INFLUENCE OF ANTIMICROBIAL CHEMOTHERAPY AND SMOKING STATUS ON THE PLASMA-CONCENTRATIONS OF VITAMIN-C, VITAMIN-E, BETA-CAROTENE, ACUTE-PHASEREACTANTS, IRON AND LIPID PEROXIDES IN PATIENTS WITH PULMONARY TUBERCULOSIS

SETTING: Inflammation-related oxidative stress has been implicated in the pathogenesis of lung fibrosis and dysfunction in patients with pul monary tuberculosis. OBJECTIVE: To investigate the effects of antimicr obial chemotherapy and smoking status on the plasma concentrations of the anti-oxidative nutrients vitamin C, vitamin E and beta-carotene, a s well as those of iron, lipid peroxides and the acute phase reactants C-reactive protein (CRP) and ferritin. DESIGN: A total of 41 patients with active pulmonary tuberculosis were studied at the outset and aft er 6 months of antimicrobial chemotherapy. RESULTS: Initial plasma con centrations of vitamin C and beta-carotene were low, returning to norm al values after chemotherapy in the non-smokers, but not in the smoker s, while those of vitamin E remained low throughout in both groups. Fe rritin and CRP concentrations decreased significantly following chemot herapy, with the former higher in smokers than in non-smokers. Serum l ipid peroxides were elevated in patients with pulmonary tuberculosis a nd were unaffected by chemotherapy or smoking habits, while iron level s were not significantly affected by chemotherapy. Although residual d ysfunction and infiltration were evident, pulmonary function (FEV1) an d radiographic score improved equally in both smokers and non-smokers following antimicrobial chemotherapy. CONCLUSIONS: Even after 6 months of apparently successful antimicrobial chemotherapy, pulmonary tuberc ulosis is associated with increased oxidative stress, which is unrelat ed to cigarette smoking and characterized by increased levels of circu lating lipid peroxides and low concentrations of plasma vitamin E.