Cytokine kinetics in the first week of tuberculosis therapy as a tool to confirm a clinical diagnosis and guide therapy
Abstract
Background
Many patients treated for
tuberculosis (TB) in low and middle income countries are treated
based on clinical suspicion without bacteriological
confirmation. This is often due to lack of rapid simple accurate
diagnostics and low healthcare provider confidence in the
predictive value of current tests. We previously reported in an
animal TB model that levels of host markers rapidly change in
response to treatment initiation.
Methods
We assessed the potential of
host biomarker kinetics of TB patients during the first two
weeks of therapy to identify patients responding to treatment.
Adult patients clinically diagnosed with and treated for TB, 29
in Nigeria and 24 in Nepal, were analyzed.
Results
Changes in concentrations of
non-specific host biomarkers, particularly IP-10, in response to
the first week of anti-TB therapy were strongly associated with
bacteriological confirmation of TB. A decrease in IP-10 level of
>300pg/ml between 0 and 7 days of treatment identified 75% of
both smear-positive and smear-negative culture positive patients
and correctly excluded TB in all nine culture negative patients.
Conclusions
Monitoring of early
IP-10 responses to treatment could form the basis of a
simplified assay and could help identify patients who were
erroneously clinically diagnosed with TB or those infected with
drug resistant strains on inappropriate treatment. We believe
this approach may be particularly appropriate for difficult to
diagnose patients, e.g. smear-negative HIV-positive, or those
with extra-pulmonary TB, often treated without bacterial
confirmation.
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Source:
PLOS ONE
