C-reactive protein versus erythrocyte sedimentation rate in monitoring multidrug-resistant tuberculosis

Abstract

Background Studies that validate new antituberculous regimens take much more time to complete as mycobacteria tend to be cleared slowly with absence of valid biomarkers to monitor treatment and outcomes. Aim To assess whether erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level would evaluate the patient’s response toward antituberculosis medication. Patients and methods A prognostic cohort study was conducted on 25 newly diagnosed multidrug-resistant patients with positive smear admitted to Abbasia Chest Hospital. Sputum Ziehl–Neelsen, culture, and GeneXpert were done. CRP and ESR were tested monthly till sputum conversion while other active illnesses were excluded with each assessment to avoid false results. Results The mean age of patients was 34.80±12.33 years; 56% of them were men and 52% were smokers. All patients presented with cough, expectoration, and toxic manifestations; 44% presented with hemoptysis. All patients received ethionamide, cycloserine, and levofloxacin. Pyrazinamide was used in 96% of patients; amikacin and kanamycin were used in 52 and 44% of patients, respectively. Eighty-eight percent of patients showed sputum conversion (80% in the second month and further 8% in the third month of treatment. The reported mortality rate was 12%. ESR and CRP showed a significant decrease within the period of treatment (P=0.03 and 0.02, respectively), with a significant decrease after sputum conversion (P=0.02 and 0.03, respectively). Conclusion CRP and ESR showed equal capabilities of monitoring response to therapy in multidrug-resistant-tuberculosis. None of them was superior to the other in monitoring response to therapy.

Keywords

• c-reactive protein
• erythrocyte sedimentation rate
• multidrug resistant
• monitoring
• sputum conversion
• therapy
• tuberculosis