Hematological and liver toxicity of anti-tuberculosis drugs
Keywords:
Tuberculosis, Hematological parameters, Liver enzymes, Isoniazid, KhuzestanAbstract
Introduction: Tuberculosis (TB) is a major global health problem, and anti-tuberculosis drugs can cause severe adverse reactions. The aim of this study was to determine hematological and biochemical changes and associated risk factors in smear positive pulmonary tuberculosis patients undergoing treatment with standard protocols.
Methods: In a descriptive study, a total of 40 tuberculosis patients aged between 15-60 years were collected from hospitals in Khuzestan Province (Iran) from March 2013 to March 2014. The patients were treated with drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) during the initial two months, followed by isoniazid and rifampicin for the next four to six months. Activities of liver enzymes (ALT, AST, and ALP) and hematological parameters were recorded before and after treatment. Data were analyzed using paired samples t-test and Wilcoxon test by SPSS 16.
Results: After using drug treatments, hematological parameters (RBC, Hb, HCT, MCV, MCH, and MCHC), except platelet count, were changed significantly (p ≤ 0.001). Liver enzyme activities (ALT, AST, and ALP) were decreased significantly (p ≤ 0.001) after treatment.
Conclusion: In this study, changes of hematological and biochemical parameters have been observed in patients with pulmonary tuberculosis. It can be concluded that the anti-tuberculosis treatment is associated with changes of hematological parameters and liver enzymes.
References
Baddeley A, Dean A, Monica-Dias H, Falzon D, Floyd K, Garcia I. Global Tuberculosis Report 2013.
World Health Organization. 2013; 306.
Shafee M, Abbas F, Ashraf M, Mengal MA, Kakar N, Ahmad Z, et al. Hematological profile and risk
factors associated with pulmonary tuberculosis patients in Quetta, Pakistan. Pak J Med Sci. 2014; 30(1):
-40. doi: 10.12669/pjms.301.4129. PMID: 24639827, PMCID: PMC3955538.
Shih TY, Pai CY, Yang P, Chang WL, Wang NC, Hu OY. A novel mechanism underlies the hepatotoxicity
of pyrazinamide. Antimicrob Agents Chemother. 2013; 57(4): 1685-90. doi: 10.1128/AAC.01866-12.
PMID: 23357778, PMCID: PMC3623344.
Al-muhammadi MO, Hayder A-S. Studying Some Hematological Changes in Patients with Pulmonary
Tuberculosis in Babylon Governorate. Medical Journal of Babylon. 2011; 8(4).
Sonika U, Kar P. Tuberculosis and liver disease: management issues. Trop Gastroenterol. 2012; 33(2): 102- 6. doi: 10.7869/tg.2012.25. PMID: 23025055.
Rattan A, Kalia A, Ahmad N. Multidrug-resistant Mycobacterium tuberculosis: Molecular perspectives.
Emerg Infect Dis. 1998; 4(2): 195-209. doi: 10.3201/eid0402.980207. PMID: 9621190, PMCID:
PMC2640153.
Chen Y, Tang Y, Guo C, Wang J, Boral D, Nie D. Nuclear receptors in the multidrug resistance through the
regulation of drug-metabolizing enzymes and drug transporters. Biochem Pharmacol. 2012; 83(8): 1112- 26. doi: 10.1016/j.bcp.2012.01.030. PMID: 22326308, PMCID: PMC3339266.
Merza MA, Farnia P, Tabarsi P, Khazampour M, Masjedi MR, Velayati AA. Anti-tuberculosis drug
resistance and associated risk factors in a tertiary level TB center in Iran: a retrospective analysis. J Infect
Dev Ctries. 2011; 5(7): 511-9. doi: 10.3855/jidc.1259. PMID: 21795819.
Lenaerts AJ, Johnson CM, Marrieta KS, Gruppo V, Orme IM. Significant increases in the levels of liver
enzymes in mice treated with anti-tuberculosis drugs. Int J Antimicrob Agents. 2005; 26(2): 152-8. doi:
1016/j.ijantimicag.2005.04.011. PMID: 15953708.
Oliva VM, Cezario GAG, Cocato RA, Marcondes-Machado J. Pulmonary Tuberculosis: Hematology,
Serum Biochemistry and the Relation with the Disease Duration. Biotechnology. 2008; 14(1): 71-8. doi:
1590/S1678-91992008000100006.
Sharma SK. Antituberculosis drugs and hepatotoxicity. Infect Genet Evol. 2004; 4(2): 167-70. doi:
1016/j.meegid.2003.01.001. PMID: 15157635.
Shirali S, Zahra Bathaie S, Nakhjavani M. Effect of Crocin on the Insulin Resistance and Lipid Profile of
Streptozotocin‐Induced Diabetic Rats. Phytother Res. 2013; 27(7): 1042-7. doi: 10.1002/ptr.4836. PMID:
Ebrahimi E, Shirali S, Talaei R. The Protective Effect of Marigold Hydroalcoholic Extract in STZ-Induced
Diabetic Rats: Evaluation of Cardiac and Pancreatic Biomarkers in the Serum. Journal of Botany. 2016; 6.
doi: 10.1155/2016/9803928.
Hosseini A, Gorjian M, Rasouli L, Shirali S. A Comparison between the Effect of Green Tea and
Kombucha Prepared from Green Tea on the Weight of Diabetic Rats. Biosceces Biotechnology Research
Asia. 2015; 12: 141-6. doi: 10.13005/bbra/1616.
Barari AR, Alavi H, Shirali S, Ghanaian F. Effect of short-term endurance training and silymarin
consumption on some of preinflammatory cytokines, growth mediators and immune system performance.
Annals of Biological Research. 2012; 3(6): 2933-7.
Akpan Patience A, Akpotuzor Josephine O, Akwiwu Ephoria C. Some haematological parameters of
tuberculosis infected Nigerians: A study in Calabar-Nigeria. Global Journal of Pure and Applied Sciences.
Bachudo Science Company Limited. 2013; 19(1): 95-100.
Taramian S, Joukar F, Asgharnezhad M, Biabani A, Mansour Ghanaei F. Side Effects of First-line Anti
Tuberculosis Drugs. Journal of Guilan University of Medical Sciences. 2012; 85(2): 42-7.
Khalili H, Dashti-Khavidaki S, Rasoolinejad M, Rezaie L, Etminani M. Anti-tuberculosis drugs related
hepatotoxicity; incidence, risk factors, pattern of changes in liver enzymes and outcome. DARU- Journal of
Faculty of Pharmacy, Tehran University of Medical Sciences. 2009; 17(3): 163-7..
Shareef HA. Abnormalities of hematological parameters in newly diagnosed Pulmonary tuberculosis
patients in Kirkuk city. Pakistan journal of medical sciences. 2012; 20(5): 1486-92.
Kumar S, Saxena K, Pharm IJ, Bio S, Singh UN, Saxena R. Comparative study of acute proteins in case of
Anemia of Chronic Disease (ACD) and Iron Deficiency Anemia (IDA) and its relationship whit
erythropoietin. International Journal of Pharmacy and Biological Sciences. 2013; 3(3): 323-8.
Thatoi PK, Khadanga S. Pulmonary Tuberculosis and its hematological correlates. Transworld Medical
Journal environment. 2013; 7(1): 8.
Yaranal PJ, Umashankar T, Govindareddy S. Hematological Profile in Pulmonary Tuberculosis. Int J
Health Rehabil Sci. 2013; 2(1): 50-5.
Muzaffar TM, Shaifuzain AR, Imran Y, Haslina MN. Hematological changes in tuberculous spondylitis
patients at the Hospital Universiti Sains Malaysia. Southeast Asian J Trop Med Public Health. 2008; 39(4):
–9. PMID: 19058606.
Al-Omar I, Al-Ashban R, Shah A. Hematological abnormalities in Saudis suffering from pulmonary
Tuberculosis and their response to the treatment. Research journal of pharmacology. 2009; 3(4): 78–85.
Kannan S, Kumar S. Hematological Observation in Tuberculosis and their Response to the Treatment.
Journal of Academic and Applied Studiesournal of Hospital and Clinical Pharmacy. 2011; 1(4): 19–24.
Ukpe IS, Southern L. Erythrocyte sedimentation rate values in active tuberculosis with and without HIV
co-infection. S Afr Med J. 2006; 96(5): 427–8. PMID: 16751918.
Mugusi S, Ngaimisi E, Janabi M, Minzi O, Bakari M, Riedel KD, et al. Liver enzyme abnormalities and
associated risk factors in HIV patients on efavirenz-based HAART with or without tuberculosis coinfection in Tanzania. PLoS ONE. 2012; 7(7): 1–9. doi: 10.1371/journal.pone.0040180. PMID: 22808112,
PMCID: PMC3394799.
Dharmik P, Gomashe A, Dolas R, Dhargave T. Effect of antituberculosis treatment on human liver.
International journal of Pharma Sciences and Research (IJPSR). 2013; 4(2): 5-9.
Jadhav AA, Bardapurkar JS, Jain A. Alkaline phosphatase: Distinguishing between tuberculous and
nontuberculous pleural effusion. Lung India. 2009; 26(3): 77-80. doi: 10.4103/0970-2113.53230. PMID:
, PMCID: PMC2862511.
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