Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load

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dc.contributor.authorKerkhoff, Andrew Den_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorLowe, David Men_ZA
dc.contributor.authorVogt, Monicaen_ZA
dc.contributor.authorLawn, Stephen Den_ZA
dc.date.accessioned2015-11-23T12:28:35Z
dc.date.available2015-11-23T12:28:35Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: Increasing evidence suggests that neutrophils play a role in the host response to Mycobacterium tuberculosis . We determined whether neutrophil counts in peripheral blood are associated with tuberculosis (TB) and with mycobacterial load in sputum in HIV-infected patients. METHODOLOGY/PRINCIPAL FINDINGS: Adults enrolling in an antiretroviral treatment (ART) clinic in a Cape Town township were screened for TB regardless of symptoms. Paired sputum samples were examined using liquid culture, fluorescence microscopy, and the Xpert MTB/RIF assay. Absolute neutrophil counts (ANC) were measured in blood samples. Of 602 HIV-infected patients screened, 523 produced one or more sputum samples and had complete results available for analysis. Among these 523 patients, the median CD4 count was 169×10 9 /L (IQR, 96-232) and median ANC was 2.6×10 9 /L (IQR, 1.9-3.6). Culture-positive pulmonary tuberculosis was diagnosed in 89 patients. Patients with TB had a median ANC of 3.4×10 9 /L (IQR, 2.4-5.1) compared to 2.5×10 9 /L (IQR, 1.8-3.4) among those who were culture negative (p<0.0001). In multivariable analyses, having pulmonary TB was associated with an adjusted risk ratio (aRR) of 2.6 (95%CI, 1.5-4.5) for having an ANC level that exceeded the median value (ANC ≥2.6×10 9 /L; p = 0.0006) and an aRR of 6.8 (95%CI, 2.3-20.4) for having neutrophilia defined by a neutrophil count exceeding the upper limit of the normal range (ANC >7.5×10 9 /L; p = 0.0005). Patients were then classified into four mutually exclusive groups with increasing sputum mycobacterial load as defined by the results of culture, Xpert MTB/RIF and sputum smear microscopy. Multivariable analyses demonstrated that increasing sputum mycobacterial load was positively associated with blood ANC ≥2.6×10 9 /L and with neutrophilia. Conclusions/Significance Increased blood neutrophil counts were independently associated with pulmonary TB and sputum mycobacterial burden in this HIV-infected patient group. This observation supports the growing body of literature regarding the potential role for neutrophils in the host response to TB.en_ZA
dc.identifier.apacitationKerkhoff, A. D., Wood, R., Lowe, D. M., Vogt, M., & Lawn, S. D. (2013). Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load. <i>PLoS One</i>, http://hdl.handle.net/11427/15295en_ZA
dc.identifier.chicagocitationKerkhoff, Andrew D, Robin Wood, David M Lowe, Monica Vogt, and Stephen D Lawn "Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15295en_ZA
dc.identifier.citationKerkhoff, A. D., Wood, R., Lowe, D. M., Vogt, M., & Lawn, S. D. (2013). Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load. PloS one, 8(7), e67956. doi:10.1371/journal.pone.0067956en_ZA
dc.identifier.ris TY - Journal Article AU - Kerkhoff, Andrew D AU - Wood, Robin AU - Lowe, David M AU - Vogt, Monica AU - Lawn, Stephen D AB - BACKGROUND: Increasing evidence suggests that neutrophils play a role in the host response to Mycobacterium tuberculosis . We determined whether neutrophil counts in peripheral blood are associated with tuberculosis (TB) and with mycobacterial load in sputum in HIV-infected patients. METHODOLOGY/PRINCIPAL FINDINGS: Adults enrolling in an antiretroviral treatment (ART) clinic in a Cape Town township were screened for TB regardless of symptoms. Paired sputum samples were examined using liquid culture, fluorescence microscopy, and the Xpert MTB/RIF assay. Absolute neutrophil counts (ANC) were measured in blood samples. Of 602 HIV-infected patients screened, 523 produced one or more sputum samples and had complete results available for analysis. Among these 523 patients, the median CD4 count was 169×10 9 /L (IQR, 96-232) and median ANC was 2.6×10 9 /L (IQR, 1.9-3.6). Culture-positive pulmonary tuberculosis was diagnosed in 89 patients. Patients with TB had a median ANC of 3.4×10 9 /L (IQR, 2.4-5.1) compared to 2.5×10 9 /L (IQR, 1.8-3.4) among those who were culture negative (p<0.0001). In multivariable analyses, having pulmonary TB was associated with an adjusted risk ratio (aRR) of 2.6 (95%CI, 1.5-4.5) for having an ANC level that exceeded the median value (ANC ≥2.6×10 9 /L; p = 0.0006) and an aRR of 6.8 (95%CI, 2.3-20.4) for having neutrophilia defined by a neutrophil count exceeding the upper limit of the normal range (ANC >7.5×10 9 /L; p = 0.0005). Patients were then classified into four mutually exclusive groups with increasing sputum mycobacterial load as defined by the results of culture, Xpert MTB/RIF and sputum smear microscopy. Multivariable analyses demonstrated that increasing sputum mycobacterial load was positively associated with blood ANC ≥2.6×10 9 /L and with neutrophilia. Conclusions/Significance Increased blood neutrophil counts were independently associated with pulmonary TB and sputum mycobacterial burden in this HIV-infected patient group. This observation supports the growing body of literature regarding the potential role for neutrophils in the host response to TB. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0067956 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load TI - Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load UR - http://hdl.handle.net/11427/15295 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15295
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0067956
dc.identifier.vancouvercitationKerkhoff AD, Wood R, Lowe DM, Vogt M, Lawn SD. Blood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial load. PLoS One. 2013; http://hdl.handle.net/11427/15295.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Kerkhoff et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherSputumen_ZA
dc.subject.otherNeutrophilsen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherBlood countsen_ZA
dc.subject.otherAntenatal careen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherBlooden_ZA
dc.titleBlood neutrophil counts in HIV-infected patients with pulmonary tuberculosis: association with sputum mycobacterial loaden_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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