Plasma vitamins and essential trace elements in multi-drug resistant tuberculosis patients before and during chemotherapy

Multi-drug-resistant tuberculosis (MDR-TB) is caused by Mycobacterium tuberculosis (Mtb) strain resistant to both rifampicin and isoniazid. Nigeria has an estimated MDR-TB rate of 2.9% and 14.3% among new and relapse cases respectively and is ranked among 4 high burden African countries for MDR-TB. Malnutrition has been implicated in the progression from dormant to active disease. This study determined the plasma level of micronutrients (Fe, Zn, Cu, vitamins A, C, D and E) in MDR-TB patients before and throughout anti-TB chemotherapy. Plasma iron, zinc, copper, vitamins A, C, D and E were determined in twenty-four (24) MDR-TB patients before the commencement of anti-TB chemotherapy, 2 months, 4 months and 6 months post-commencement of anti-TB chemotherapy, as well as in twenty (20) healthy controls. Plasma vitamin A level was significantly decreased before chemotherapy compared with controls. At 2 months of anti-TB treatment there were significant decreases in plasma levels of iron, vitamins A, C and E compared to controls whereas plasma zinc level was significantly increased compared with levels before treatment. At 4 months of treatment, plasma levels of copper and vitamin D were significantly increased while plasma vitamin E level was reduced significantly compared with controls. There were significant increases in iron, zinc, copper, vitamin A and vitamin D levels with decreased plasma levels of vitamins C and E at 4 months of treatment compared with their levels before chemotherapy. At 6 months of treatment, plasma levels of iron, zinc, copper and vitamin D were significantly increased while vitamin E was significantly decreased compared with controls. Plasma levels of iron, zinc, copper, vitamins A and D were significantly increased whereas the levels of vitamins C and E were significantly reduced at 6 months of treatment compared with levels before chemotherapy. Plasma levels of iron, zinc, copper, vitamins A and D were raised while plasma levels of vitamins E and C were reduced in MDR-TB patients from 4 months post commencement of anti-TB chemotherapy. Thus, there is need to monitor micronutrient supplementation and plasma levels of these micronutrients to avoid complications associated with overload or deficiency.