Therapeutic nutrition for children and adolescents with persistent tuberculosis

Thu, 21/01/2021 - 23:02

Information about authors

Bekembaeva Gulbadan Sabitovna, Doctor of Medical Sciences, Professor of the Department of Phthisiology

NJSC "Astana Medical University"

(010000, Republic of Kazakhstan, Nur-Sultan, Beibitshilik street, 49a, e-mail: gbekem@mail.ru)

Aldiyarbek Nurlan Adiluly, 4th course student

NJSC "Astana Medical University"

(010000, Republic of Kazakhstan, Nur-Sultan, Beibitshilik street, 49a, e-mail: n_aldiyarbek@mail.ru)

Introduction

Improving the treatment of patients with multidrug-resistant tuberculosis (MDR) mycobacteria is an important and difficult task for phthisians. Drugs are prescribed to patients with MDR TB for a long period and therefore often lead to side effects. Overcoming and stopping the side effects of anti-tuberculosis drugs is an extremely important component of the treatment of patients with MDR. Methods to eliminate side effects include dietary therapy for tuberculosis, and treatment with kumis. However, this method is contraindicated in acute and chronic suppressions in the lungs and pleura (abscess, bronchiectases, pyopnevomothorax), peptic ulcer and gastritis with increased secretion, liver, intestinal and metabolic disorders (diabetes mellitus, gout, obesity), etc. As you know, tuberculosis requires an increased need for vitamins (retinol, ascorbic acid, ergocalci-ferol, thiamine, riboflavin, pyridoxine, niacin), especially in digestive organs (enterocolitis, gastritis, hepatitis, etc.), which makes it difficult to absorb vitamins. Deficiency of some vitamins (pyridoxine, ascorbic acid, etc.) can also be caused by the use of a number of antibacterial agents (PASK-sodium, isoniazid, etc.). However, this method is contraindicated in acute and chronic suppressions in the lungs and pleura (abscess, bronchiectases, pyopnevomothorax), peptic ulcer and gastritis with increased secretion, liver, intestinal and metabolic disorders (diabetes mellitus, gout, obesity), etc. As you know, tuberculosis requires an increased need for vitamins (retinol, ascorbic acid, ergocalci-ferol, thiamine, riboflavin, pyridoxine, niacin), especially in digestive organs (enterocolitis, gastritis, hepatitis, etc.), which makes it difficult to absorb vitamins. Deficiency of some vitamins (pyridoxine, ascorbic acid, etc.) can also be caused by the use of a number of antibacterial agents (PASK-sodium, isoniazid, etc.). At the same time, goat's milk contributes to the enrichment of the human body with full-fledged proteins, fats, mineral salts and vitamins. The nutritionality and good digestibility of the product is due not only to the good amino acid composition, but also to the high content of phosphorus, cobalt, vitamins A, B, C and D. The use of this product is useful not only in pulmonary forms of tuberculosis, but also in various extra pulmonary localizations. Thus, in case of intestinal tuberculosis, it is necessary to keep in mind possible disturbances in the absorption of the most important nutrients (proteins, vitamins, calcium, phosphorus, iron, etc.), which leads to deficiencies in the body and the need to include them in the diet in high doses. An important role in the epithelization and repair of affected intestines is played by retinol, which is available in goat milk.

Goal

The purpose of this work is to reduce the risk of adverse reactions of anti-tuberculosis drugs (first and second row) in the adolescent contingent with MDR TB by incorporating the Goat's milk product into comprehensive tuberculosis therapy

Materials and research methods

Subjects of the study, children and adolescents who were treated in an anti-tuberculosis hospital for TB and MDR TB.

The first group (main) was children and adolescents with tuberculosis, who included goat's milk in the diet.

In terms of sexual development of girls and boys, there were 15 (50.0%), 11 children (the age ranged from 3 to 14 years) and 19 adolescents.

The second (control) group was 10 children and 10 adolescents with tuberculosis, in whom goat's milk was not included in the diet.

With the highest frequency in both groups, infiltrative tuberculosis was diagnosed - 50.0% and 70.0%, respectively, less often primary tubing. complex - 20.0% and 15.0%, respectively, tube pleurisy. etiologies occurred in two cases (6.7% and 10.0%).

Multidrug resistance was detected in half (15-50.0%) of children and adolescents from the main group and in 45.0% of cases in patients of the second group.

Thus, by age, sex and clinical forms of TB, the presence of multidrug resistance, the study contingent had no particular differences.

Results

The analysis revealed that all children and adolescents of both groups had symptoms of intoxication, intolerance of anti-tuberculosis drugs in the form of nausea, vomiting, reduced appetite, pains in the epigastric region before taking goat milk.

Goat milk was given to patients of the first group after taking anti-tuberculosis drugs (one day), young children in 100.0, adolescents in 200.0 ml for 3 months.

We studied the detoxification effect of goat's milk in patients with tuberculosis in the lungs of children and adolescents at various times (after 1 month, 2 months, 3 months).

Analysis of the obtained data showed the effectiveness of using goat milk for detoxification purposes at various stages of treatment of patients with pulmonary tuberculosis. Thus, symptoms of intoxication after 1 month of goat milk intake were eliminated in sick children and adolescents of I and II subgroups in 66.7% and 50.0% cases, respectively, after 2 months the symptoms of intoxication were stopped in 26.5% and 33.3% of patients, after 3 months of goat milk intake disappeared in 6.8% and 16.7%, respectively.

Nausea intolerance phenomena, which were observed in half of the children and adolescents of the first group, were stopped after 1 month of goat milk intake in 66.7% of patients, after 2 months in the remaining 33.3% of patients. In all cases (100.0%), patients of group I had a reduced appetite before starting milk, and after a month of goat milk, appetite increased in 80.0% of patients. Vomiting was observed before taking milk in 5 (16.7%) and stopped 1 week after taking goat milk in 2 (6.7%) children and adolescents, after 2 weeks vomiting stopped in the remaining children.

In children and adolescents from the second group, intolerance phenomena were stopped 2 months after symptomatic treatment in 60.0%, after 3 months in the remaining (40.0%) children and adolescents.

Analysis of humoral and cellular composition showed that these rates increased markedly after taking goat milk in children and adolescents of the first group, while in children and adolescents of the second group, humoral and cellular immunity remained at the same level.

Before the research, to children and teenagers of both groups conducted complex immunological blood test which included studying indicators of cellular (CD3, CD3+CD4+, CD3+CD8+, CD3+CD4+/CD3+CD8+, CD3+CD56+, CD3+CD25+, CD3+HLA-DR+) and humoral (CD19, CD3-CD25+, CD3-HLA-DR+IgM, IgA, IgG, the CEC) immunity.

The study of the quantitative composition of lymphocyte subpopulations in peripheral blood was performed on a flow cytometer Facscan from “BectonDickinson” (USA) using triple combinations of direct monoclonal antibodies (CD4/CD8/CD3, CD3/CD19, CD56/HLA-DR/CD3, CD25/CD3), Leucogate (CD45/CD14) to isolate the lymphocytic ring and isotypic control (IgG1/IgG2) of the same firm.

Serum immunoglobulins of classes M, G and A were determined by G. Mancinietal simple radial immunodiffusion. (1965). Determination of circulating immune complexes (CEC) was carried out by the method proposed by Yu.A. Grinevich and A.N. Alferov (1981) [9,11].

Before the study, 50.2% and 45.0% of children and adolescents of both groups showed a decrease in humoral and cellular immunity. At least 48.5% of patients showed activation of B-cell immune response, reflected in increased content of B-lymphocytes expressing HLA-DR, serum immunoglobulins M, A, G and low molecular weight circulating immune complexes. An increase in the concentration of low molecular weight CECs could be a prerequisite for their deposition in tissues and the development of immunopathological reactions [4,6,9,10].

After completing the course of taking goat's milk, as can be seen from Table 1, in patients with MDR TB, children and adolescents of group I CD3 reliably (p≤0,5) increased from 40.5 ± 4.46 to 46.1 ± 14.66, and in group II this indicator was preserved in the previous figures - 43.6 ± 10.42 (before), 43.8 ± 2.14 (after) (p≤0,5). The indicator CD4 significantly increased from 22.5 ± 4.15 to 27.6 ± 2.62 (p≤0,5), and in children and adolescents of the control group this indicator almost remained the same - 23.5 ± 3.74. 24.6 ± 4.33, respectively. The same pattern is observed in the analysis of CD8, Helper/suppressor indices, blood enzyme-linked.

Thus, analysis of humoral and cellular composition showed that these indicators increased markedly after taking goat milk in children and adolescents of the first group, while in children and adolescents of the second group, immunity indicators remained at the same level.

Discussion

Thus, the analysis of clinical efficacy in patients with pulmonary tuberculosis, including MDR TB, showed the advantage of taking goat's milk in complex chemotherapy, carried out in patients with intoxication, side effects in the first two months from the beginning of therapy. The data obtained by us make it possible to recommend inclusion in the comprehensive treatment of patients with first-time detected pulmonary tuberculosis and multidrug tuberculosis in children and adolescents - goat's milk, as this reduces the time to achieve a positive clinical effect, with normalization of a number of patient immunity indicators.

The efficiency of intake of goat milk of patients with for the first time the detected tuberculosis of respiratory organs and MLU TB was estimated on the basis of a complex of signs: speed of disappearance of symptoms of intoxication, phenomena of side effect of antitubercular medicines and normalization of indicators of cellular (CD3, CD3+CD4+, CD3+CD8+, CD3+CD4+/CD3+CD8+, CD3+CD56+, CD3+CD25+, CD3+HLA-DR+) and humoral (CD19, CD3-CD25+, CD3-HLA-DR+IgM, IgA, IgG, CEC) immunity.

Conclusions

1. Analysis of the study suggests the inclusion of goat's milk in the comprehensive treatment of first-identified pulmonary tuberculosis and drug-resistant tuberculosis in children and adolescents.

2. Taking goat's milk helps reduce the risk of developing side effects from chemotherapy, improve the tolerability of anti-tuberculosis drugs, and increase immunity. At the same time, the symptoms of intoxication decrease much faster, dyspeptic phenomena disappear and appetite is restored, which undoubtedly leads to faster recovery.

References

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Therapeutic nutrition for children and adolescents with persistent tuberculosis