TRIPLE TROUBLE. Tuberculosis, HIV infection and malnutrition.
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[S.l. : s.n.]
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RU Radboud Universiteit Nijmegen, 7 maart 2005
Promotores : Meer, J.W.M. van der, West, C.E. Co-promotor : Semba, R.D.
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SubjectUMCN 4.1: Microbial pathogenesis and host defense
Tuberculosis has emerged as the second commonest cause of death from infectious disease worldwide, after HIV/AIDS, killing nearly 2 million people each year. Most cases occur in less-developed countries. The human immunodeficiency virus (HIV) is the greatest single risk factor for the development of active tuberculosis in adults. Hence, over the past decade, tuberculosis incidence has increased in Africa, mainly as a result of the burden of HIV infection. The association between tuberculosis and wasting has long been recognized, and is probably one of the determinants of disease severity and outcome. Yet, little is known about the etiology of tuberculosis-associated wasting. The nutritional status in relation to disease of patients with pulmonary tuberculosis with and without HIV co-infection, form the basis of this thesis. The studies described in this thesis were carried out in newly diagnosed adult pulmonary tuberculosis patients in Zomba Central Hospital, in the Southern region of Malawi. We demonstrated that malnutrition in pulmonary tuberculosis is associated with the severity of lung disease; that micronutrient concentrations are related to wasting; that micronutrient malnutrition, anemia and wasting are more severe in adults with pulmonary tuberculosis who have higher HIV load and that low selenium concentrations, high HIV load and high IL-6 concentrations are associated with anemia in adults with pulmonary tuberculosis. We showed that plasma leptin concentrations are associated with the percentage of fat mass and with the inflammatory cytokine response. We demonstrated that leptin was not, but IL-6 was, associated with loss of appetite and concluded that the anorexia and wasting in patients with tuberculosis seem primarily determined by the level of inflammation and the level of HIV infection.
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