[Nutritional status and support in chronic intractable pulmonary tuberculosis].
Nutritional assessment was conducted in 30 patients with chronic, intractable pulmonary tuberculosis. More prevalent and severer protein-energy malnutrition was found in the chronic patients compared with that in newly-diagnosed, drug-sensitive tuberculous bacilli-excreting patients. Duration of excreting bacilli in 163 newly-diagnosed patients was found to be significantly associated with ChE, hypersensitivity reaction to PPD, lymphocytes transformation response to ConA before treatment. The grade of malnutrition was significantly associated with the reduction in delayed-type hypersensitivity response, ratio of CD4/CD8, IL-2 production by peripheral blood mononuclear cells and NK cell activity. Nutritional and immunological spectrum, which was classified with the combination of serum albumin level, hypersensitivity response to DNCB and NK cell activity, was significantly associated with clinical course and manifestations in patients with chronic, intractable pulmonary tuberculosis. TNF-alpha production by peripheral blood monocytes was significantly higher in moderately to mildly-malnourished tuberculous patients than that in healthy controls. TNF-alpha production in patients with severely-malnourished patients was significantly lower than that in healthy controls. Level in TNF-alpha production was inversely related with visceral proteins and the ratio of plasma amino acid BCAA/AAA. In conclusion these findings suggested that nutritional support should be taken in consideration in combination with conventional chemotherapy in treating chronic, intractable pulmonary tuberculosis.
Yoneda
T
T
2nd Department of Internal Medicine, Nara Medical University, Japan.
D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D009752:Nutritional Status; D018529:Nutritional Support; D018088:Tuberculosis, Multidrug-Resistant / Q000378:metabolism* / Q000628:therapy; D014397:Tuberculosis, Pulmonary / Q000378:metabolism* / Q000628:therapy