Tuberculosis is the prototype of infections that require a cellular immune response for their control. It has been shown that CD4+ T-lymphocytes are most important in the protective response against Mycobacterium tuberculosis. CD8+ T-lymphocytes are also important for effective T-cell immune response. This study compares CD4+ and CD8+ baseline values in patients with different manifestations of tuberculosis. CD4+ and CD8+ in three groups of patients with tuberculosis (pulmonary, lymphadenitis, meningitis/milliary involvement) and a group of healthy volunteers were enumerated using flowcytometry. Twenty-six patients with pulmonary tuberculosis, 10 with adenitis, 16 with meningitis or milliary tuberculosis and 16 healthy volunteers entered the study. Mean CD4 in meningitis/milliary group was significantly lower than all other groups (p<0.05). Mean CD4 counts of patients with pulmonary tuberculosis was also significantly lower than control group (p=0.01). Mean CD8 in meningitis/milliary group was significantly lower than control group (p=0.02). No relation was found between results of TSTs and CD4 values in three groups. CD4 depletion is an expectable phenomenon in patients with tuberculosis. This study shows that patients with more severe form of disease had the lowest number of both CD4 and CD8 cells which can be a sign of suppressed cellular immunity in these patients.

Background: Tuberculosis has been one of the common diseases of human communities. Besides of disease-related complications, there are serious adverse reactions due to Anti-tuberculosis (Anti-TB) drug therapy. Objectives: To assess the rate of Adverse Drug Reactions (ADRs) induced by Anti-TB drugs in the infectious disease department for a period of one year. To detect serious and preventable recognized ADRs. Methods: All patients admitted to the infectious disease department at Imam tertiary teaching hospital in Iran who received Anti-TB drugs from July 2001 to July 2002 entered the study. These patients were monitored for ADRs during hospital stay. The ADRs were then classified based on patients and reactions factors. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively. Results: During the study period, 83 patients received Anti-TB drugs; of them 44 developed at least one ADR. Total number of 81 ADRs was detected in this study. ADRs were recognized as the major cause of hospital admission in 11 (13.3%) patients. The most frequent system-organ class affected by ADRs was Liver and biliary system (37%). Hepatitis was observed in 21 (25.3%) patients leading to death in two patients. Conclusion: Anti-TB drugs could cause significant adverse effects both in quantity and severity leading to hospitalization, prolonged hospital stay and even death. More attention is needed to prevent these reactions.

Antecedentes: La tuberculosis ha sido una de las enfermedades comunes de la humanidad. Además de las complicaciones relacionadas con la enfermedad, existen efectos adversos graves debidos al tratamiento antituberculoso (Anti-TB). Objetivos: Evaluar la tasa de reacciones adversas a medicamentos (RAM) inducidas por medicamentos Anti-TB en el departamento de enfermedades infecciosas durante el periodo de un año. Detectar las RAM reconocidas como graves y prevenibles. Métodos: Entraron en el estudio todos los pacientes admitidos que recibían medicamentos Anti-TB en el departamento de infecciosos del Hospital Universitario terciario Iman en Irán entre julio 2001 y julio 2002. Se monitorizaron las RAM de estos pacientes durante su estancia hospitalaria. Se clasificaron las RAM en función de los factores de los pacientes y de las reacciones. Se determinaron la causalidad y la gravedad de las reacciones adversas utilizando el algoritmo de Naranjo y el cuestionario de Hartwig, respectivamente. Resultados: Durante el periodo de estudio, 83 pacientes recibieron medicamentos Anti-TB; de ellos, 44 desarrollaron al menos una RAM. El número total de RAM detectadas en este estudio fue de 81. Las RAM se reconocieron como la causa principal de ingreso hospitalario en 11 (13,3%) pacientes. El órgano-sistema más frecuentemente afectado fue el hígado y el sistema biliar (37%). Se observó hepatitis en 21 (25,3%) de los pacientes, y condujo a la muerte en dos casos. Conclusión: Los medicamentos Anti-TB podrían causar significativos efectos adversos tanto en cantidad como en gravedad, conduciendo a hospitalización, prolongación de la estancia e incluso la muerte. Se necesita prestar más atención para prevenir estas reacciones.