Effect of malnutrition on radiographic findings and mycobacterial burden in pulmonary tuberculosis

• Published in: PloS one Vol. 14; no. 3; p. e0214011
• Main Authors: Hoyt, Kacie J., Sarkar, Sonali, White, Laura, Joseph, Noyal Mariya, Salgame, Padmini, Lakshminarayanan, Subitha, Muthaiah, Muthuraj, Vinod Kumar, Saka, Ellner, Jerrold J., Roy, Gautam, Horsburgh, C. Robert, Hochberg, Natasha S.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.03.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Alcohol; Ambulatory care; Analysis; Bacteriological Techniques; Biology and Life Sciences; Body mass; Body Mass Index; Body size; Body weight; Case studies; Cavitation; Chest; Chest x-rays; Cohort Studies; Cross-Sectional Studies; Diabetes; Diabetes mellitus; Diagnostic imaging; Disease prevention; Epidemiology; Female; Humans; Illnesses; Immunomodulation; India; Infectious diseases; Lung - diagnostic imaging; Lung - immunology; Lung - microbiology; Lung diseases; Lungs; Male; Malnutrition; Malnutrition - complications; Malnutrition - immunology; Malnutrition - pathology; Medical radiography; Medicine; Medicine and Health Sciences; Middle Aged; Multivariable control; Mycobacterium tuberculosis - growth & development; Mycobacterium tuberculosis - immunology; Mycobacterium tuberculosis - isolation & purification; Overweight; Physical Sciences; Prospective Studies; Pulmonary tuberculosis; Radiographs; Radiography; Regression analysis; Regression models; Risk factors; Smear; Smoking; Studies; Tuberculosis; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - microbiology; Young Adult; India; United States > US; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0214011

The relationship between malnutrition and tuberculosis (TB) severity is understudied. We investigated the effect of malnutrition on radiographic findings and mycobacterial burden. Subjects included newly diagnosed, smear-positive, culture-confirmed, pulmonary TB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort. Multivariate regression models were used to evaluate the relationship at start of treatment between body mass index (BMI) and chest radiograph (CXR) findings of cavitation and percentage of lung affected and mycobacterial growth indicator tube (MGIT) time to positive (TTP). Severe malnutrition was defined as BMI<16 kg/m2, moderate malnutrition as 16-18.4kg/m2, and "normal"/overweight as ≥18.5 kg/m2. Of 173 TB cases with chest x-ray data, 131 (76%) were male. The median age was 45 years (range 16-82); 42 (24%) had severe malnutrition and 58 (34%) moderate malnutrition. Median percentage of lung affected was 32% (range 0-95), and 132 (76%) had cavitation. Individuals with severe malnutrition had, on average, 11.1% [95% CI: 4.0-13.3] more lung affected, compared to those with normal BMI, controlling for diabetes and cavitation. In multivariable analyses, cases with severe malnutrition had a 4.6-fold [95% CI, 1.5-14.1] increased odds of cavitation compared to those with normal BMI, controlling for smoking. Median MGIT TTP was 194.5 hours. Neither severe (aRR 0.99; 95% CI, 0.9-1.2) nor moderate (aRR 0.97; 95% CI, 0.8-1.1) malnutrition was associated with MGIT TTP. We found that malnutrition was associated with increased extent of disease and cavitation on CXR. These findings may reflect the immunomodulatory effect of malnutrition on pulmonary pathology.