Research and Reports in Pulmonology

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Editorial - Research and Reports in Pulmonology (2021) Volume 2, Issue 1

Radiologic and clinical manifestations in active pulmonary tuberculosisCorrelation of serum tumor necrosis factor


The precise clinical manifestations of tuberculosis are likely
to result from a complex interaction between the host and the
pathogen. We took serum samples from a group of patients
with a variety of clinical and radiological stages of pulmonary
tuberculosis in order to characterize tumor necrosis factor-alpha
(TNF-alpha), interleukin-4 (IL-4) and soluble interleukin-2
receptor (sIL-2R) response. We further evaluated whether the
levels of TNF-alpha, IL-4 and soluble IL-2R are related with
each other, and also evaluated the levels of TNF-alpha, IL-4
and sIL-2R after anti-tuberculosis therapy and relation with
radiologic scores. Forty-three inpatients with active pulmonary
tuberculosis and 19 healthy controls participated in the study.
Patients were divided into four categories radiologically on
chest X-ray (minimal, moderate-advanced, far-advanced and
with miliary infiltration). Concentrations of TNF-alpha (20.9+/-
10/15.4+/-8 pg/ml) and sIL-2R (2569+/-842/1444+/-514 pg/
ml) were statistically different between patients and controls
(p=0.02 and p=0.0001, respectively). Before chemotherapy
there was a positive correlation between TNF-alpha and sIL-2R
(r=0.34), but there was no correlation between IL-4 and TNFalpha,
and between IL-4 and sIL-2R (r=-0.23 and r=-0.22). The
TNF-alpha level was not statistically different in four groups
before and after chemotherapy. Results of this study provided
some evidence confirming the previously reported role of
TNF-alpha, IL-4 and sIL 2R in the control of tuberculosis, but
these cytokines were not found related with disease severity.
Cytokines are primarily involved in host responses to disease
or infection and any involvement with homeostatic mechanism
has been less than dramatic. Many cytokines are produced
during tuberculosis (TB),1,2 with a predominance of Th1
cytokines during the early stage3,4 and Th2 cytokines in the
later stages of the infection.5 These cytokines exert important
roles to limit or exacerbate the disease depending on their
balance and combinations. An understanding of the basis of
these associations and correlations during TB could be useful
in elucidating protection/pathogenesis. Some cytokines promote
inflammation and are called proinflammatory cytokines [tumor
necrosis factor-a (TNF-a), interleukin (IL)-1, IL-6, IL-8],
whereas other cytokines suppress the activity of proinflammatory
cytokines and are called anti-inflammatory cytokines (IL-4, IL-
10, IL-13).6 TNF-a has harmful effects, such as acute-phase
pathophysiologic events including fever and tissue necrosis. It
also plays a protective role against mycobacterial infection.7,8
Soluble interleukin 2 receptor (sIL-2R) is a surrogate marker of
T-lymphocyte activation and proliferation. A soluble fraction of
the IL-2 receptor, released from the cell membrane, is detectable
in serum and its concentration is known to be elevated in TB.9
In the literature, most reports on cytokines during TB are from
studies on in vitro-stimulated lymphoid cells with few reports on
in vivo plasma levels. We consider immunity of an individual
to TB to sometimes be reflected in the plasma levels of some
cytokines. In addition, the plasma is easily accessible, thus
requiring simple procedures and equipment to process it. In the
present study we therefore examined the levels of TNF-a, IL-4
and sIL-2R in the serum of pulmonary TB patients.
To understand systemic Tcell response in pulmonary tuberculosis
to some degree, we analyzed TNF-a, IL-4 and sIL-2R in serum.
Also, to evaluate the hypothesis that different clinical and
radiological manifestations of active pulmonary tuberculosis are
associated with different patterns of cellular immune response
systemically, we took serum samples from a group of patients
with avariety of clinical and radiological stages of pulmonary
tuberculosis. We further evaluated whether the levels of TNF-a,
IL-4 and sIL-2R are related with each other and also evaluated
the levels of TNFa, IL-4 and sIL-2R before and after anti-TB
therapyForty-three inpatients (20 male and 23 female) with
active pulmonary TB and 19 healthy controls (eight male and
11 female) participated in the study. All patients were recruited
from the Tuberculosis Hospital and Erciyes University Medical
Faculty, Clinic of Pulmonology in Kayseri, which is located in
the central region of Turkey. Their mean age was 36.49/ 15.5
years (range 16/67 years). On entry, all patients had positive
smear for acid-fast bacilli in sputum or bronchial lavage and
subsequent cultures of these specimens yielded tubercle bacilli.
None of the patients had any evidence of concomitant bacterial
or viral infections as indicated by sputum and blood cultures and
viral serologic study including HIV. Five patients had diabetes
mellitus. All patients were administered anti-TB therapy in
which isoniazid, rifampicin, pyrazinamide and streptomycin
or ethambutol were used. We evaluated patients with physical
Author(s): Abdelgani M Abdelgani

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