P215 Lymphocyte levels association with bacterial load and pulmonary lesion form in MDR TB patient

• Published in: Thorax Vol. 73; no. Suppl 4; p. A218
• Main Authors: Vidiast, F, Pratiwi, AP, Irbah, SN, Handayani, D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.12.2018
• Subjects: Diabetes; Hospitals; Lymphocytes; Mortality; Patients; Thorax; Tuberculosis; Indonesia
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2018-212555.372

Background and aimsMulti-drug resistant tuberculosis (MDR TB) is still a burden in Indonesia. There were 2.293 of cases registered in 2016 with only 54% of succeeded treatment in 2014. This disease severity shown in various manifestation, including bacterial load and lesion form. Many research has mentioned the great role of CD4 T lymphocyte in representing these manifestations. However, measuring CD4 T lymphocyte is still beyond Indonesian clinical practice. This study aims to analyze whether the regularly done lymphocyte levels measurement has association with these disease severities for its role in managing the disease.MethodsThis study uses cross-sectional design and 99 subjects from consecutive sampling at the biggest center of MDR TB in Indonesia during May-September 2017. Subjects were diagnosed by Xpert MTB/Rif. The lymphocyte count and chest x-ray were conducted before treatment. Lymphocyte count was divided into 2 categories (normal, under normal) then its associations with bacterial load (positive, negative) and pulmonary lesion form (cavitary, no cavitary) were analyzed by chi-square using SPSS version 20.ResultsThere were 54 males and 45 females in 41.9±11.4 average of age. Majority of subjects has lymphocyte levels under normal (67.6%),+2 bacterial load (27.3%), no cavitary lesion (57.6%), and no diabetes (66.7%). Significant association of under normal lymphocyte level with positive bacterial load was found (p=0.008) while cavitary lesion shows otherwise (p=0.854). Therefore, the crosstabulation shows there are proportional differences in each relation, which are 73.2% and 16.4% respectively.ConclusionIt is possible to use lymphocyte level as a representation of disease severity in bacterial load aspect. Not being the major determinant of cavitary formation might underlie its insignificant finding in association with pulmonary lesion form. Majority of subjects has under normal lymphocyte level which indicates that MDR TB patient encounters immunity problem. Therefore, it should be included in the focus when treating the patients.