Pattern of Neopterin serum level in pulmonary tuberculosis patients

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Illustration by detik health
Illustration by detik health

Pulmonary tuberculosis (pulmonary TB) is a pulmonary infectious disease caused by Mycobacterium tuberculosis causing lung damage. Pulmonary TB is classified as airborne disease, which is a disease transmitted by air and is the highest case among other organ TBs with a high mortality rate. Infection to the lungs can be transmitted through aerosols which contain the bacteria Mycobacterium tuberculosis. These germs spread when pulmonary TB patients transmit germs through the air, through coughing, talking, and sneezing.

Tuberculosis is a major health problem in the world that caused 10 million TB cases and 1.2 million deaths from TB in 2018. About a quarter of the world’s population is infected with Mycobacterium tuberculosis and is at risk of developing active TB disease. Indonesia is the country with the 3rd largest number of TB cases in the world with 842,000 cases in 2017.

An accurate diagnosis is needed to prevent TB transmission. TB diagnosis methods currently used are examination of Acid Resistant Bacteria (BTA) and Mycobacterium tuberculosis culture from sputum samples as conventional methods and GeneXpert as molecular rapid tests (TCM). The culture method is known to be the standard measure for TB diagnosis, but this method requires a long time (8 weeks) and causes delay in treatment. In sputum examination with negative results based on culture and GeneXpert, some clinicians find it difficult to determine the diagnosis of active TB or former TB based on chest x-ray examination, so examination of TB markers is needed in this case.

One marker for TB that has been widely studied is neopterin. Some studies suggest that the production of neopterin in pulmonary TB has a relationship with the level of TB disease activation and can also be used for monitoring TB treatment. Some studies suggest that an increase in neopterin serum levels is significantly related to the severity of TB disease based on chest x-rays. Neopterin serum levels are also known to decrease along with anti-TB drugs. Comparison of neopterin serum levels between active TB patients with former TB should be identified as an additional method in TB diagnosis.

This study uses a cross-sectional analytic study design that aims to examine and compare neopterin serum levels in new cases of pulmonary TB and former pulmonary TB. Samples were taken from pulmonary TB patients with positive acid resistant bacteria (BTA) results (smear results +1, +2, and +3) and former TB in Dr. Soetomo Hospital Surabaya. The study inclusion criteria were research subjects aged ≥21 years who were willing to participate in this study. Exclusion criteria were research subjects with pneumonia, HIV, cancer, asthma, chronic obstructive pulmonary disease, hepatitis C, autoimmune diseases, and diabetes mellitus. The total samples were 50 samples consisting of 25 samples of pulmonary TB patients and 25 samples of former TB.

Blood samples for each object of study were taken for examination of neopterin serum levels by the ELISA method. This examination was carried out in the clinical pathology laboratory, Dr. Soetomo Hospital Surabaya. We conducted statistical tests with the SPSS 21.0 program. Statistical test results are considered significant if the significance value

The results of our study showed significant differences in neopterin serum levels between pulmonary TB patients and former pulmonary TB patients with neopterin serum levels in each study group were 74.92 nmol / l and 9.84 nmol / l. There were significant differences in neopterin serum levels between smear TB patients with +1, +2 and +3 with neopterin serum levels of 60.10 nmol / l, 80.81 nmol / l, and 110.70 nmol / l respectively. Based on these results, it can be concluded that neopterin serum levels in the pulmonary TB group in new cases have positive BTA compared to the former TB group.

Author: Dr. Soedarsono, dr., Sp.P (K) Details of this research available at

Soedarsono Soedarsono, Parluhutan Dolli. Comparison of Serum Neopterin Levels in Pulmonary Tuberculosis Patients with Positive Acid Fast Bacilli and Inactive Pulmonary Tuberculosis. J Clin Tuberc Other Mycobact Dis. 2020;18:100138.

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