Background:The diagnosis of tuberculosis (TB) is frequently challenging given that
the clinical and radiographic features of TB are often nonspecific. Altered
leukocyte count ratios could serve as new tools of diagnostic orientation of
tuberculosis. The aim of this study was to assess the diagnostic value of the
leukocyte count ratios for the diagnosis of TB. Methods: This was a
cross-sectional study including cases of newly diagnosed TB patients from
registers of the TB treatment center of the Douala General Hospital. Control
subjects were healthy volunteers, age and sex matched, recruited at the blood
bank. Sociodemographic, clinical data and peripheral blood parameters were
collected. The diagnostic value of leukocyte counts was determined using
receiver operating characteristics curve analysis. Results: In total,
204 TB patients and 204 control subjects were included in the study. The gender
of the participants was equitably distributed in the 2 study groups (male 61.8%;
female 38.2%). The median age of TB patients was 33 years while that of
control patients was 32 years. The monocyte-lymphocyte count ratio (MLR) and neutrophil-lymphocyte
count ratio (NLR) were significantly higher in the TB patients group compared
to control group. A NLR>1.19 and MLR>0.29 were identified as cut-off values for discriminating TB
patients. The areas under the curves (AUC) were 0.77 and 0.84 for the MLR and
NLR respectively. Conclusion: A raised NLR> 1.19 and MLR
References
[1]
World Health Organization (2016) Global Tuberculosis Report. Geneva, Switzerland.
[2]
Zumla, A., George, A., Sharma, V., Herbert, R.H.N., Baroness Masham of Ilton, Oxley, A., et al. (2015) The WHO 2014 Global Tuberculosis Report-Further to Go. The Lancet Global Health, 3, e10-e12. https://doi.org/10.1016/S2214-109X(14)70361-4
[3]
Noeske, J., Nana Yakam, A. and Abena Foe, J.-L. (2016) Epidemiology of Tuberculosis in Cameroon as Mirrored in Notification Data, 2006-2014. The International Journal of Tuberculosis and Lung Disease, 20, 1489-1494. https://doi.org/10.5588/ijtld.16.0252
[4]
Wang, J., Yin, Y., Wang, X., Pei, H., Kuai, S., Gu, L., et al. (2015) Ratio of Monocytes to Lymphocytes in Peripheral Blood in Patients Diagnosed with Active Tuberculosis. The Brazilian Journal of Infectious Diseases, 19, 125-131. https://doi.org/10.1016/j.bjid.2014.10.008
[5]
Eum, S.-Y., Kong, J.-H., Hong, M.-S., Lee, Y.-J., Kim, J.-H., Hwang, S.-H., et al. (2010) Neutrophils Are the Predominant Infected Phagocytic Cells in the Airways of Patients with Active Pulmonary TB. Chest, 137, 122-128. https://doi.org/10.1378/chest.09-0903
[6]
Naranbhai, V., Hill, A.V.S., Abdool Karim, S.S., Naidoo, K., Abdool Karim, Q., Warimwe, G.M., et al. (2014) Ratio of Monocytes to Lymphocytes in Peripheral Blood Identifies Adults at Risk of Incident Tuberculosis among HIV-Infected Adults Initiating Antiretroviral Therapy. The Journal of Infectious Diseases, 209, 500-509. https://doi.org/10.1093/infdis/jit494
[7]
Lowe, D.M., Redford, P.S., Wilkinson, R.J., O’Garra, A. and Martineau, A.R. (2012) Neutrophils in Tuberculosis: Friend or Foe? Trends in Immunology, 33, 14-25. https://doi.org/10.1016/j.it.2011.10.003
[8]
Iliaz, S., Iliaz, R., Ortakoylu, G., Bahadir, A., Bagci, B. and Caglar, E. (2014) Value of Neutrophil/Lymphocyte Ratio in the Differential Diagnosis of Sarcoidosis and Tuberculosis. Annals of Thoracic Medicine, 9, 232-235. https://doi.org/10.4103/1817-1737.140135
[9]
Yoon, N.-B., Son, C. and Um, S.-J. (2013) Role of the Neutrophil-Lymphocyte Count Ratio in the Differential Diagnosis between Pulmonary Tuberculosis and Bacterial Community-Acquired Pneumonia. Annals of Laboratory Medicine, 33, 105-110. https://doi.org/10.3343/alm.2013.33.2.105
[10]
Odubanjo, M.O. and Dada-Adegbola, H.O. (2011) The Microbiological Diagnosis of Tuberculosis in a Resource-Limited Setting: Is Acid-Fast Bacilli Microscopy Alone Sufficient? Annals of Ibadan Postgraduate Medicine, 9, 24-29. https://doi.org/10.4314/aipm.v9i1.72431
[11]
Shea, Y.R., Davis, J.L., Huang, L., Kovacs, J.A., Masur, H., Mulindwa, F., et al. (2009) High Sensitivity and Specificity of Acid-Fast Microscopy for Diagnosis of Pulmonary Tuberculosis in an African Population with a High Prevalence of Human Immunodeficiency Virus. Journal of Clinical Microbiology, 47, 1553-1555. https://doi.org/10.1128/JCM.00348-09
[12]
Farnia, P., Mohammadi, F., Zarifi, Z., Tabatabee, D.J., Ganavi, J., Ghazisaeedi, K., et al. (2002) Improving Sensitivity of Direct Microscopy for Detection of Acid-Fast Bacilli in Sputum: Use of Chitin in Mucus Digestion. Journal of Clinical Microbiology, 40, 508-511. https://doi.org/10.1128/JCM.40.2.508-511.2002
[13]
Ministère de la santé publique (2012) Programme National de Lutte contre la Tuberculose. Guide technique pour le personnel de santé. Yaoundé, Cameroun.
[14]
Iqbal, S., Ahmed, U. and Khan, M.A. (2015) Haematological Parameters Altered in Tuberculosis. Pakistan Journal of Physiology, 11, 13-16.
[15]
Goodman, D.A., Goodman, C.B. and Monk, J.S. (1995) Use of the Neutrophil: Lymphocyte Ratio in the Diagnosis of Appendicitis. The American Surgeon, 61, 257-259.
[16]
Zahorec, R. (2001) Ratio of Neutrophil to Lymphocyte Counts-Rapid and Simple Parameter of Systemic Inflammation and Stress in Critically Ill. Bratislavské lekárske listy, 102, 5-14.
[17]
de Jager, C.P., van Wijk, P.T., Mathoera, R.B., de Jongh-Leuvenink, J., van der Poll, T. and Wever, P.C. (2010) Lymphocytopenia and Neutrophil-Lymphocyte Count Ratio Predict Bacteremia Better Than Conventional Infection Markers in an Emergency Care Unit. Critical Care, 14, R192. https://doi.org/10.1186/cc9309
[18]
Gibson, P.H., Croal, B.L., Cuthbertson, B.H., Small, G.R., Ifezulike, A.I., Gibson, G., et al. (2007) Preoperative Neutrophil-Lymphocyte Ratio and Outcome from Coronary Artery Bypass Grafting. American Heart Journal, 154, 995-1002. https://doi.org/10.1016/j.ahj.2007.06.043
[19]
Sarraf, K.M., Belcher, E., Raevsky, E., Nicholson, A.G., Goldstraw, P. and Lim, E. (2009) Neutrophil/Lymphocyte Ratio and Its Association with Survival after Complete Resection in Non-Small Cell Lung Cancer. The Journal of Thoracic and Cardiovascular Surgery, 137, 425-428. https://doi.org/10.1016/j.jtcvs.2008.05.046
[20]
Baldridge, M.T., King, K.Y., Boles, N.C., Weksberg, D.C. and Goodell, M.A. (2010) Quiescent Haematopoietic Stem Cells Are Activated by IFN-γ in Response to Chronic Infection. Nature, 465, 793-797. https://doi.org/10.1038/nature09135
[21]
Das, B., Kashino, S.S., Pulu, I., Kalita, D., Swami, V., Yeger, H., et al. (2013) CD271+ Bone Marrow Mesenchymal Stem Cells May Provide a Niche for Dormant Mycobacterium Tuberculosis. Science Translational Medicine, 5, 170ra13. https://doi.org/10.1126/scitranslmed.3004912
[22]
Müller-Sieburg, C.E., Cho, R.H., Thoman, M., Adkins, B. and Sieburg, H.B. (2002) Deterministic Regulation of Hematopoietic Stem Cell Self-Renewal and Differentiation. Blood, 100, 1302-1309. https://doi.org/10.1182/blood.V100.4.1302.h81602001302_1302_1309
[23]
Pang, W.W., Price, E.A., Sahoo, D., Beerman, I., Maloney, W.J., Rossi, D.J., et al. (2011) Human Bone Marrow Hematopoietic Stem Cells Are Increased in Frequency and Myeloid-Biased with Age. Proceedings of the National Academy of Sciences of the United States of America, 108, 20012-20017. https://doi.org/10.1073/pnas.1116110108
[24]
Muller-Sieburg, C.E., Sieburg, H.B., Bernitz, J.M. and Cattarossi, G. (2012) Stem Cell Heterogeneity: Implications for Aging and Regenerative Medicine. Blood, 119, 3900-3907. https://doi.org/10.1182/blood-2011-12-376749
[25]
Schroeder, T. (2010) Hematopoietic Stem Cell Heterogeneity: Subtypes, Not Unpredictable Behavior. Cell Stem Cell, 6, 203-207. https://doi.org/10.1016/j.stem.2010.02.006
