Plasma vitamins and essential trace elements in newly diagnosed pulmonary tuberculosis patients and at different durations of anti-tuberculosis chemotherapy

TLDR

Tuberculosis remains a global public health threat, with rising drug resistance linked to immune suppression, and malnutrition is empirically associated with this immune compromise. The study aimed to quantify micronutrient levels in TB patients and identify the critical period for supplementation during anti‑tuberculosis therapy. Plasma concentrations of iron, zinc, copper, and vitamins A, C, D, E were measured in 24 active TB patients at diagnosis and at 2, 4, 6 months of treatment, and compared with 20 healthy controls. TB patients showed significant reductions in all measured micronutrients at diagnosis and throughout treatment, with zinc and copper increasing at 4–6 months, iron decreasing at 4 months, and vitamins A, C, D, E remaining low at 2–4 months, indicating persistent malnutrition and supporting supplementation within the first four months of therapy.

Abstract

Tuberculosis (TB) is a public health challenge worldwide and advancement of latent TB to active disease and drug resistant TB is on the increase as a result of immune suppression induced by Mycobacterium tuberculosis. There are empirical evidences relating immune suppression and malnutrition. To improve the management strategy of TB patients, this study determined micronutrient concentrations in TB patients and established duration (months) post commencement of anti-tuberculosis (anti-TB) chemotherapy that is most important for micronutrient supplementation. Plasma iron, zinc, copper, vitamins A, C, D and E were determined in twenty-four (24) active tuberculosis patients at diagnosis, 2 months, 4 months and 6 months post-commencement of anti-TB chemotherapy, as well as twenty (20) healthy controls. Plasma concentrations of the micronutrients iron, zinc, copper, vitamins A, C, D and E were significantly reduced in TB patients at diagnosis and throughout the period of treatment when compared to controls. Plasma zinc and copper levels were significantly increased at 4 months and 6 months of drug therapy when compared with levels at diagnosis whereas plasma iron was significantly reduced at 4 months of treatment compared with their levels at diagnosis. Vitamins A, C, D and E in TB patients were significantly reduced at 2 months and 4 months of treatment compared to diagnosis. This study concluded that there is micronutrient (Fe, Zn, Cu, Vit A, C, D and E) malnutrition in tuberculosis patients at diagnosis and throughout the duration (6 months) of chemotherapy. Supplementation with vitamins and zinc is advised within the first 4 months of commencing anti-tuberculosis chemotherapy.