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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Microbial Immunology
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1451046
This article is part of the Research Topic Immune Response in Tuberculosis with Comorbidities or Coinfections View all 7 articles

Assessing the Effects of Diabetes Mellitus on the Monocyte-to-Lymphocyte Ratio and the QuantiFERON-TB Gold Plus Assays for Tuberculosis Treatment Monitoring: a Prospective Cohort Study

Provisionally accepted
Paulo Ranaivomanana Paulo Ranaivomanana 1RAZAFIMAHEFA Arimanitra RAZAFIMAHEFA Arimanitra 1Mame Diarra Bousso Ndiaye Mame Diarra Bousso Ndiaye 1Crisca Razafimahatratra Crisca Razafimahatratra 1Haja Ramamonjisoa Haja Ramamonjisoa 2Perlinot Herindrainy Perlinot Herindrainy 1Mamy Serge Raherison Mamy Serge Raherison 1Antso Hasina Raherinandrasana Antso Hasina Raherinandrasana 3Julio RAKOTONIRINA Julio RAKOTONIRINA 3Jonathan Hoffmann Jonathan Hoffmann 4Rila Ratovoson Rila Ratovoson 1Niaina Rakotosamimanana Niaina Rakotosamimanana 1*
  • 1 Institut Pasteur de Madagascar, Antananarivo, Madagascar
  • 2 Association Malagasy contre le Diabète (AMADIA), Antananarivo, Madagascar
  • 3 Centre hospitalier universitaire de soins et de santé publique d’Analakely, Antananarivo, Madagascar
  • 4 Emerging Pathogens Laboratory–Fondation Mérieux, International Center for Infectiology Research, Lyon, Rhône-Alpes, France

The final, formatted version of the article will be published soon.

    Diabetes mellitus (DM) is an important risk factor for the development of active tuberculosis (TB). QuantiFERON-TB Gold Plus (QFT-P), white blood cell count (WBC) assays and monocyte-tolymphocyte ratio (MLR) that reflect the inflammatory reactions associated with TB offer the potential to monitor TB treatment, predict outcomes, and allow optimization of management of the disease. The aim of this study was to assess the influence of DM on the respective performances of QFT-P and WBC assays in their capacities to monitor the TB treatment of drug-sensitive pulmonary TB. The QFT-P and WBC were prospectively compared between TB patients with and without diabetes (TBDM and TBP) at inclusion (D0), at the end of treatment (M6), and at 2 months after the end of treatment (M8). After laboratory measurement of glycated hemoglobin (HbA1c), these patients were categorized into two groups: the TBP (n=43) and the TBDM (n=30) groups. The TBDM patients were characterized by an elevated Mycobacterium tuberculosis-specific QFT-P IFN-γ response after TB treatment compared to the TBP group (p<0.001 and p<0.05, respectively, after TB1 and TB2 antigens stimulation). A significantly higher proportion of positive QFT-P tests was observed in the TBDM group compared to the TBP group (91.3% vs 64.1%) at the end of the treatment (p=0.03). MLR analysis showed a decrease of MLR value after TB treatment for both diabetic and nondiabetic TB patients (p<0.001 and p<0.05). Our data seemed to confirm previous studies suggesting that TB with concomitant DM is associated with a persistent inflammatory response after TB treatment. This response is reflected in immune-host based tests used to monitor the TB treatment, which has to be adapted to patients with comorbidities, sush as DM, that disturb the immune system.

    Keywords: Tuberculosis, Diabetes Mellitus, QuantiFERON-TB Gold plus, White blood cell count, immune response

    Received: 18 Jun 2024; Accepted: 19 Dec 2024.

    Copyright: © 2024 Ranaivomanana, Arimanitra, Ndiaye, Razafimahatratra, Ramamonjisoa, Herindrainy, Raherison, Raherinandrasana, RAKOTONIRINA, Hoffmann, Ratovoson and Rakotosamimanana. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Niaina Rakotosamimanana, Institut Pasteur de Madagascar, Antananarivo, Madagascar

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