Relationships between serum concentrations of C-reactive protein and micronutrients, in patients with tuberculosis

Abstract

Studies on the serum concentrations of micronutrients in tuberculosis (TB), and their relationship to the acute-phase response (APR), are scarce. The serum concentrations of zinc, copper, selenium and vitamins A and E in 46 smear-positive cases of pulmonary TB (PTB) from Ecuador were therefore compared with those in 10 healthy Ecuadorian volunteers, and the correlations between these concentrations and the serum concentration of C-reactive protein (CRP) were evaluated. Compared with the healthy volunteers, the PTB cases had significantly lower serum concentrations of zinc, retinol and selenium and significantly higher serum concentrations of copper. Both groups had moderately high concentrations of selenium in their sera. The PTB cases who had >50 mg CRP/ litre (a concentration indicative of an APR) had lower serum concentrations of retinol and zinc than the cases with lower CRP concentrations. In patients with PTB, hypozincaemia and hyporetinolaemia are strongly associated with the APR. It is therefore necessary to consider the extent of activation of the APR when interpreting serum micronutrient concentrations in patients with TB.

Alterations in serum levels of trace elements in tuberculosis and HIV infections

“…The high serum copper concentrations observed in the TB patients were also in line with previous reports (Bogden et al, 1977;Ahmad et al, 1985;Ciftci et al, 2003;Koyanagi et al, 2004). The elevated serum levels of copper may reflect a nonspecific increase in serum concentration of copperbinding protein, ceruloplasmin (Beisel, 1976).…”

“…The low zinc concentrations in serum observed in adult Ethiopian TB patients was in agreement with the reports from India (Ahmad et al, 1985), Indonesia (Karyadi et al, 2000), Turkey (Ciftci et al, 2003) and Ecuador (Koyanagi et al, 2004). The decline was probably due to redistribution of zinc from serum to other tissues (Cousins and Leinart, 1988) or reduction of zinc-carrier proteins and or a rise in the production of metallothionein, a protein that transports zinc to the liver (Gabay and Kushner, 1999).…”

Serum Retinol, Alpha-Tocopherol and Systemic Inflammatory Response in Metastatic Colorectal Carcinoma Patients Treated with Combination Chemotherapy and Cetuximab

“…Consequently, retinol decreases as part of the acute phase response ( 20 , 21 ). A negative correlation between C-reactive protein or other acute phase proteins and retinol has been documented in cancer patients ( 13 , 14 ) as well as in patients with other inflammatory disorders associated with acute phase response ( 22 ). A correlation between C-reactive protein and alpha-tocopherol has been noted in some ( 13 , 23 ), but not in other reports ( 14 ).…”

Association of Nutritional Status with Drug Sensitive and Drug Resistant Outcomes Among Pulmonary Tuberculosis Patients

“…In drug resistant patients, serum vitamin A may also be affected by the APR, with a consequent decrease in RBP which is responsible for transport of retinol to various tissues [19][20]. Increased APR may increases the urinary losses of vitamin A associated with fever and infection which leads to decrease the RBP concentration [19][20]. A zinc deficiency may cause a secondary vitamin A deficiency by impairing the production of RBP.…”

“…In the initial phase of the disease, the APR was responsible for the increase in energy expenditure in patients, but once they are on treatment, the APR declines and nutritional status may improve Serum zinc and serum RBP concentration were statistically significantly lower in drug resistant patients as compared to drug sensitive patients at six month. In drug resistant patients, serum vitamin A may also be affected by the APR, with a consequent decrease in RBP which is responsible for transport of retinol to various tissues [19][20]. Increased APR may increases the urinary losses of vitamin A associated with fever and infection which leads to decrease the RBP concentration [19][20].…”