Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection

doi:10.1186/1471-2334-8-146

BMC Infectious Diseases

Volume 8

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Idh J
Westman A
Elias D
Moges F
Getachew A
Gelaw A
Sundqvist T
Forslund T
Alemu A
Ayele B
Diro E
Melese E
Wondmikun Y
Britton S
Stendahl O
Schön T

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Idh J
Westman A
Elias D
Moges F
Getachew A
Gelaw A
Sundqvist T
Forslund T
Alemu A
Ayele B
Diro E
Melese E
Wondmikun Y
Britton S
Stendahl O
Schön T
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Research article

Nitric oxide production in the exhaled air of patients with pulmonary tuberculosis in relation to HIV co-infection

Jonna Idh¹ , Anna Westman⁵ , Daniel Elias³^,4 , Feleke Moges⁶ , Assefa Getachew⁶ , Aschalew Gelaw⁶ , Tommy Sundqvist¹ , Tony Forslund¹ , Addis Alemu⁶ , Belete Ayele⁶ , Ermias Diro⁶ , Endalkachew Melese⁶ , Yared Wondmikun⁶ , Sven Britton⁷ , Olle Stendahl¹ and Thomas Schön¹^,2

¹Department of Medical Microbiology, Faculty of Health Sciences, Linköping University, 581 85 Linköping, Sweden

²Department of Clinical Microbiology, Kalmar County Hospital, 391 85 Kalmar, Sweden

³Armauer Hansen Research Institute, P.O. Box 1005, Addis Ababa, Ethiopia

⁴Microbiology and Tumour Biology Centre, Karolinska Institute, 171 77 Stockholm, Sweden

⁵Department of Clinical Microbiology, Karolinska Hospital, 171 76 Stockholm, Sweden

⁶Gondar College of Medical and Health Sciences, Gondar University, P.O. Box 196, Gondar, Ethiopia

⁷Department of Infectious Diseases, Karolinska Hospital, 171 76 Stockholm, Sweden

author email corresponding author email

BMC Infectious Diseases 2008, 8:146doi:10.1186/1471-2334-8-146


Published:	24 October 2008

Abstract

Background

Nitric oxide (NO) is essential for host defense in rodents, but the role of NO during tuberculosis (TB) in man remains controversial. However, earlier observations that arginine supplementation facilitates anti-TB treatment, supports the hypothesis that NO is important in the host defense against TB. Local production of NO measured in fractional exhaled air (FeNO) in TB patients with and without HIV co-infection has not been reported previously. Thus, our aim was to investigate levels of FeNO in relation to clinical symptoms and urinary NO metabolites (uNO).

Methods

In a cross sectional study, FeNO and uNO were measured and clinical symptoms, chest x-ray, together with serum levels of arginine, tumor necrosis factor alpha (TNF-alpha) and interleukin 12 (IL-12) were evaluated in sputum smear positive TB patients (HIV+/TB, n = 36, HIV-/TB, n = 59), their household contacts (n = 17) and blood donors (n = 46) from Gondar University Hospital, Ethiopia.

Results

The proportion of HIV-/TB patients with an increased FeNO level (> 25 ppb) was significantly higher as compared to HIV+/TB patients, but HIV+/TB patients had significantly higher uNO than HIV-/TB patients. HIV+ and HIV-/TB patients both had lower levels of FeNO compared to blood donors and household contacts. The highest levels of both uNO and FeNO were found in household contacts. Less advanced findings on chest x-ray, as well as higher sedimentation rate were observed in HIV+/TB patients as compared to HIV-/TB patients. However, no significant correlation was found between FeNO and uNO, chest x-ray grading, clinical symptoms, TNF-alpha, IL-12, arginine levels or sedimentation rate.

Conclusion

In both HIV negative and HIV co infected TB patients, low levels of exhaled NO compared to blood donors and household were observed. Future studies are needed to confirm whether low levels of exhaled NO could be a risk factor in acquiring TB and the relative importance of NO in human TB.