the most part of the body especially the lungs, it is a bacterial infection that can spread through lymph nodes and bloodstream to any organs in the body. Most often found in the lungs, also the second greatest killer due to a single infectious agent worldwide. Tuberculosis (TB) is also a highly prevalent chronic infectious disease caused by Mycobacterium tuberculosis, an aerobic intracellular binding bacteria (Oliva et al., 2008). Mycobacterium tuberculosis is a bacillus, a member of the Mycobacterium tuberculosis complex. After inhaling the bacillus, transmitted by tiny droplets of saliva, the infected individual may develop the disease depending on his immunological state (Amin, 2006).

In pulmonary tuberculosis – formerly known as consumption and phthisis (wasting) – the bacillus is inhaled into the lungs where it sets up a primary tubercle and spreads to the nearest lymph nodes (the primary complex natural immune defences may heal it at this stage, alternatively the disease may smoulder for months or years and fluctuate with the patient’s resistance. TB primarily attacks the lungs, but it can also affect organs in the central nervous system, lymphatic system, and circulatory system among others. It is a world threatening disease, with about 20,000 people developing active TB daily and 5,000 people dying from the disease daily (Ekene et al., 2005). Current annual estimate suggest that 9 million new cases of T B and 3 million deaths from TB occurs globally (Peters et al., 2005).

The co-infection with HIV, inadequate treatment, malnutrition, overcrowding and emergency of multi-drug resistance tuberculosis have become contributory factors to the resurgence of tuberculosis in the developing countries ( Nwanjo and Oze, 2007). Tuberculosis generally classified as being either latent or active. Latent TB means that you have TB- causing bacteria in your body, but you have no symptoms and cannot spread it to others. However, you can still develop active TB, if your body’s immune system is unable to fight the TB. Active TB, means that the infection is spreading in your body, and your lungs are infected, you have the symptoms and can spread the disease to others. Treatment of TB depends whether the disease is latent or active (Batemen, 2007).

Despite the grave statistics, TB is a treatable disease. Response rate to effective therapy are excellent when patients are complaint with their medications. An effective control has been achieved by the widespread use of antimicrobial agents such as Isoniazid, Streptomycin, Ethambutol, Rivampicin, Pyrizinamide, Ethionamide, Aminosalicylic acid, etc. Treatment usually involves the combination of any four of these antibiotic drugs, given for at least 6 months, sometimes, for as long as 12 months. Firstly combined agents with the greatest level of efficacy and with an acceptable degree of toxicity includes: Isoniazid, Ethambutol, Rivampicin, Streptomycin and Pyrizinamide (Hardman et.al., 2001). The success of the treatment depends on the use of appropriate anti tuberculous drugs, the adherence of the patient to treatment, the sensitivity of the mycobacteria to drugs, and the control of associated diseases (Friedman and Selwyn, 1994). With the currently available drugs, about 90% of TB cases can be cured (Rieder, 2002). Tuberculosis is one of the oldest diseases afflicting the human race since ancient times (Mohamed and Hesham, 2012).

Approximately one third of the word population infected with Mycobacterium Tuberculosis. These organisms include Mycobacterium tuberculosis, Mycobacterium bovix, Mycobacterium Africana, Bacterium Mycroti and Mycobacterium Canetti. Upon these Mycobacteria, M.Tuberculosis is the most recognized and most common cause of tuberculosis although members of the complex (except M. Microti) can cause disease (tuberculosis) in humans. Infection with the tubercle bacillus usually involves the lungs but any area of the body can be involved (Jammer et al., 2004). Guzman et al., (2002) and Perez-Guzman (2008), found that most patients with pulmonary TB had low total serum cholesterol levels, and that values of about 90mg/dl were strongly associated with mortality in those patients with miliary disease (Guzman et al., (2000; Perez-Guzman, 2008).

Lipids are chemically diversified group of organic materials of biological origin. It includes all fats and substance of a fat like nature. Lipid are practically insoluble in water but readily soluble in organic non polar (chloroform, diethylene, benzene, dichloroethy) solvents. They are utilizable in metabolism by living organisms. The pathophysiology of plasma lipid metabolism is based on the concept of lipoproteins, the form in which lipids circulate in plasma. Biological functions of lipids in living organisms are quite diverse. They serve as the reservoir of high energy value. They can be stored in concentrated form of water free state in the adipose tissue. They form important constituent of nervous tissue. In the form of oil soluble vitamins (A, D, E, K) and essential fatty acid (linoleic and linolenic acid) they are important dietary constituents (Nwanjo, 2009). Classification of lipids, the diversity of chemical structures of lipids makes difficult their rational classification. It can be classified into three groups. Simple lipids, Compound Conjugate lipids and Derived lipids. Simple lipids are ester of fatty acids with certain alcohol. They are further classified according to the nature of alcohols. Compound or conjugate lipids, these lipids on hydrolysis yield other substances such as phosphoric acid, nitrogenous bases, galactose, sulphuric acid. Derived lipids, these are formed in the hydrolysis of simple or compound lipids. Examples are fatty acids, bile acids, steroids and alcohol (Nwanjo and Nwokoro, 2005). The lipid storage diseases are characterized by the accumulation of excessive quantities of specific fatty substances in various tissues with attendant malfunction of the involved organs. For example, elevated levels of cholesterol in blood plasma are recognized as a risk factor toward artheroscherotic disease (Nwosu, 2007).


1.2 Justification

Tuberculosis (TB) is an infectious disease that usually affects the most part of the body especially the lungs, it is a bacterial infection that can spread through lymph nodes and bloodstream to any organs in the body. The success of the treatment depends on the use of appropriate anti tuberculous drugs, the adherence of the patient to treatment, the sensitivity of the mycobacteria to drugs, and the control of associated diseases (Friedman and Selwyn, 1994). Lipids are chemically diversified group of organic materials of biological origin. They are utilizable in metabolism by living organisms. Cholesterol constitutes up to 30% of the total lipid content in the cell membrane, and participates in the fluidity of this structure (Delvin, 1992). Consequently cholesterol is involved in the activity of membrane-bound enzymes and membrane functions such as phagocytosis and cell growth. Gatfield and Pieters (2000), observed a clear derangement of the ability of the macrophage to phagocytose Mycobacteria when they were reduced of lipids. There is need to study lipid profile level amongst tuberculosis patients on anti-tuberculosis therapy attending Imo state specialist hospital, Owerri.


1.3 Aim And Objectives

A. Aim

To evaluate the levels of serum lipids in tuberculosis subjects on anti-tuberculosis therapy.

B. Objectives
  1. To determine the level of total cholesterol in tuberculosis individuals on anti-tuberculosis therapy.
  2. To determine the level of serum triglycerides in tuberculosis individuals on anti-tuberculosis therapy
  3. To determine the level of high density lipoproteins in tuberculosis individuals on anti-tuberculosis therapy.
  4. To determine the level of low density lipoproteins in tuberculosis individuals on anti-tuberculosis therapy.

Chapter Five


Discussion of Findings, Conclusion and Recommendation

5.1 Discussion

The result of this study showed that patients with tuberculosis undergoing anti-tuberculosis therapy attending imsuth orlu, imo state have low lipid profile values as noted in a study by Taparia et al., (2015) where they showed that all lipid parameters were significantly (p<0.05) low in both newly diagnosed and relapse cases of Pulmonary Tuberculosis (PTB) than controls. This was also in agreement with the report of Perez Guzma et al., (2002) where they suggested that hypolipidaemia was a risk factor for the disease. Also in accordance to another research by Mohamed and heshman (2012), patients with pulmonary tuberculosis have hypocholesterolemias that proved be a consequence of the disease itself rather than a factor. Deniz et al., (2006) as well as Akpovid et al., (2013) has shown that the level of Total Cholesterol was significantly lower in patients with Tuberculosis subjects (Deniz et al., 2006; Akpovid et al., 2013). Similar results were reported elsewhere by Gonzales and Sande, (2000) whose result as well supports the observation that the level of circulating Total Cholesterol decreases in severe infections (Gonzales and Sande, 2000). In a study by Akpovid et al., (2013), it was noted that although subjects had assumingly normal high density lipoprotein (HDL) values with chances of increment as therapy goes on when compared with the control however, other lipid parameters were seemingly low (Akpovid et al., 2013). chances of increment as therapy goes on was also shown in this study as it was possible that the anti- tuberculosis therapy taken by the patients might also have effect on the lipid level of these individuals. The results from this study showed that anti-tuberculosis subjects on therapy had increased the lipid profile levels when compared to tuberculosis subjects not on anti-tuberculosis therapy.


5.2 Conclusion

In conclusion, it is observed that, patients with pulmonary tuberculosis have hypolipidaemia which proved to be a consequence of the disease tuberculosis. The hypolipidaemia condition can be corrected probably by regular intake of anti-TB drugs and normal diet. The findings of the study are of diagnostic importance in pulmonary TB infection and could be used to assess the severity of the disease and progress of treatment.


5.3 Recommendation

Further research is needed on this work and a follow up study to provide additional support to the findings of this study. Subjects who have fully recovered from pulmonary tuberculosis should check their lipid profile status to ensure their lipid level are normal.


Evaluation Of Lipids Profile In Tuberculosis (TB) Patients On Anti-Tuberculosis Therapy In General Hospital Umuguma, Owerri


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