Liver Dysfunction in Pulmonary Tuberculosis Patients on DOTS: A Study and Review

Abstract

eGFR were done. Development of hepatotoxicity was watched by monthly monitoring of liver enzymes and bilirubin serum profiles. RESULT: The selected 148 patients were older and four fifths were males. 16 patients developed ATT-DIH at first or second month monitoring following DOTS. They were more undernourished, hypoproteinaemic, bore more extensive disease and were sputum AFB positive. Their eGFR profiles were normal but significantly lower and plasma antioxidant capacity significantly reduced. Oxidative stress marker levels also were insignificantly raised. They exhibited subclinical elevation of serum enzymes AST and ALT. No significant influence of age and gender was seen on incidence of ATT-DIH. CONCLUSION: Frailty with extensive disease constituted phenotype vulnerable to ATT-DIH. Hypoalbuminaemia, reduced plasma antioxidant capacity, subclinical elevated profile of transaminases before starting DOTS were forewarning laboratory indices. LFT ought to be monitored at fortnight, a month and at 2 months in such patients as minimum necessity to timely detect and address hepatotoxicity. INTRODUCTIONTuberculosis continues as huge health care problem globally. Currently recommended first line treatment for TB includes regimen of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA) and ethambutol (EMB) for initial 2 months followed by 4 months of INH and RMP and/or EMB [1] . Among the first line quadruple therapy drugs (INH, RMP, PZA, EMB), first three are metabolized mainly by the liver and are potentially hepatotoxic. A fair fraction of TB patients on chemotherapy with isoniazide and rifampicin exhibit elevations in serum levels of liver enzymes, alanine aminotransferase (ALT, earlier called SGPT) and aspartate aminotransferase (AST, earlier SGOT) activities. A small fraction of these can worsen further to compel ABSTRACT CONTEXT: Phenomenal number of people suffers tuberculosis and is prescribed primary line DOTS antitubercular chemotherapy. Evidence based clinical practice to minimize risk of hepatotoxicity is primary imperative. AIM: Study generates evidence for predicting individual hepatotoxic risk using patient's constitutional and health parameters and disease characteristics and adopting right course of management. It is observational study in patients consecutively selected by defined inclusion and exclusion criteria. METHODS: Newly enrolled pulmonary tuberculosis patients for DOTS were studied to examine host and disease specific predictors of hepatotoxicity risk. Pretreatment baseline liver function tests and

Status of Serum Ferritin, C-Reactive Protein and Liver Function Tests in Pulmonary Tuberculosis

“…In our study, the concentration of Aspartate Transaminase (AST), Alanine Transaminase (ALT) and Alkaline phosphatases (ALP) were increased in patients of pulmonary tuberculosis as compared to healthy Control group. Our results are similar to studied by other researchers 11,12 . Higher levels of AST and ALT are indicator of liver damage in Pulmonary Tuberculosis 11 .…”

Hepatitis B and C virus infections and associated factors among HIV-positive and HIV-negative tuberculosis patients in public health facilities, Northeast Ethiopia: A comparative cross-sectional study

“… 28 Liver enzyme elevation in serum is common in these patients due to isoniazid and rifampicin chemotherapy. 28 – 30…”

“…28 Liver enzyme elevation in serum is common in these patients due to isoniazid and rifampicin chemotherapy. [28][29][30] Despite no further attempts made to escape these problems and/or risks, the WHO Global Health Sector Plan 2016-2021 has launched an elimination strategy to prevent and monitor HBV and HCV infection. 4 Thus, further study is very important to get epidemiological data which are crucial to control and monitor HBV and HCV infection during TB treatment.…”