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. 2011 Aug 1;204(3):358-62.
doi: 10.1093/infdis/jir265.

Early deaths during tuberculosis treatment are associated with depressed innate responses, bacterial infection, and tuberculosis progression

Catriona John Waitt  1 , N Peter K Banda, Sarah A White, Beate Kampmann, Jean Kumwenda, Robert S Heyderman, Munir Pirmohamed, S Bertel Squire
Affiliations

Early deaths during tuberculosis treatment are associated with depressed innate responses, bacterial infection, and tuberculosis progression

Catriona John Waitt et al. J Infect Dis. .

Abstract

Up to 14% of Malawian adults die during the intensive phase of tuberculosis treatment. In a prospective cohort of 199 Malawian adults with microbiologically confirmed pulmonary tuberculosis, clinical and laboratory parameters were compared between those who died or deteriorated with those who had an uneventful recovery. Baseline tumor necrosis factor alpha responses to stimulation with heat-killed Mycobacterium tuberculosis and lipopolysaccharide were reduced among the 22 patients with poor outcome (P = .017). Low body mass index (P = .002) and elevated respiratory rate (P = .01) at tuberculosis diagnosis independently predicted poor outcome. Validation of a clinical score identifying high-risk individuals is warranted, together with further investigation of immunological derangements.

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Figures

Figure 1.
Figure 1.
Scattergraphs (and medians) of cytokine production in response to stimulation of whole blood with heat-killed H37Rv, lipopolysaccharide (LPS), and phytohemagglutinin (PHA) immediately prior to the start of tuberculosis (TB) treatment. Patients who died or suffered a significant acute episode are grouped together under ”poor outcome” whereas patients who had an uncomplicated clinical course were considered to have a ”good outcome.” A, Production of tumor necrosis factor alpha (TNF-α) after 24 hours incubation. B, Production of interferon (IFN)-γ after 6 d incubation.
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