In with TB disease and CD4 cell count

In
our study, the level of CD4 cell count is significantly higher in the controls
when compared with that of with that of newly diagnosed TB-patients. This is in
agreement with previously literature.  Evidence
also shown that a low CD4 cell count associated with TB disease and CD4 cell
count is substantially low in more advanced disease among HIV-negative TB
patients and more advanced disease was shown CD4 lympcytopenia (14). Because of protective immune response against this pathogen
mediated by cellular immunity mediated by Th1 cells. This leads the patients
for the progression of tuberculosis (3).  More over most of TB cases show low BMI in our
study, which may play a great role for the decreasing of CD4 counts and their
functionality by reducing the transportation of differ co-factors and elements
than controls with normal BMI value. This Low level of CD4 cells play a great
for the pathogenesis of TB disease, because it may be due to the low respond in
delayed type immune response and due to low level of cell frequency may lead to
decrease in granuloma formation, which is fundamental for proper immune
response.

IFN-?
is one of the Th1 cytokine where identified as the most important agents of antimycobacterial
cytokine (15)
 by activate macrophage to enhance
intracellular killing (16)
and enhance the production other cytokine (17).
In our study the level of IFN-? was significantly higher in TB patients
compared with the control groups. The finding is consistent with other similar
studies on TB (18-20)
and the level of this cytokine is decrease through and after treatment   (20)
The probable reason why INF- ? is higher in TB patients while CD4 cell are low
is that, may be due to IFN- ? comes out from both local production and spill
over of it from the activated lymphocytes sequestered at the site of MTB
infection. This condition can able to contribute to the cytokine not be able to
elicit downstream events involving in effective activation of macrophages and
intracellular killing of MTB. All these conditions play a great role for the
pathogenesis of MTB infections.

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The
level of IL- 6 in TB patients also higher than that of the controls, other
similar studies had the result which is in line with our findings, done in
humans (21,
22).
On the other hand also study showed that there is increased IL- 6 in active TB
disease condition when compared with that of the latent condition of TB
infection (23).
In addition study showed that the concentration of IL-6 very high in TB
patients with pulmonary cavities than without cavities. This great indication
that IL-6 plays it own role for the TB disease outcome (24).
High level of IL-6 during TB infection can inhibit the type 1 interferon
signalling on macrophage and consequently lead to the disease progression (25).
On the other hand  of IL-6 level
correlated with disease severity, nutritional status has a great contribution
for the incereasement of IL-6 concentration (24),
our studies support this because of the level of BMI in TB patients were
significantly lower than that on health controls.

The level of monceyt in the blood of TB patients
is higher than that of the controls and show significant association, one of
the probable reason that the incensement of the monocyte during TB infection is
that during TB infection there is a production of pro-inflamatory cytokines and
chemo attractant factors that direct the monocyte from the bone marrow to lymph
node and other infected tissue to act like macrophages. At this condition there
may be an increasment of monocyte in the vascular. On the other hand cytokines
that is produced by infected macrophages may have an impact on monocyte not to
change in to macrophages to go to the infected area. This high frequency of
monocyet in TB patients may also contribute for the increasement of IL- 6 in TB
patients; they have high level than of the controls.