Effect of smoking on acute phase reactants, stress hormone responses and vitamin C in pulmonary tuberculosis.

John O Opolot,Annette J Theron, Patrick MacPhail,Charles Feldman,Ronald Anderson.

1. Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic
Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2. Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
3. Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
4. Division of Haematology/Oncology, Department of Internal Medicine, Charlotte Maxeke Johannesburg
Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Abstract
Background: Chronic inflammation, possibly exacerbated by cigarette smoking, is considered to be the primary cause of pulmonary damage in patients with tuberculosis (TB). However, the mechanisms which underpin these harmful inflammatory responses, have not been well documented.

Objectives:The current study was undertaken to determine possible associations between systemic biomarkers of inflammation (acute phase reactants, stress hormones, leukocyte vitamin C) and smoking status in patients (n=71, 20 smokers) with newly-diagnosed pulmonary TB presenting at a tertiary hospital, Johannesburg, South Africa.

Methods:Plasma concentrations of C-reactive protein (CRP), ferritin, cortisol, epinephrine, norepinephrine, dopamine and leukocyte vitamin C were measured using a combination of immunonephelometric, radioimmunoassay, immunochromatographic and spectrophotometric procedures. Demographic, clinical and laboratory data was captured and analysed by parametric and non-parametric analyses where appropriate.

Results:Smokers were predominantly males (P<0.0001), of older age (P<0.0003) with a significantly lower body mass index (P<0.03). Plasma levels of CRP, ferritin and dopamine were higher in the group of smokers in the setting of lower levels of epinephrine, and leukocyte vitamin C, with CRP and vitamin C attaining statistical significance (P<0.04 and P<0.02 respectively). Those of cortisol and norepinephrine were comparable to those of non-smokers, as were radiographic changes and clinical indices of disease activity.

Conclusion:Cigarette smoking is associated with an exaggerated systemic inflammatory response in pulmonary TB in the setting of decreased concentrations of leukocyte vitamin C. Although no significant associations with radiographic changes and most clinical indices of disease activity were evident on presentation, these pro-inflammatory interactions may have prognostic significance.

Keywords:Catecholamines, C-reactive protein, ferritin, Mycobacterium tuberculosis, leukocyte vitamin C.