Abstract

Tuberculosis is a lethal bacterial infection around the globe. Its severity is more potent in poor economic countries. Every year more than 10 million tuberculosis cases are reported, of which 11% are children. Socioeconomic factors such as malnourishment, poverty, unhygienic lifestyle, TB contact, HIV infection etc. worsen the situation further. From available research we can say that malnutrition is a predictor of this disease with worse outcomes both in adults and children. Malnourishment leads to reduced immune response to fight tuberculosis. thymic atrophy, reduced functions of APCs, shifting of Th1 response to Th2 type are thought to be related to malnourishment in children. Malnourished children are poor responder of vaccination and supplementation treatment against TB. Malnourishment among children of a TB endemic country is surely a main problem in eradicating TB. But there are more research needs on childhood TB emphasising on malnourishment.

Keywords: Tuberculosis; Malnutrition; Child Health; Immune Response

References

1. World Health Organization (WHO). Global tuberculosis report 2017. Geneva: WHO (2017): 1-3.
2. World Health Organization (WHO). Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva: World Health Organization (2006).
3. Black RE., et al. “Maternal and child undernutrition: global and regional exposures and health consequences”. Lancet 371 (2008): 243-260.
4. World Health Organization. Global tuberculosis report, 2016. WHO/HTM/TB/2016.13. Geneva, Switzerland: WHO, (2016).
5. Food and Agriculture Organization of the United Nations (FAO), International Fund for Agricultural Development United Nations Children’s Fund, World Food Programme, World Health Organization. The state of food security and nutrition in the world 2017. Building resilience for peace and food security. Rome: FAO, (2017): 13.
6. Lonnroth K and Raviglione M. “The WHO’s new End TB Strategy in the post-2015 era of the sustainable development goals”. Transactions of the Royal Society of Tropical Medicine and Hygiene 110 (2016): 148-150.
7. Lonnroth K., et al. “A consistent log-linear relationship between tuberculosis incidence and body mass index”. International Journal Epidemiology 39 (2010): 149-155.
8. Bhargava A., et al. “Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality”. PLoS One 8 (2013): e77979.
9. Hochberg NS., et al. “Comorbidities in pulmonary tuberculosis cases in Puducherry and Tamil Nadu, India: opportunities for intervention”. PLoS One 12 (2017): e0183195.
10. Macallan DC., et al. “Whole body protein metabolism in human pulmonary tuberculosis and undernutrition: evidence for anabolic block in tuberculosis”. Clinical Science 94 (1998): 321-331.
11. Birlie A., et al. “Time to death and associated factors among tuberculosis patients in Dangila Woreda, Northwest Ethiopia”. PLoS One 10 (2015): e0144244.
12. Kvasnovsky CL., et al. “Treatment outcomes for patients with extensively drug-resistant tuberculosis, KwaZulu-Natal and Eastern cape Provinces, South Africa”. Emerging Infectious Diseases 22 (2016): 1529.
13. Basu RR., et al. “Current understanding of the immune response to tuberculosis in children”. Current Opinion in Infectious Diseases 25 (2012): 250-257.
14. Levy O. “Innate immunity of the newborn: basic mechanisms and clinical correlates”. Nature Review Immunology 7 (2007): 379-390.
15. Shennan DH and Kibel MA. “Tuberculosis”. In: Stanfield P, Brueton M, Chan M, Parkin M, Waterston T, eds. Diseases of Children in the Subtropics and Tropics. 4^th London: Arnold, (1991): 519-552.
16. Newburg DS and Walker WA. “Protection of the neonate by the innate immune system of developing gut and of human milk”. Pediatric Research 61 (2007): 2-8.
17. Moore SE., et al. “Early-life nutritional and environmental determinants of thymic size in infants born in rural Bangladesh”. Acta Paediatrica 98 (2009): 1168-1175.
18. Ngom PT., et al. “Improved thymic function in exclusively breastfed infants is associated with higher interleukin 7 concentrations in their mothers’ breast milk”. American Journal of Clinical Nutrition 80 (2004): 722-728.
19. Savino W., et al. “The thymus is a common target in malnutrition and infection”. British Journal of Nutrition 98 (2007): S11-16.
20. Scrimshaw NS., et al. “Interactions of nutrition and infection”. Monograph Series World Health Organization 57 (1968): 3-329.
21. McFarland CT., et al. “Dietary polyunsaturated fatty acids modulate resistance to Mycobacterium tuberculosis in guinea pigs”. Journal of Nutrition 138 (2008): 2123-2128.
22. Cegielski JP and McMurray DN. “The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals”. International Journal of Tuberculosis and Lung Disease 8 (2004): 286-298.
23. Rodriguez L., et al. “Assessment by flow cytometry of cytokine production in malnourished children”. Clinical and Diagnostic Laboratory Immunology 12 (2005): 502-507.
24. Anuradha R., et al. “Coexistent malnutrition is associated with perturbations in systemic and antigen-specific cytokine responses in latent tuberculosis infection”. Clinical and Vaccine Immunology 23 (2016): 339-345.
25. McMurray DN., et al. “Development of impaired cell-mediated immunity in mild and moderate malnutrition”. American Journal of Clinical Nutrition 34 (1981): 68-77.
26. Hoest C., et al. “Evaluating associations between vaccine response and malnutrition, gut function, and enteric infections in the MAL-ED cohort study: methods and challenges”. Clinical Infectious Diseases4 (2014): S273-279.
27. Cuevas LE., et al. “Effect of zinc on the tuberculin response of children exposed to adults with smear-positive tuberculosis”. Annals of Tropical Paediatrics 22 (2002): 313-319.
28. Hanekom WA., et al. “Vitamin A status and therapy in childhood pulmonary tuberculosis”. The Journal of Pediatrics 131 (1997): 925-927.
29. Das BS., et al. “Effect of iron supplementation on mild to moderate anaemia in pulmonary tuberculosis”. British Journal of Nutrition 90 (2003): 541-550.
30. Hanekom WA., et al. “Plasma-soluble CD30 in childhood tuberculosis: Effects of disease severity, nutritional status, and vitamin A therapy”. Clinical and Diagnostic Laboratory Immunology 6 (1999): 204-208.
31. Lönnroth K and Raviglione M. “Global epidemiology of tuberculosis: prospect for control”. Seminars in Respiratory and Critical Care Medicine 29 (2008): 481-491.
32. Martin SJ and Sabina EP. “Malnutrition and associated disorders in tuberculosis and its therapy”. Journal of Dietary Supplements 29 (2018): 1-9.
33. Mirsaeidi M and Sadikot RT. “Patients at high risk of tuberculosis recurrence”. International Journal of Mycobacteriology 7 (2018): 1-6.
34. Lettow M., et al. “Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi PDF hosted at the Radboud Repository of the Radboud University”. International Journal of Tuberculosis and Lung Diseases 8 (2004): 211-217.
35. Lönnroth K., et al. “A consistent loglinear relationship between tuberculosis incidence and body mass index”. International Journal of Epidemiology 39 (2010): 149-155.
36. Creswell J., et al. “Series: ‘‘Update on tuberculosis’’ --- tuberculosis and noncommunicable diseases: neglected links and missed opportunities”. European Respiratory Journal 37 (2011): 1269-1282.
37. Franco I., et al. “Social profile of the highest tuberculosis incidence areas in Portugal”. Revista Portuguesa de Pneumologia 22 (2016): 50-56.
38. Sousa P., et al. “Longitudinal clustering of tuberculosis incidence and predictors for the time profiles: the impact of HIV”. International Journal of Tuberculosis and Lung Diseases 20 (2016): 1027-1032.
39. Uplekar M., et al. “WHO’s new END TB strategy”. Lancet 385 (2015): 1799-1801.
40. Sachs JD. “From millennium development goals to sustainable development goals”. Lancet 379 (2012): 2206-2211.