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Effect of adding inhalation of sodium bicarbonate 8.4% to the usual treatment on smear-positive pulmonary tuberculosis: a prospective controlled study

Egyptian Journal of Bronchology volume 13, pages 531–538 (2019)Cite this article

Abstract

Background

Pulmonary tuberculosis (TB) lesion is acidic, and changing this acidic pH may affect growth of TB bacilli and response to therapy. We aimed to assess the effect of adjuvant inhalation of sodium bicarbonate (SB) 8.4% on clinical, radiological, and microbiological responses in patients with sputum-positive drug-sensitive pulmonary TB.

Patients and methods

One hundred and three patients with pulmonary TB completed the study, and they were classified into two groups: group I included 55 patients who received standard anti-TB regimen plus SB inhalation, and group II included 48 patients who received anti-TB regimen only. The responses in both groups were evaluated clinically, microbiologically, and radiologically.

Results

There was no statistically significant difference between both groups in baseline bacillary load, clinical picture, and radiology. Both groups improved clinically 1 month after start of therapy. In group I only, there was a statistically significant improvement in chest radiograph after 1 month (P<0.001). The median duration of smear conversion for group I was 3 weeks (1–8) compared with 9.5 (2–17) in group II, with a statistically significant difference (P<0.001). Moreover, the median duration of culture conversion for group I was 1 month (1–3) compared with 3 months (1–4) in group II, with a statistically significant difference (P<0.001).

Conclusion

Adjuvant inhalation of SB in smear-positive pulmonary TB to standard anti-TB drugs accelerates smear conversion, culture conversion, and clinical and radiological improvement.

References

  1. Global Tuberculosis Report. Geneva: World Health Organization; 2015. Available at: http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1 http://www.who.int/tb/publications/global_report/indicators_global_and_regional_summaries.pdf. [Accessed 13 September 2016].

  2. Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis: What the Clinician Should Know. Chapter 2 Transmission and Pathogenesis of Tuberculosis. Sixth Edition; 2013. Available at: https://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf. [Accessed 13 September 2016].

  3. Republic of South Africa Department of Health. South African National Tuberculosis Management Guidelines; 2014.

  4. Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. J Am Med Assoc 1995; 273:220–226.

    Article  CAS  Google Scholar 

  5. Dannenberg AM. Pathogenesis of human pulmonary tuberculosis: insights from the rabbit model. Washington, DC: ASM Press 2006.

    Book  Google Scholar 

  6. Saviola B. Response of Mycobacterial species to an acidic environment. In: Cardona PJ, editor. Understanding tuberculosis – deciphering the secret life of the bacilli. InTech; 2012. pp. 89–102.

  7. Sabatini S, Kurtzman NA. Bicarbonate therapy in severe metabolic acidosis. J Am Soc Nephrol 2009; 20:692–695.

    Article  CAS  Google Scholar 

  8. Abdalla D, El Badrawy M, AbouElela M, Abou El-khier N, Abdelgawad T, Moawad A, et al. Effect of bronchoalveolar lavage with sodium bicarbonate on lower respiratory tract pathogens. Chest 2016; 149:4S.

    Article  Google Scholar 

  9. Treatment of Tuberculosis Guidelines. Fourth edition. World Health Organization; 2010. Available at: http://apps.who.int/iris/bitstream/10665/44165/1/9789241547833_eng.pdf?ua=1&ua=1. [Accessed 22 November 2016].

  10. Lohmann EM, Koster BF, le Cessie S, Kamst-van Agterveld MP, van Soolingen D, Arend SM. Grading of a positive sputum smear and the risk of Mycobacterium tuberculosis transmission. Int J Tuberc Lung Dis 2012; 16:1477–1484.

    Article  CAS  Google Scholar 

  11. National Tuberculosis Association of the USA. Diagnostic standards and classification of tuberculosis. New York, NY: National Tuberculosis Association; 1961.

    Google Scholar 

  12. Ng AW, Bidani A, Heming TA. Innate host defense of the lung: effects of lung-lining fluid pH. Lung 2004; 182:297–317.

    Article  Google Scholar 

  13. Bodem CR, Lampton LM, Miller DP, Tarka EF, Everett ED. Endobronchial pH. Relevance of aminoglycoside activity in Gram-negative bacillary pneumonia. Am Rev Respir Dis 1983; 127:39–41.

    Article  CAS  Google Scholar 

  14. Dalhoff A, Schubert S, Ullmann U. Effect of pH on the in vitro activity of and propensity for emergence of resistance to fluoroquinolones, macrolides, and a ketolide. Infection 2005; 33:36–43.

    Article  CAS  Google Scholar 

  15. Bidani A, Heming TA. Effects of bafilomycin A1 on functional capabilities of LPS-activated alveolar macrophages. J Leukoc Biol 1995; 57: 275–281.

    Article  CAS  Google Scholar 

  16. Bidani A, Reisner BS, Haque AK, Wen J, Helmer RE, Tuazon DM, et al. Bactericidal activity of alveolar macrophages is suppressed by V-ATPase inhibition. Lung 2000; 178:91–104.

    Article  CAS  Google Scholar 

  17. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare settings. MMWR Recomm Rep 2005; 54:1–141.

    Google Scholar 

  18. Agarwal SP, Chauhan LS. Tuberculosis Control In India. Directorate General of Health Services, Ministry of Health and Family Welfare. New Delhi, India: Government of India; 2005.

    Google Scholar 

  19. Frieden T, editor. Toman’s tuberculosis case detection, treatment, and monitoring – questions and answers. 2nd edition. Geneva, Switzerland: World Health Organisation 2004.

    Google Scholar 

  20. Parikh R, Nataraj G, Kanade S, Khatri V, Mehta P. Time to sputum conversion in smear positive pulmonary TB patients on category I DOTS and factors delaying it. J Assoc Physicians India 2012; 60:22–26.

    PubMed  Google Scholar 

  21. Ngamtrakulpanit L, Yu Y, Adjei A, Amoah G, Gaston B, Hunt J. Identification of intrinsic airway acidification in pulmonary tuberculosis. Glob J Health Sci 2010; 2:106–110.

    Article  Google Scholar 

  22. Treatment of Tuberculosis Disease. Available at: http://www.cdc.gov/TB/education/corecurr/pdf/chapter6.pdf. [Accessed 22 November 2016].

  23. Hess D, Fisher D, Williams P, Pooler S, Kacmarek RM. Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996; 110:498–505.

    Article  CAS  Google Scholar 

  24. Iivanainen E, Martikainen PJ, Vaananen P, Katila ML. Environmental factors affecting the occurrence of myco-bacteria in brook sediments. J Appl Microbiol 1999; 86:673–681.

    Article  CAS  Google Scholar 

  25. Parashar D, Kabra SK, Lodha R, Singh V, Mukherjee A, Arya T, et al. Does neutralization of gastric aspirates from children with suspected intrathoracic tuberculosis affect mycobacterial yields on MGIT culture? J Clin Microbiol 2013; 51:1753–1756.

    Article  Google Scholar 

  26. MacMicking JD, Taylor GA, McKinney GD. Immune control of tuberculosis by IFN-gamma-inducible LRG-47. Science 2003; 302:654–659.

    Article  CAS  Google Scholar 

  27. Schaible UE, Sturgill-Koszycki S, Schlesinger PH, Russell DG. Cytokine activation leads to acidification and increases maturation of Mycobacterium avium-containing phagosomes in murine macrophages. J Immunol 1998; 160:1290–1296.

    PubMed  CAS  Google Scholar 

  28. Via LE, Fratti RA, McFalone M, Pagan-Ramos E, Deretic D, Deretic V. Effects of cytokines on mycobacterial phagosome maturation. J Cell Sci 1998; 111:897–905.

    PubMed  CAS  Google Scholar 

  29. Vandal OH, Nathan CF, Ehrt S. Acid resistance in Mycobacterium tuberculosis. J Bacteriol 2009; 191:4714–4721.

    Article  CAS  Google Scholar 

  30. Jackett PS, Aber VR, Lowrie DB. Virulence and resistance to superoxide, low pH and hydrogen peroxide among strains of Mycobacterium tuberculosis. J Gen Microbiol 1978; 104:37–45.

    Article  CAS  Google Scholar 

  31. Vandal OH, Pierini LM, Schnappinger D. A membrane protein preserves intrabacterial pH in intraphagosomal Mycobacterium tuberculosis. Nat Med 2008; 14:849–854.

    Article  CAS  Google Scholar 

  32. Armstrong JA, Hart PD. Phagosome-lysosome interactions in cultured macrophages infected with virulent tubercle bacilli. Reversal of the usual nonfusion pattern and observations on bacterial survival. J Exp Med 1975; 142:1–16.

    Article  CAS  Google Scholar 

  33. Gomes MS, Paul S, Moreira AL, Appelberg R, Rabinovitch M, Kaplan G. Survival of Mycobacterium avium and Mycobacterium tuberculosis in acidified vacuoles of murine macrophages. Infect Immun 1999; 67:3199–3206.

    Article  CAS  Google Scholar 

  34. Metchnikoff E. Immunity to infective disease. Cambridge, UK: Cambridge University Press 1905. p. 182.

    Google Scholar 

  35. Hoffmann C, Leis A, Niederweis M, Plitzko JM, Engelhardt H. Disclosure of the mycobacterial outer membrane: cryo-electron tomography and vitreous sections reveal the lipid bilayer structure. Proc Natl Acad Sci USA 2008; 105:3963–3967.

    Article  Google Scholar 

  36. Zuber B, Chami M, Houssin C, Dubochet J, Griffiths G, Daffé M. Direct visualization of the outer membrane of mycobacteria and corynebacteria in their native state. J Bacteriol 2008; 190:5672–5680.

    Article  CAS  Google Scholar 

  37. Mesquita ED, Gil-Santana L, Ramalho D, Tonomura E, Silva EC, Oliveira MM, et al. Associations between systemic inflammation, mycobacterial loads in sputum and radiological improvement after treatment initiation in pulmonary TB patients from Brazil: a prospective cohort study. BMC Infect Dis 2016; 16:368.

    Article  CAS  Google Scholar 

  38. Rubin BK. Mucolytics, expectorants, and mucokinetic medications. Respir Care 2007; 52:859–865.

    Google Scholar 

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Authors and Affiliations

  1. Department of Chest Medicine, Mansoura University Hospital, Elgomhoria Street, 35511, Mansoura, Dakahliya, Egypt

    Mohammad K. El-Badrawy, Eman O. Arram & Dina A. Abdalla

  2. Department of Radiology, Mansoura University Hospital, Mansoura, Egypt

    Adel El-Badrawy

  3. Department of Chest Medicine Department, Mansoura Chest Hospital, Mansoura University, Mansoura, Egypt

    Dina Al-Sagheer & Alaa Zahran

  4. Department of Medical Microbiology and Immunology, Mansoura University, Mansoura, Egypt

    Mohammad A. AboElEla

  5. Department of National TB Control Program, Cairo, Egypt

    Wagdy Amin

Authors
  1. Mohammad K. El-Badrawy
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  2. Eman O. Arram
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  3. Dina A. Abdalla
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  4. Dina Al-Sagheer
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  7. Adel El-Badrawy
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Corresponding author

Correspondence to Dina A. Abdalla.

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El-Badrawy, M.K., Arram, E.O., Abdalla, D.A. et al. Effect of adding inhalation of sodium bicarbonate 8.4% to the usual treatment on smear-positive pulmonary tuberculosis: a prospective controlled study. Egypt J Bronchol 13, 531–538 (2019). https://doi.org/10.4103/ejb.ejb_18_19

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  • DOI: https://doi.org/10.4103/ejb.ejb_18_19

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