INTER RELATION OF TUBERCULOSIS WITH SELECTED INFECTIOUS AND METABOLIC DISORDERS

Abstract

The world health organisation (WHO) reported that Pakistan ranks fifth among highest tuberculosis (TB) burden countries. The present study was carried out on 366 cases, including 52% females and 48% males. The results showed that a higher percentage of patients with TB were between 16 to 30 years, having a body weight between 41 to 50 kg, in married, in uneducated people, having a high school education and in house wives. Out of 258 patients, 24% were diabetic, 17.8% were co-morbid with hepatitis C virus (HCV), 4.2% with human immunodeficiency virus (HIV) and 3.4% also had myocardial infarction. The TB patients revealed an increase in white blood cell counts (WBCs), erythrocyte sedimentation rate (ESR), alkaline phosphatase (ALP) and urea, while decrease in packed cell volume (PCV), eosinophils and immunoglobulin-G (IgG). The TB+ diabetes co- morbid group showed increases in WBCs, ESR, globulins, alanine transaminase (ALT), ALP, glucose, IgG and immunoglobulin-M (IgM), while a decrease in PCV, haemoglobin (Hb), eosinophil, albumin and albumin/globulin (A/G) ratio. The TB+ hepatitis co-morbid group showed increases in monocyte, ESR, ALT, ALP and IgG, while a decrease in PCV, Hb and eosinophil. The TB+HIV co-morbid group revealed an increase in ALP, IgG and IgM, while a decrease in monocyte and eosinophil. TB+ myocardial infarcted group showed increase in WBCs, neutrophil, ESR, serum proteins, globulin, ALP, serum cholesterol, high density lipoprotein (HDL), low density lipoproteins (LDL), creatinine kinase-MB (CKMB), creatinine phosphokinase (CPK), lactate dehydrogenase (LDH), creatinine and urea, while decrease in platelets (PLT) and lymphocyte. TB + diabetes + hepatitis C co-morbid cases showed increase in WBCs, ESR, bilirubin, ALT, AST, ALP, glucose, serum creatinine, serum urea, IgG, IgM, potassium and phosphorous, while a decrease in RBCs, PCV, Hb and eosinophil. TB + hepatitis C+AIDS co-morbid group showed increases in lymphocyte, monocyte, eosinophil, ALP, IgG and IgM, while a decrease in PCV, PLT and neutrophil. The prevalence of drug resistance by proportion method was 45.7%. Out of 118 drug resistant isolates, 61.02% were resistant to isoniazid (INH), 59.32% to ethambutol (EMB), 41.53% to streptomycin (SM), 5.08% to ofloxacin (OFX) and 49.15% were MDR detected by proportion method, while 31.36% isolates were resistant to INH, 22.03% to EMB, 17.08% to SM, 2.54% to OFX and 18.64% were MDR by PCR-RFLP. The consensus sequence alignment of three strains of KatG gene showed mutation at codon 282, 286, 279, 309 and 427. The change at codon 279 was observed in all the strains which added restriction site for MspI. The embB 306 showed mutation at codon 299, 300, while embB 497 at codon 70, 71, 76 and 78. The gyrA showed point mutation at codon 70, 71, 76, 78 and 95. It can be concluded from the present study that 24% TB patients were diabetic, 17.8% were co-morbid with hepatitis C, 4.2% with HIV and 3.4% also had myocardial infarction and 45.7% of cases were drug resistant.