Resolution of the acute-phase response in West African patients receiving treatment for pulmonary tuberculosis

SETTING: The Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa. OBJECTIVE: To evaluate simple and commonly used parameters of the acute-pha se response as correlates of successful resolution of smear-positive pulmon ary tuberculosis (PTB) during drug treatment. DESIGN: Serum C-reactive protein (CRP) concentration, erythrocyte sedimenta tion rate (ESR), body weight, and blood haemoglobin were measured in human immunodeficiency virus (HIV) negative Ghanaian patients with PTB (n = 15) a nd in age- and sex-matched healthy controls (n = 15). These parameters were subsequently measured in patients after 1, 2 and 3 months of antituberculo sis treatment. Serum concentrations of soluble interleukin-2-receptor-alpha (sCD25) were also measured as a comparative index of resolution of the sys temic inflammatory process. RESULTS: Anti-tuberculosis treatment resulted in sputum smear conversion in all 15 patients, After one month of treatment, reductions in serum CRP con centration (>20%) and increases in haemoglobin concentration (>0.4 g/dl) oc curred in the majority of patients and correlated with steep reductions in serum levels of sCD25, In contrast, weight loss and elevated ESR were slowe r to resolve, and were insensitive early markers of response to treatment. CONCLUSION: A fail in serum CRP and a rise in blood haemoglobin are correla tes of the initial response to drug treatment of PIS. These parameters may assist in the evaluation of empiric trials of treatment in microbiologicall y unconfirmed cases of suspected PTB.