Higher Neutrophil-lymphocyte Ratio in TB/HIV Co-infection Compared to Pulmonary Tuberculosis
Abstract
BACKGROUND: Neutrophils and lymphocytes play a significant role in inflammation and a high ratio of neutrophils over lymphocytes (NLR) has been used as an inflammatory marker to predict the severity of various diseases. Here we compared the NLR among pulmonary tuberculosis and TB/HIV co-infection.
METHODS: A retrospective cross-sectional study was conducted, included patients with pulmonary TB without cavitation TB (n=50), with cavitation TB (n=50) and HIV co-infection (n=27). Complete blood count was examined, including neutrophils and lymphocyte. NLR was calculated and compared between groups.
RESULTS: Neutrophils were significantly higher (p=0.004) in TB with cavitation compared to those with no cavitation (8.27±1.45 x103/μL vs. 6.61±1.4 x103/μL, respectively); whereas the lymphocytes were similar in both groups, resulting in a significantly higher NLR (p=0.009) in pulmonary TB with cavitation compared to pulmonary TB with no cavitation (5.98±1.85 vs. 4.42±1.86, respectively). On the contrary, both neutrophils as well as lymphocyte were significantly lower in TB/HIV compared to pulmonary TB, which for neutrophil were 5.14±2.19 x103/μL vs. 7.4±1.45 x103/μL, respectively (p=0.003) and for lymphocyte (1.02 ±0.57 x103/μL vs. 1.57±0.64 x103/μL, respectively (p=0.001), resulting in a significantly higher (p=0.041) NLR value in TB/HIV (6.05±2.67) compared to pulmonary TB (5.16±1.88).
CONCLUSION: High NLR in pulmonary TB with cavitation as well as in TB with HIV co-infection may be of great interest for biomarker in TB severity. Further study confirming NLR as potential marker is imperative.
KEYWORDS: lymphocyte, neutrophil, NLR, tuberculosis, TB/HIV
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World Health Organization. Global Tuberculosis Report. Geneva: World Health Organization; 2020, article.
Cohen SB, Gern BH, Delahaye JL, Adams KN, Plumlee CR, Winkler JK, et al. Alveolar macrophages provide an early Mycobacterium tuberculosis niche and initiate dissemination. Cell Host Microbe. 2018; 24: 439-46.e4, CrossRef.
Ito T, Connett JM, Kunkel SL, Matsukawa A. The linkage of innate and adaptive immune response during granulomatous development. Front Immunol. 2013; 4: 10, CrossRef.
Sershen CL, Plimpton SJ, May EE. Oxygen modulates the effectiveness of granuloma mediated host response to Mycobacterium tuberculosis: a multiscale computational biology approach. Front Cell Infect Microbiol. 2016; 6: 6, CrossRef.
Carow B, Hauling T, Qian X, Kramnik I, Nilsson M, Rottenberg ME. Spatial and temporal localization of immune transcripts defines hallmarks and diversity in the tuberculosis granuloma. Nat Commun. 2019; 10: 1823, CrossRef.
Marino S, Cilfone NA, Mattila JT, Linderman JJ, Flynn JL, Kirschner DE. Macrophage polarization drives granuloma outcome during Mycobacterium tuberculosis infection. Infect Immun. 2015; 83: 324-38, CrossRef.
Muefong CN, Sutherland JS. Neutrophils in tuberculosis-associated inflammation and lung pathology. Front Immunol. 2020; 11: 962, CrossRef.
Warren E, Teskey G, Venketaraman V. Effector mechanisms of neutrophils within the innate immune system in response to Mycobacterium tuberculosis infection. J Clin Med. 2017; 6: 15, CrossRef.
Liu CH, Liu H, Ge B. Innate immunity in tuberculosis: host defense vs pathogen evasion. Cell Mol Immunol. 2017; 14: 963-75, CrossRef.
Urbanowski ME, Ordonez AA, Ruiz-Bedoya CA, Jain SK, Bishai WR. Cavitary tuberculosis: the gateway of disease transmission. Lancet Infect Dis. 2020; 20: e117-28, CrossRef.
Bruchfeld J, Correia-Neves M, Källenius G. Tuberculosis and HIV coinfection. Cold Spring Harb Perspect Med. 2015; 5: a017871, CrossRef.
Huante MB, Saito TB, Nusbaum RJ, Naqvi KF, Chauhan S, Hunter RL, et al. Small animal model of post-chemotherapy tuberculosis relapse in the setting of HIV co-infection. Front Cell Infect Microbiol. 2020; 10: 150, CrossRef.
Muema DM, Mthembu M, Schiff AE, Singh U, Corleis B, Chen D, et al. Contrasting inflammatory signatures in peripheral blood and bronchoalveolar cells reveal compartment-specific effects of HIV infection. Front Immunol. 2020; 11: 864, CrossRef.
Tornheim JA, Dooley KE. Tuberculosis associated with HIV infection. Microbiol Spectr. 2017; 5: [n.p], CrossRef.
Desalegn G, Tsegaye A, Gebreegziabiher D, Aseffa A, Howe R. Enhanced IFN-γ, but not IL-2, response to Mycobacterium tuberculosis antigens in HIV/latent TB co-infected patients on long-term HAART. BMC Immunol. 2019; 20: 35, CrossRef.
Quiros-Roldan E, Raffetti E, Donato F, Magoni M, Pezzoli C, Ferraresi A, et al. Neutrophil to lymphocyte ratio and cardiovascular disease incidence in HIV-infected patients: a population-based cohort study. PLoS One. 2016; 11: e0154900, CrossRef.
Oehadian A, Suryadinata H, Dewi S, Pramudyo R, Alisjahbana B. The role of neutrophyl lymphocyte count ratio as an inflammatory marker in systemic lupus erythematosus. Acta Med Indones. 2013; 45: 170-4, PMID.
Leem AY, Song JH, Lee EH, Lee H, Sim B, Kim SY, et al. Changes in cytokine responses to TB antigens ESAT-6, CFP-10 and TB 7.7 and inflammatory markers in peripheral blood during therapy. Sci Rep. 2018; 8: 1159, CrossRef.
Miyahara R, Piyaworawong S, Naranbhai V, Prachamat P, Kriengwatanapong P, Tsuchiya N, et al. Predicting the risk of pulmonary tuberculosis based on the neutrophil-to-lymphocyte ratio at TB screening in HIV-infected individuals. BMC Infect Dis. 2019; 19: 667, CrossRef.
Yin Y, Kuai S, Liu J, Zhang Y, Shan Z, Gu L, et al. Pretreatment neutrophil-to-lymphocyte ratio in peripheral blood was associated with pulmonary tuberculosis retreatment. Arch Med Sci. 2017; 13: 404-11, CrossRef.
Ştefanescu S, Cocoş R, Turcu-Stiolica A, Mahler B, Meca AD, Giura AMC, et al. Evaluation of prognostic significance of hematological profiles after the intensive phase treatment in pulmonary tuberculosis patients from Romania. PLoS One. 2021; 16: e0249301, CrossRef.
Han Y, Kim SJ, Lee SH, Sim YS, Ryu YJ, Chang JH, et al. High blood neutrophil-lymphocyte ratio associated with poor outcomes in miliary tuberculosis. J Thorac Dis. 2018; 10: 339-46, CrossRef.
Moreira-Teixeira L, Mayer-Barber K, Sher A, O'Garra A. Type I interferons in tuberculosis: Foe and occasionally friend. J Exp Med. 2018; 215: 1273-85, CrossRef.
Meintjes G, Brust JCM, Nuttall J, Maartens G. Management of active tuberculosis in adults with HIV. Lancet HIV. 2019; 6: e463-74, CrossRef.
Singh KP, Crane M, Audsley J, Avihingsanon A, Sasadeusz J, Lewin SR. HIV-hepatitis B virus coinfection: epidemiology, pathogenesis, and treatment. AIDS. 2017; 31: 2035-52, CrossRef.
Frischknecht F, Fackler OT. Experimental systems for studying Plasmodium/HIV coinfection. FEBS Lett. 2016; 590: 2000-13, CrossRef.
Sohrab SS, Suhail M, Ali A, Qadri I, Harakeh S, Azhar EI. Consequence of HIV and HCV co-infection on host immune response, persistence and current treatment options. Virusdisease. 2018; 29: 19-26, CrossRef.
DOI: https://doi.org/10.18585/inabj.v13i4.1698
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