Evaluación hepática y renal en pacientes que recibieron conjuntamente zinc y tratamiento antituberculosis acortado / Hepatic and renal evaluation in patients that received jointly zinc and antituberculosis shortened treatment

La terapia de la tuberculosis con el esquema 2RHZE/4HE comprende la administración durante seis meses de rifampicina, isoniazida, pirazinamida y etambutol, de las cuales las tres primeras son potencialmente hepatotoxicas y excepcionalmente nefrotoxicas. La tuberculosis produce depleción de la concentración de zinc lo que incrementa la susceptibilidad a la cronicidad de la infección. OBJETIVO: evaluar el efecto de la administración conjunta de zinc y la terapia 2RHZE/4HE sobre la función hepática y renal en pacientes con tuberculosis pulmonar. MÉTODOS: estudio descriptivo de tipo caso control, doble ciego aleatorizado con 22 pacientes con tuberculosis pulmonar en terapia farmacológica y 22 controles sanos reclutados en los centros de salud Sebastián pagador y Alalay. Los pacientes fueron divididos aleatoriamente en dos grupos a los que se les administró zinc (45mg/día) o placebo durante tres meses. En todos los pacientes se tomó muestras de sangre antes y después de la intervención para medir pruebas de función renal y hepática. En los sujetos control la muestra de sangre se tomó al inicio del estudio para realizar las mismas determinaciones. RESULTADOS: no se encontró deferencias en la concentración de marcadores específicos de daño hepático o renal. CONCLUSIONES: la adición de un suplemento diario de 45mgr de zinc a la terapia 2RHZE/4HE no produjo daño renal ni hepático en las personas evaluadas.

Tuberculosis therapy with the 2RHZE / 4HE scheme comprises the administration for six months of rifampin, isoniazid, pyrazinamide and ethambutol, of which the first three are potentially hepatotoxic and exceptionally nephrotoxic. Tuberculosis produces depletion of the zinc concentration which increases the susceptibility to chronicity of the infection. OBJECTIVE: to evaluate the effect of co-administration of zinc and 2RHZE /4HE therapy on hepatic and renal function in patients with pulmonary tuberculosis. METHODS: a, descriptive case-control, randomized double-blind study. 22 patients with pulmonary tuberculosis receiving pharmacological therapy and 22 healthy controls recruited in the health centers Sebastián Pagador and Alalay. The patients were randomly divided into two groups. Who were given zinc (45mg / day) or placebo for three months. All patients were blood sampling before and after intervention to measure hepatic and renal functional tests. For the control subjects were blood sampling before the study to do the same test. RESULTS: no deference was found in the concentration of specific markers of hepatic or renal damage. CONCLUSIONS: the addition of a daily supplement of 45 mg of zinc to 2RHZE/4HE therapy did not cause hepatic, neither renal damage in the people evaluated.

The immune response in patients with cutaneous leishmaniasis and the influence of zinc supplementation.

Cutaneous leishmaniasis triggers a varied immune response depending on parasite and host factors, which in turn can be influenced by nutrients. The resistance to the infection is associated with the Th1 type of cytokine production. The Th1 type can be reduced as a consequence of zinc deficiency, which may increase the risk for chronicity of the infection. Using in vitro and ex vivo models, we studied the influence of zinc supplementation on the immune response in patients with cutaneous leishmaniasis treated with antimony and the data were also compared to those of matched controls. Twenty-nine patients with cutaneous leishmaniasis (n=14 in zinc-supplemented group [45mg/day] and n=15 in placebo group) were treated by intramuscular injections of antimony for 20 days and took supplements for 60 days. Immunoglobulins in plasma and cell proliferation, IFN-γ production and CD markers of isolated peripheral blood mononuclear cells (PBMC) were measured. It was found that the cellular immune response of the patients maintained its activity as assessed by the ability of the PBMC to proliferate and produce IFN-γ in response to concanavalin A. Moreover, there was no difference in these variables between the zinc-supplemented and placebo groups after 60 days. The addition of zinc sulphate in vitro to PBMC reduced the IFN-γ production in the placebo group only. It is concluded that the cellular immune response of the cutaneous leishmaniasis patients remained active during treatment by antimony when compared to that of controls. It was not possible to document an additional effect of zinc supplementation for 60 days on the immune response.

Nutritional status in patients with cutaneous leishmaniasis and a study of the effects of zinc supplementation together with antimony treatment.

BACKGROUND: The role of micronutrient status for the incidence and clinical course of cutaneous leishmaniasis is not much studied. Still zinc supplementation in leishmaniasis has shown some effect on the clinical recovery, but the evidence in humans is limited. OBJECTIVE: To compare biochemical nutritional status in cutaneous leishmaniasis patients with that in controls and to study the effects of zinc supplementation for 60 days. DESIGN: Twenty-nine patients with cutaneous leishmaniasis were treated with antimony for 20 days. Fourteen of them got 45 mg zinc daily and 15 of them got placebo. Biomarkers of nutritional and inflammatory status and changes in size and characteristics of skin lesions were measured. RESULTS: The level of transferrin receptor was higher in patients than in controls but otherwise no differences in nutritional status were found between patients and controls. No significant effects of zinc supplementation on the clinical recovery were observed as assessed by lesion area reduction and characteristics or on biochemical parameters. CONCLUSIONS: It is concluded that nutritional status was essentially unaffected in cutaneous leishmaniasis and that oral zinc supplementation administered together with intramuscular injection of antimony had no additional clinical benefit.