Adjunctive Therapeutic Effects of Zinc Supplementation in Tuberculosis Treatment among Adults in Calabar, Nigeria | Chapter 01 | Emerging Research in Medical Sciences Vol. 3
Tuberculosis (TB) is a contagious
bacterial disease caused by Mycobacterium tuberculosis, which most commonly
affects the lungs. It is the leading killer from a single infectious agent
worldwide, especially in Asia and Africa. Each year globally, about 1.3 million
people die of TB. Majority of the cases are pulmonary TB (PTB) with
approximately 15% being extra pulmonary (ETB). The infection is an insidious;
chronic process which may take several weeks or months to become clinically
patent. The symptoms of PTB include cough, chest pain and hemoptysis.
Systemic symptoms of TB include fevers,
chills, night sweats, easy fatigability, loss of appetite and weight loss.
Tuberculosis has long been associated with malnutrition. Micronutrients
including Zinc; deficiency is considered to be the most frequent cause of
secondary immunodeficiency and infection related to morbidity such as
tuberculosis. Zinc deficiency affects the host defences in a variety of ways.
It results in decreased phagocytosis and leads to a reduced number of
circulating T-cells and reduced tuberculin reactivity, at least in animals. In
vitro cellular killing by macrophages was found to be reduced during zinc
deficiency and rapidly restored after zinc supplementation. This article aimed
to describe the convalescence of patients with tuberculosis who received Zinc
supplementation in comparison to those that did not during the course of
tuberculosis treatment in Calabar, Cross River State, Nigeria.
Eligible patients (81) out of the 182 assessed were randomized to receive
anti-TB drug regimen plus oral administration of individual zinc, 25 mg daily
for 60 days (intervention group), while the control group received
anti-tuberculosis drug regimen only for 60 days. Both qualitative and
quantitative data were collected. Clinical examination, Karnofsky performance
scale index, direct sputum examination, anthropometric measurements and blood
collection for haematological and zinc assessment were carried out before and 2
months after anti-TB treatment began. The mean serum zinc levels at 2 months of
TB treatment were significantly higher in the intervention group (14.4 ± 0.37
µmol/L) in comparison with the control (12.9 ± 0.37 µmol/L); (p = 0.004). A
significant difference (p = 0.010) in the serum concentrations of zinc was
observed between the two groups when adjustments were made for TB-HIV
co-infection. Risk reduction of about 41% for acid fast bacilli (AFB)
positivity (RR: 0.59; 95% CI 0.23 to 1.46) was observed after 2 months of
anti-TB treatment in favour of the intervention group. There was a significant
improvement in the haematological parameters as evidenced by significant higher
proportion of patients in the intervention group than the control group with
values above the lower ranges for these parameters. Therefore, irrespective of
HIV status in individuals with TB, zinc supplementation significantly increases
clinical outcomes, haematological parameters, improves nutritional status as
proxied by anthropometric indices and leads to faster sputum smear conversion.
The article adds to the growing body of evidence in support of the beneficial
role of zinc in TB control.
Author(s) Details
Regina I. Ejemot-Nwadiaro
Department of Public Health,
Faculty of Allied Medical Sciences, University of Calabar, Nigeria
Edisua H. Itam
Department of Biochemistry,
Faculty of Basic Medical Sciences, University of Calabar, Nigeria.
Prof. Emmanuel N.
Ezedinachi [MD, DTMH]
Calabar Institute of
Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital,
Calabar, Nigeria.
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