EC Pulmonology and Respiratory Medicine

Background: Sputum conversion of active pulmonary TB occurs in 48% and 58% patients after four and eight weeks of standard anti-tuberculosis treatment, respectively. Without an effective immune system, standard anti-tuberculosis therapy are not able to eradicate mycobacterium completely, thus using adjunctive immunomodulator Phyllanthus niruri extracts is hypothesized to hasten sputum conversion.

Method: A double-blind randomization of 67 newly diagnosed tuberculosis patients into treatment group (RHZE and PNE thrice daily) or control group (RHZE and placebo) was conducted.

Result: Bivariate statistical analysis revealed no significant difference in sputum conversion, radiologic score, and cytokine levels between two groups. Logistic regression analysis showed that adjuvant PNE and higher IL-6 levels were correlated with faster spu- tum conversion (RR 0.32 and 0.14, respectively). No correlation was found between sputum conversion and reduction of pulmonary lesion area.

Discussion: Faster sputum conversion, as reported in the treatment group, benefits at the community level despite the insignificant statistical difference. Further, faster conversion may assist in controlling the spread of tuberculosis as most lost to follow-up TB cases were happened during the intensive anti-tuberculosis phase. Additionally, sputum conversion mostly occurred within the first week of treatment, thus evaluation of the role of cytokines in the second month was not representative of its function in eliminating mycobacterium tuberculosis. As severe lung damage is correlated with oxygen free radicals, PNE prescription as an antioxidant may be rationalized.

Conclusion: PNE hastens sputum conversion in pulmonary tuberculosis patients which may lower tuberculosis burden by decreas- ing spread of the disease

Keywords: Sputum Conversion; Pulmonary Tuberculosis; Phyllanthus niruri; Herbal Medicine; Phytopharmaca; Loss to Follow Up

1. “Global Tuberculosis Report 2015. 20th ed”. Geneva: WHO Press (2015): 36-68.
2. Zaitzeva SI., et al. “Treatment of cavitary and infiltrating pulmonary tuberculosis with and without the immunomodulator dzherelo”. Clinical Microbiology and Infection 15.12 (2009): 1154-1162.
3. Adhvaryu MR., et al. “Prevention of hepatotoxicity due to anti tuberculosis treatment: A novel integrative approach”. World Journal of Gastroenterology 14.30 (2008): 4753-4762.
4. Karyadi E., et al. “Cytokines related to nutritional status in patients with untreated pulmonary tuberculosis in Indonesia”. In book: Karyadi E, ed. Tuberculosis in Indonesia: nutrition, immune response, and social aspects. Wageningen: Grafisch Bedrijf Ponsen and Looijen BV (2001): 53-70.
5. Putoyo CW., et al. “The correlation between serum tumor necrosis factor-α, nutritional status, and sputum conversion in patients with lung tuberculosis”. Actamedica 35.2 (2003): 60-69.
6. Maat S. “Phyllanthus niruri L sebagai imunomodulator pada mencit”. Disertasi pasca sarjana Universitas Airlangga, Surabaya (1997).
7. Barba C., et al. “Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies”. Lancet 363.9403 (2004): 157-163.
8. Amin ZA., et al. “Assessment of In vitro antioxidant, antibacterial, and immune activation potentials of aqueous and ethanol extracts of Phyllanthus niruri”. Journal of the Science of Food and Agriculture 92.9 (2012): 1874-1877.
9. Nworu CS., et al. “Aqueous extract of Phyllanthus niruri (Euphorbiaceae) enhances the phenotypic and functional maturation of bone marrow-derived dendritic cells and their antigen-presentation function”. Immunopharmacology and Immunotoxicology 32.3 (2010): 393-401.
10. Tupasi TE., et al. “Factors associated with loss to follow-up during treatment for multidrug-resistant tuberculosis, the Philippines, 2012–2014”. Emerging Infectious Disease 22.3 (2016).
11. Agarwal A., et al. “Effect of green tea extract (catechins) in reducing oxidative stress seen in patients of pulmonary tuberculosis on DOTS Cat I regimen”. Phytomedicine 17.1 (2010): 23-27.
12. Nikolaeva LG., et al. “Cytokine profiles of HIV patients with pulmonary tuberculosis resulting from adjunct immunotherapy with herbal phytoconcentrates Dzherelo and Anemin”. Cytokine 44.3 (2008): 392-396.
13. Nworu CS., et al. “The effects of Phyllanthus niruri Aqueous Extract on Activation of Murine Lymphocytes and Bone Marrow Derived Macrophages”. Immunological Investigations 39.3 (2010): 245-267.