Assessment of risk factors of multidrug resistant tuberculosis with emphasis on serum zinc

Abstract

Multi-drug resistant tuberculosis (MDR-TB) is a form of TB resistant to isoniazid and rifampicin and considered as a major threat to TB control worldwide. Limited data are available regarding risk factors and serum zinc status of MDR-TB in Bangladesh. Tuberculosis is a disease which blocks a key part of the body’s immune defense. As zinc deficiency causes immune suppression, we assume that it may play a role in the development of MDR-TB. So, this study was carried out to evaluate and assess the serum zinc level as well as different risk factors in patients of MDR-TB. This case control study was carried out in the Department of Clinical Pathology, in collaboration with Department of Public Health and Informatics, Department of Biochemistry, BSMMU and National tuberculosis referral laboratory (NTRL) in NIDCH, Mohakhali, Dhaka from March’ 2012 to February 2013.We enrolled 50 newly diagnosed cases of MDR-TB patients from NTRL and 50 age matched healthycontrols from a selective community Sirajdikhan Upazilla, Munshiganj District. The two groups were compared based on various demographic factors, behavioral factors, factors related with personal illness history and also laboratory related factors. Serum zinc deficiency, changing trend of number of family members, presence of smoking history, absence of BCG scar and past history of contact TB were statistically significant risk factors for development of MDR-TB in logistic regression model. In our study, we found the mean (SD) serum zinc level in case group 60.40 (8.91) ?g/dL and 84.00 (13.62) ?g/dL in healthy controls which was significant statistically. The risk factors that we found, specially lower level of serum zinc, are the major concern for the development of MDR-TB and attempt to minimize them might contribute to control TB DOI: http://dx.doi.org/10.3329/bmj.v43i1.21368 Bangladesh Med J. 2014 January; 43 (1): 3-8

Risk Factors of Multidrug-Resistant Tuberculosis

“…Amin et al (2009) conducted a study in Bangladesh, which showed that the highest proportion of MDR-TB cases (61.2%) were involved in occupations like agriculture, production and transport but no significant difference was obtained in income level between cases and controls. In other study done by Baghaei et al (2009) and Barman et al (2014) family size showed significant association with MDR-TB as in our study. Individual staying in a crowded living condition are more vulnerable to develop MDR-TB.…”

Kadar seng dan kadar malondialdehyde pada penderita multi drug resistant tuberculosis dan tuberkulosis sensitif

“…Bakteri M.tb merupakan bakteri patogen pada paru, namun dapat menyebabkan penyakit di hampir seluruh bagian tubuh. [1][2][3][4] Tuberkulosis menjadi penyebab utama morbiditas dan mortalitas di negara-negara yang berpendapatan rendah dan berpenghasilan menengah. 5 Penderita tuberkulosis paru di dunia tahun 2014 sebanyak ±9,6 juta kasus dan tahun 2015 sebanyak ±10,4 juta kasus.…”

“…6,7 Penderita tuberkulosis paru di Indonesia pada tahun 2015 sebanyak 330.910 kasus dan meningkat pada tahun 2016 menjadi 351.893 kasus. Kasus TB paru di Indonesia didominasi oleh provinsi dengan jumlah penduduk besar yaitu Provinsi Jawa 1 10 Jumlah penderita MDR-TB di dunia meningkat dari tahun 2014 sampai 2015 yaitu dari 480.000 kasus menjadi 580.000 kasus, sedangkan di Indonesia juga terjadi peningkatan dari 9.399 kasus pada tahun 2014 menjadi 15.380 kasus pada tahun 2015. 7,11 Penyakit menular kronis ditandai dengan peningkatan respon kekebalan tubuh yaitu proses yang menyebabkan kerusakan sel.…”

“…22,25,26 Penelitian sebelumnya dilakukan oleh Bahi et.al., menunjukkan bahwa kadar serum seng ditemukan lebih rendah pada pasien MDR-TB dibandingkan dengan kontrol sehat. 1 Penderita MDR-TB dan TB sensitif yang terdiagnosis TB aktif mempunyai kadar seng sebagai antioksidan ditemukan lebih rendah, sedangkan kadar MDA sebagai penanda stres oksidatif ditemukan dengan kadar yang tinggi. Terjadinya mutasi gen karena gangguan sistesis DNA dan RNA yang diakibatkan oleh stres oksidatif menyebabkan kuman TB menjadi resisten.…”

“…30 Hasil penelitian ini tidak sejalan dengan penelitian Barman, et al, mengemukakan bahwa kadar serum seng ditemukan lebih rendah pada pasien MDR-TB. 1 Kadar seng yang lebih tinggi pada penderita MDR-TB dimungkinkan karena rerata asupan seng pada kelompok MDR-TB lebih tinggi dibandingkam dengan kelompok TB sensitif. Konsentrasi seng serum dipengaruhi oleh beberapa faktor, salah satunya adalah waktu makan terahir dan jenis makanan yang dikonsumsi.…”