Longitudinal assessment of the impact of tuberculosis treatment on the levels of haemostatic and inflammatory markers of pulmonary tuberculosis infected individuals in Abakaliki, Nigeria
Okeke Chizoba O.1*, Ifeanyichukwu Martin O.1, Amilo Grace I.2, Obi Ejeatuluchukwu O3.
1Department of Medical of Medical Laboratory Science, 2Department of Haematology, 3Department of Pharmacology and Therapeutics, College of Health Sciences, Nnamdi Azikiwe University, Nigeria.
Tuberculosis (TB) is a chronic infectious disease usually marked by a high level of inflammatory response with up and down-regulation of various cytokines. Haemostasis and inflammation are closely linked such that inflammation leads to activation of the haemostatic system that in turn influences inflammatory activity. This research was a prospective follow-up study aimed at determining the levels of haemostatic markers, pro and anti- inflammatory cytokines in Mycobacterium tuberculosis infected individuals before and during anti-tuberculosis treatment. The objectives were to (i) evaluate the levels of Tumour necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), Interleukin-2 (IL-2), Interleukin-10 (IL-10), transforming growth factor-beta (TGF-β), P-selectin (P-SEL), platelet glycoprotein IIb/IIIa complex (GP IIb/IIIa) , platelet activating factor (PAF), platelet factor-4 (PF-4), thrombopoietin (TPO) and platelet counts in TB infected individuals before treatment, after intensive phase (2-month) treatment and after continuation phase (6-month) treatment (ii) correlate the inflammatory and haemostatic parameters. The study included 60 TB-infected individuals aged 18-80 years. The participants were recruited before initiation of therapy and followed up to 6 month treatment. Tuberculosis was diagnosed using Ziehl Neelsen AFB test and GeneXpert MTB/RIF assay. Whole blood was used for malaria screening and platelet (PLT) counts. Plasma samples were used for assay of P-selectin, PAF, PF-4 and GP IIb/IIIa complex, while serum samples were used for the analysis of TNF-α, IL-10, IL-6, IL-2, TGF-β and TPO, using ELISA test kits. Data were analyzed using SPSS version 22. The median values of TNF-α, IL-6, IL-2, P-SEL, GP IIb/IIIa and TPO were significantly increased after 2 month treatment compared to pre-treatment values. After 6 month treatment in comparison to the values after 2-month treatment, there were significant increases in IL-10 and TGF-β as well as a significant decline in PF-4. There were significant positive correlations between GP IIb/IIIa and TNF-α, IL-6 and PSEL, IL-6 and TPO, while PAF correlated negatively with TGF-β. Moreover, there was a significant increase in platelet count after 2 month treatment and a higher increase after 6 months treatment compared to the pre-treatment value. Conclusively, the levels of pro-inflammatory cytokines in TB individuals were highest after 2 month treatment, while the anti-inflammatory cytokine were highest after 6 month treatment. The changes in the pro- inflammatory cytokines aligned with changes in the levels of P-selectin, GP IIb/IIIa, PF-4 and TPO suggesting that inflammation affects the levels of these haemostatic parameters in TB individuals.