Skip to main content
The Egyptian Journal of Bronchology
Download PDF

Serum neopterin level in cases of pulmonary tuberculosis and pneumonia

Egyptian Journal of Bronchology volume 10, pages 140–146 (2016)Cite this article

Abstract

Background

Pulmonary tuberculosis (TB) sometimes has diagnostic difficulties and a lot of differential diagnosis such as pneumonia. The aim of this work was to assess the role of serum neopterin in differentiating between pulmonary TB and pneumonia and to estimate the effect of antituberculous drugs for 2 months on serum levels of neopterin in patients with pulmonary TB.

Patients and methods

We measured serum neopterin in patients with TB, pneumonia patients, and controls. Serum neopterin was measured again after 2 months of antituberculous therapy in patients with pulmonary TB.

Results

Serum neopterin was significantly higher in tuberculous patients than in pneumonia patients, with a sensitivity of 90% and a specificity of 80% at an optimal cut-off value of 20.5 nmol/l. It decreased significantly after 2 months of antituberculous therapy in tuberculous patients.

Conclusion

Serum neopterin levels significantly increase in pulmonary TB and correlate with the radiological extent of the disease. Combined anti-TB treatment decreases the levels of serum neopterin. Measurement of the serum neopterin levels may be useful in following up the drug response in pulmonary TB. Serum neopterin levels may also be helpful in discriminating pulmonary TB from pneumonia.

References

  1. Knut L, Mario R. Global epidemiology of tuberculosis: prospects for control. Am J Respir Crit Care Med 2008;29:481–491.

    Article  Google Scholar 

  2. Zink A, Haas CJ, Reischl U, Szeimies U, Nerlich AG. Molecular analysis of skeletal tuberculosis in an ancient Egyptian population. Med Microbiol J 2001;50:355–366.

    Article  CAS  Google Scholar 

  3. Gerhard W, Katharina R, Willem H,Thomas J, Alimuddin Z. Immunological biomarkers of tuberculosis. Nat Rev Immunol 2011;11:343–354.

    Article  Google Scholar 

  4. Lee SW, Jang YS, Park CM, Kang HY, Koh WJ, Yim JJ, Jeon K. The role of chest CT scanning in TB outbreak investigation. Chest 2010;137:1057–1064.

    Article  Google Scholar 

  5. Bartlett JG, Dowell SF, Mandell LA, FileJr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis 2000;31:347–382.

    Article  CAS  Google Scholar 

  6. De Zeeuw J, Duggirala S, Nienhuis WA, Abass KM, Tuah W, Omansen TF et al. Serum levels of neopterin during antimicrobial treatment for Mycobacterium ulcerans infection. Am J Trop Med Hyg 2013;89:498–500.

    Article  Google Scholar 

  7. Arshadi D, Nikbin B, Shakiba Y, Kiani A, Jamshidi AR, Boroushaki MT. Plasma level of neopterin as a marker of disease activity in treated rheumatoid arthritis patients: association with gender, disease activity and anti-CCP antibody. Int Immunopharmacol 2013;17:763–767.

    Article  CAS  Google Scholar 

  8. Cesur S. Neopterin: a marker used for monitoring infections. Mikrobiyol Bul 2005;39:251–260.

    PubMed  Google Scholar 

  9. Tozkoparan E, Deniz O, Cakir E, Yaman H, Ciftci F, Gumus S et al. The diagnostic values of serum, pleural fluid and urine neopterin measurements in tuberculous pleurisy. Int J Tuberc Lung Dis 2005;9:1040–1045.

    CAS  PubMed  Google Scholar 

  10. Hoare Z, Lim WS. Pneumonia: update on diagnosis and management. BMJ 2006;332:1077–1079.

    Article  Google Scholar 

  11. World Health Organization. Tuberculosis control: the DOTS strategy (Directly Observed Treatment Short-Course). An annotated bibliography. Geneva, Switzerland: WHO; 1997.

    Google Scholar 

  12. Immanuel C, Swamy R, Kannapiran M, Vijayalakshmi S, Sundaram V, Jagannath K, Paramasivan CN. Neopterin as a marker for cell-mediated immunity in patients with pulmonary tuberculosis. Int J Tuberc Lung Dis 1997;1:175–180.

    CAS  PubMed  Google Scholar 

  13. Mohamed KH, Mobasher AA, Yousef AR, Salah A, El-Naggar IZ, Ghoneim AH, Light RW. BAL neopterin: a novel marker for cell-mediated immunity in patients with pulmonary tuberculosis and lung cancer. Chest 2001;119:776–780.

    Article  CAS  Google Scholar 

  14. Yuksekol I, Ozkan M, Akgul O, Tozkoparan E, Al-Rashed M, Balkan A et al. Urinary neopterin measurement as a noninvasive diagnostic method in pulmonary tuberculosis. Int Tuberc Lung Dis 2003;7:771–776.

    CAS  Google Scholar 

  15. Berktas M, Guducuoglu H, Bozkurt H, Onbasi KT, Kurtoglu MG, Andic S. Change in serum concentrations of interleukin-2 and interferon-gamma during treatment of tuberculosis. J Int Med Res 2004;32:324–330.

    Article  CAS  Google Scholar 

  16. Turgut T, Akbulut H, Deveci F, Kacar C, Muz MH. Serum interleukin-2 and neopterin levels as useful markers for treatment of active pulmonary tuberculosis. Tohoku J Exp Med 2006;209:321–328.

    Article  CAS  Google Scholar 

  17. Guler M, Huddam D, Unsal E, Ciftçi B, Bukan N, Erdogan Y, Capan N. The role of serum neopterin level in the evaluation of activation and response to treatment in the patients with pulmonary tuberculosis. Tuberk Toraks 2006;54:330–335.

    PubMed  Google Scholar 

  18. Ozdemir D, Cesur S, Annakkaya AN, Tarhan G, Sencan I, Cesur S et al. Serum neopterin concentrations in healthy healthcare workers compared with healthy controls and patients with pulmonary tuberculosis. Med Sci Monit 2006;12:CR521–CR524.

  19. Esma A, Fusun E, Remise G, Özlem KA, Gulcan G, Cuneyt M et al. Serum adenosine deaminase activity and neopterin levels during therapy in patients with pulmonary tuberculosis and community-acquired pneumonia. Istanbul Med J 2014;15:78–82.

    Article  Google Scholar 

  20. Salih C, Turan A, Nevin TH, Filiz C, Gulnur T, Aydın C et al. Clinical importance of serum neopterin level in patients with pulmonary tuberculosis. Int J Mycobacteriol 2014;3:5–8.

    Article  Google Scholar 

  21. Immanuel C, Victor L, Chelvi KS, Padmapriyadarsini C, Rehman F, Iliayas S, Swaminathan S. Serum neopterin levels in HIV infected patients with & without tuberculosis. Indian J Med Res 2005;121:220–225.

    CAS  PubMed  Google Scholar 

  22. Gordeuk VR, Moyo VM, Nouraie M, Gangaidzo IT, Murphree NL, Gomo ZA et al. Circulating cytokines in pulmonary tuberculosis according to HIV status and dietary iron content. Int J Tuberc Lung Dis 2009;13:1267–1273.

    CAS  PubMed  Google Scholar 

  23. Fuchs D, Hausen A, Kofler M, Kosanowski H, Reibnegger G, Wachter H. Neopterin as an index of immune response in patients with tuberculosis. Lung 1984;162:337–346.

    Article  CAS  Google Scholar 

  24. Sodhi A, Gong J, Silva C, Qian D, Barnes PF. Clinical correlates of interferon-gamma production in patients with tuberculosis. Clin Infect Dis 1997;25:617–620.

    Article  CAS  Google Scholar 

  25. Tsao TCY, Hong J-H, Li L-F, Hsieh MJ, Liao SK, Chang KS. Imbalances between tumor necrosis factor and its soluble receptor forms, and interleukin-1B and interleukin-1 receptor antagonist in BAL fluid of cavitary pulmonary tuberculosis. Chest 2000;117:103–109.

    Article  CAS  Google Scholar 

  26. Cok G, Parildar Z, Basol G, Kabaroglu C, Bayindir U, Habif S, Bayindir O. Pleural fluid neopterin levels in tuberculous pleurisy. Clin Biochem 2007;40:876–880.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest, Faculty of Medicine, Tanta University, Tanta, 33311, Egypt

    Wafaa S. El-Shimy & Adel S. Bediwy (MD)

  2. Department of Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt

    Azza M. Hassan

  3. Al-Mahalla Chest Hospital, Al-Mahalla Al-Kobra, Egypt

    Lamiaa R. Ismail

Authors
  1. Wafaa S. El-Shimy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adel S. Bediwy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Azza M. Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lamiaa R. Ismail
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adel S. Bediwy.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El-Shimy, W.S., Bediwy, A.S., Hassan, A.M. et al. Serum neopterin level in cases of pulmonary tuberculosis and pneumonia. Egypt J Bronchol 10, 140–146 (2016). https://doi.org/10.4103/1687-8426.184360

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.184360

Keywords