Back
 JTR  Vol.8 No.1 , March 2020
Impact of Pulmonary Tuberculosis Activity on Exhaled Breath Markers Levels in the Egyptian Population
Abstract: Introduction: Tuberculosis still characterizes till now a major respiratory insult with concurrent pulmonary manifestations and later disability. Aim of Work: To evaluate the level of exhaled fraction of nitric oxide (FENO) and fraction of exhaled carbon monoxide (FECO) as markers of pulmonary tuberculosis TB activity in patients under chemotherapy in comparison to healthy negative patients and latent TB patients. Patients and Methods: This cross-sectional study was conducted on 130 patients recruited from the outpatient clinic of Mansoura Chest hospital during the period from May 2019 to December 2019. They were categorized into the three groups: 1) Pulmonary tuberculous patients PTB (group1) which included 48 cases with positive sputum for TB bacilli in the initiation phase after 1 month of starting anti-tuberculous chemotherapy; 2) Latent patients (group 2): included 40 patients with positive tuberculin skin test (Mantoux test) > 10 mm. 3) Control patients (group 3) which included 42 healthy volunteers with negative sputum for TB bacilli. They were subjected to portable spirogram as well as exhaled fractional NO and CO measurement. Results: FECO and FENO levels prevailed in pulmonary TB patients followed by Latent TB patients and lastly healthy volunteers (42 ± 12.32/5 ± 0.16 & 38 ± 8.25/6 ± 2.25 and 23 ± 3.25/2 ± 0.40 respectively). Conclusion: Measurement of CO and NO level in expired air may correlate with active pulmonary TB infection in comparison to healthy negative tuberculous patients and latent tuberculous patients.
Cite this paper: Abumossalam, A. , Ehab, A. , Elhalaby, H. , Mohamad, M. , Elhadidy, T. (2020) Impact of Pulmonary Tuberculosis Activity on Exhaled Breath Markers Levels in the Egyptian Population. Journal of Tuberculosis Research, 8, 22-32. doi: 10.4236/jtr.2020.81003.
References

[1]   Parsons, L.M., et al. (2011) Laboratory Diagnosis of Tuberculosis in Resource-Poor Countries: Challenges and Opportunities. Clinical Microbiology Reviews, 24, 314-350.
https://doi.org/10.1128/CMR.00059-10

[2]   Lawn, S.D. (2012) Point-of-Care Detection of Lipoarabinomannan (LAM) in Urine for Diagnosis of HIV-Associated Tuberculosis: A State of the Art Review. BMC Infectious Diseases, 12, Article No. 103.
https://doi.org/10.1186/1471-2334-12-103

[3]   Boots, A.W., Van Berkel, J.J.B.N., Dallinga, J.W., Smolinska, A., Wouters, E.F. and Van Schooten, F.J. (2012) The Versatile Use of Exhaled Volatile Organic Compounds in Human Health and Disease. Journal of Breath Research, 6, Article ID: 027108.
https://doi.org/10.1088/1752-7155/6/2/027108

[4]   Kolk, A.H.J., et al. (2012) Breath Analysis as a Potential Diagnostic Tool for Tuberculosis. The International Journal of Tuberculosis and Lung Disease, 16, 777-782.
https://doi.org/10.5588/ijtld.11.0576

[5]   Dang, N.A., Janssen, H.G. and Kolk, A.H.J. (2013) Rapid Diagnosis of TB Using GC-MS and Chemometrics. Bioanalysis, 5, 3079-3097.
https://doi.org/10.4155/bio.13.288

[6]   Beccaria, M., et al. (2018) Preliminary Investigation of Human Exhaled Breath for Tuberculosis Diagnosis by Multidimensional Gas Chromatography—Time of Flight Mass Spectrometry and Machine Learning. Journal of Chromatography B, 1074-1075, 46-50.
https://doi.org/10.1016/j.jchromb.2018.01.004

[7]   Horváth, I., et al. (2017) A European Respiratory Society Technical Standard: Exhaled Biomarkers in Lung Disease. European Respiratory Journal, 49, Article ID: 1600965.
https://doi.org/10.1183/13993003.00965-2016

[8]   Das, M.K., et al. (2014) Investigation of Gender-Specific Exhaled Breath Volatome in Humans by GCxGC-TOF-MS. Analytical Chemistry, 86, 1229-1237.
https://doi.org/10.1021/ac403541a

[9]   Blanchet, L., et al. (2017) Factors That Influence the Volatile Organic Compound Content in Human Breath. Journal of Breath Research, 11, Article ID: 016013.
https://doi.org/10.1088/1752-7163/aa5cc5

[10]   Wang, C.-H., et al. (1998) Increased Exhaled Nitric Oxide in Active Pulmonary Tuberculosis Due to Inducible NO Synthase Up-Regulation in Alveolar Macrophages. European Respiratory Journal, 11, 809-815.
https://doi.org/10.1183/09031936.98.11040809

[11]   Biernacki, W. (1998) Carbon Monoxide in Exhaled Air in Patients with Lower Respiratory Tract Infection. European Respiratory Journal, 12, 345S.

[12]   A. T. Society (2005) European Respiratory Society. ATS/ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide, 2005. The American Journal of Respiratory and Critical Care Medicine, 171, 912-930.
https://doi.org/10.1164/rccm.200406-710ST

[13]   Pisi, R., Aiello, M., Tzani, P., Marangio, E., Olivieri, D. and Chetta, A. (2010) Measurement of Fractional Exhaled Nitric Oxide by a New Portable Device: Comparison with the Standard Technique. Journal of Asthma, 47, 805-809.
https://doi.org/10.3109/02770903.2010.485667

[14]   Harnan, S.E., et al. (2015) Measurement of Exhaled Nitric Oxide Concentration in Asthma: A Systematic Review and Economic Evaluation of NIOX MINO, NIOX VERO and Nobreath. Health Technology Assessment, 19, 1-330.
https://doi.org/10.3310/hta19820

[15]   Dweik, R.A., et al. (2011) An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. American Journal of Respiratory and Critical Care Medicine, 184, 602-615.
https://doi.org/10.1164/rccm.9120-11ST

[16]   Lawin, H., et al. (2017) Exhaled Carbon Monoxide: A Non-Invasive Biomarker of Short-Term Exposure to Outdoor Air Pollution. BMC Public Health, 17, Article No. 320.
https://doi.org/10.1186/s12889-017-4243-6

[17]   Taylor, E., et al. (2015) A Chest Radiograph Scoring System in Patients with Severe Acute Respiratory Infection: A Validation Study. BMC Medical Imaging, 15, Article No. 61.
https://doi.org/10.1186/s12880-015-0103-y

[18]   López, J.W., et al. (2018) Exhaled Nitric Oxide Is Not a Biomarker for Pulmonary Tuberculosis. The American Journal of Tropical Medicine and Hygiene, 98, 1637-1639.
https://doi.org/10.4269/ajtmh.17-0425

[19]   Ralph, A.P., et al. (2013) Impaired Pulmonary Nitric Oxide Bioavailability in Pulmonary Tuberculosis: Association with Disease Severity and Delayed Mycobacterial Clearance with Treatment. The Journal of Infectious Diseases, 208, 616-626.
https://doi.org/10.1093/infdis/jit248

[20]   Idh, J., et al. (2008) Nitric Oxide Production in the Exhaled Air of Patients with Pulmonary Tuberculosis in Relation to HIV Co-Infection. BMC Infectious Diseases, 8, Article No. 146.
https://doi.org/10.1186/1471-2334-8-146

[21]   Yhi, J.Y., et al. (2016) Measurement of Levels of Fractional Exhaled Nitric Oxide in Patients with Pulmonary Tuberculosis. The International Journal of Tuberculosis and Lung Disease, 20, 1174-1180.
https://doi.org/10.5588/ijtld.15.1019

[22]   Van Beek, S.C., Nhung, N.V., Sy, D.N., Sterk, P.J., Tiemersma, E.W. and Cobelens, F.G.J. (2011) Measurement of Exhaled Nitric Oxide as a Potential Screening Tool for Pulmonary Tuberculosis.

[23]   Olin, A.C., Bake, B. and Torén, K. (2007) Fraction of Exhaled Nitric Oxide at 50 ml/s: Reference Values for Adult Lifelong Never-Smokers. Chest, 131, 1852-1856.
https://doi.org/10.1378/chest.06-2928

[24]   Kim, M.-A., Shin, Y.S., Pham, L.D. and Park, H.-S. (2014) Adult Asthma Biomarkers. Current Opinion in Allergy and Clinical Immunology, 14, 49-54.
https://doi.org/10.1097/ACI.0000000000000028

[25]   Barnes, P.J. (2008) The Cytokine Network in Asthma and Chronic Obstructive Pulmonary Disease. Journal of Clinical Investigation, 118, 3546-3556.
https://doi.org/10.1172/JCI36130

[26]   O’Garra, A., Redford, P.S., McNab, F.W., Bloom, C.I., Wilkinson, R.J. and Berry, P.R. (2013) The Immune Response in Tuberculosis. Annual Review of Immunology, 31, 475-527.
https://doi.org/10.1146/annurev-immunol-032712-095939

[27]   Slebos, D.J., Ryter, S.W. and Choi, A.M.K. (2003) Heme Oxygenase-1 and Carbon Monoxide in Pulmonary Medicine. Respiratory Research, 4, 7.
https://doi.org/10.1186/1465-9921-4-7

[28]   Donnelly, L.E. and Barnes, P.J. (2001) Expression of Heme Oxygenase in Human Airway Epithelial Cells. American Journal of Respiratory Cell and Molecular Biology, 24, 295-303.
https://doi.org/10.1165/ajrcmb.24.3.4001

[29]   Shiloh, M.U., Manzanillo, P. and Cox, J.S. (2008) Mycobacterium Tuberculosis Senses Host-Derived Carbon Monoxide during Macrophage Infection. Cell Host Microbe, 3, 323-330.
https://doi.org/10.1016/j.chom.2008.03.007

[30]   Kumar, A., et al. (2008) Heme Oxygenase-1-Derived Carbon Monoxide Induces the Mycobacterium Tuberculosis Dormancy Regulon. The Journal of Biological Chemistry, 283, 18032-18039.
https://doi.org/10.1074/jbc.M802274200

[31]   Berk, P.D., Rodkey, F.L., Blaschke, T.F., Collison, H.A. and Waggoner, J.G. (1974) Comparison of Plasma Bilirubin Turnover and Carbon Monoxide Production in Man. Journal of Laboratory and Clinical Medicine, 83, 29-37.

[32]   Levine, A.S., Bond, J.H., Prentiss, R.A. and Levitt, M.D. (1982) Metabolism of Carbon Monoxide by the Colonic Flora of Humans. Gastroenterology, 83, 633-637.
https://doi.org/10.1016/S0016-5085(82)80200-X

 
 
Top