The Effect of Alcohol Use on the Clinical Presentation of Tuberculosis

Wang, Heqiong; Hosford, Jennifer; Lauzardo, Michael

doi:10.4172/2161-1068.1000123

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…Whether alcohol may have an antagonistic, additive, or synergistic effect with these comorbidities or with other demographics is unclear. The four previous studies [ 9 – 11 , 33 ] that investigated alcohol and TB disease severity were in populations where women consume alcohol; one study reported 15% of those who consumed alcohol were female [ 10 ] compared to <1% in our cohort. Similarly, only one study reported comorbid diabetes [ 33 ]; 19% of their cohort had diabetes compared to 34% of our cohort.…”

Section: Discussionmentioning

confidence: 81%

“…Researchers previously hypothesized that heavy alcohol use would be associated with infectiousness among TB patients due to increased cavitation and a higher likelihood of smear-positivity [ 10 , 32 ]. Previous studies found an approximately 25% increased risk of cavitation among those who use alcohol and a similar increased risk of smear positivity [ 9 – 10 ] However, these studies were done in low-burden settings and only one assessed alcohol use with a validated instrument. The only prior study which used standardized questionnaires for frequency and quantity of alcohol consumption found no independent relationship between recent alcohol use or lifetime alcohol use and lung cavitation at the time of TB diagnosis [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol use has been associated with both progression to TB disease and poor TB treatment outcomes [5][6][7][8]. Studies have shown an association between alcohol use and both lung cavitation and smear positivity, but these studies are limited to low-burden settings and results have been conflicting [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Alcohol use and tuberculosis clinical presentation at the time of diagnosis in Puducherry and Tamil Nadu, India

et al. 2020

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Setting Alcohol use increases the risk of tuberculosis (TB) disease and is associated with worse outcomes. Objective To determine whether alcohol use affects TB severity at diagnosis in a high-burden setting. Design Participants were smear-positive people living with TB (PLWTB) in India. Disease severity was assessed as 1) high versus low smear grade, 2) time to positivity (TTP) on liquid culture, 3) chest radiograph cavitation, and 4) percent lung affected. Alcohol use and being at-risk for alcohol use disorders (AUD) were assessed using the AUDIT-C. Univariable and multivariable analyses were conducted. Results Of 1166 PLWTB, 691 (59.3%) were drinkers; of those, 518/691 (75.0%) were at-risk for AUD. Drinkers had more lung affected than non-drinkers (adjusted mean difference 10.8%, p<0.0001); this was not significant for those at-risk for AUD (adjusted mean difference 3.7%, p = 0.11). High smear grade (aOR 1.0, 95%CI: 0.7–1.4), cavitation (aOR 0.8, 95%CI 0.4–1.8), and TTP (mean difference 5.2 hours, p = 0.51) did not differ between drinkers and non-drinkers, nor between those at-risk and not at-risk for AUD. Conclusions A large proportion of PLWTB were drinkers and were at-risk for AUD. Alcohol drinkers had more lung affected than non-drinkers. Studies are needed to explore mechanisms of this association.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Alcohol use and tuberculosis clinical presentation at the time of diagnosis in Puducherry and Tamil Nadu, India

et al. 2020

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“…Those with AUD and TB are more likely to present with pulmonary rather than extrapulmonary TB ( 25 , 26 ). More of their lungs are affected by TB and they are predisposed to advanced, cavitary disease at the time of presentation ( 25 , 26 , 35 , 37 ).…”

Section: Alcohol and Tb Epidemiologymentioning

confidence: 99%

The Impact of Alcohol Use Disorder on Tuberculosis: A Review of the Epidemiology and Potential Immunologic Mechanisms

et al. 2022

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Globally, an estimated 107 million people have an alcohol use disorder (AUD) leading to 2.8 million premature deaths each year. Tuberculosis (TB) is one of the leading causes of death globally and over 8% of global TB cases are estimated to be attributable to AUD. Social determinants of health such as poverty and undernutrition are often shared among those with AUD and TB and could explain the epidemiologic association between them. However, recent studies suggest that these shared risk factors do not fully account for the increased risk of TB in people with AUD. In fact, AUD has been shown to be an independent risk factor for TB, with a linear increase in the risk for TB with increasing alcohol consumption. While few studies have focused on potential biological mechanisms underlying the link between AUD and TB, substantial overlap exists between the effects of alcohol on lung immunity and the mechanisms exploited by Mycobacterium tuberculosis (Mtb) to establish infection. Alcohol misuse impairs the immune functions of the alveolar macrophage, the resident innate immune effector in the lung and the first line of defense against Mtb in the lower respiratory tract. Chronic alcohol ingestion also increases oxidative stress in the alveolar space, which could in turn facilitate Mtb growth. In this manuscript, we review the epidemiologic data that links AUD to TB. We discuss the existing literature on the potential mechanisms by which alcohol increases the risk of TB and review the known effects of alcohol ingestion on lung immunity to elucidate other mechanisms that Mtb may exploit. A more in-depth understanding of the link between AUD and TB will facilitate the development of dual-disease interventions and host-directed therapies to improve lung health and long-term outcomes of TB.

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“…More recent studies have confirmed the increased risk of TB among persons with AUD and found that the latter is an independent risk factor for TB even after controlling for confounders such as comorbidities, lifestyle, or social determinants of health (Imtiaz et al, 2017; Lonnroth et al, 2008; Rehm et al, 2009). Further, those with AUD and TB are more infectious and have more clinically severe TB, including more cavitary disease and larger areas of the affected lung, compared to those without AUD (Classen et al, 1999; Diel et al, 2004; Fiske et al, 2009; Volkmann et al, 2015; Wang & Lauzardo, 2012). Even when treated, AUD is associated with poor outcomes, including increased risk of treatment failure and death (Ragan et al, 2020; Thomas et al, 2019; Volkmann et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Alcohol impairs recognition and uptake of Mycobacterium tuberculosis by suppressing toll‐like receptor 2 expression

Wigger

Khani

Ahmed

et al. 2022

Alcoholism Clin & Exp Res

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Background Alcohol impairs pulmonary innate immune function and is associated with an increased risk of tuberculosis (TB). Toll‐like receptor 2 (TLR2) is a pattern recognition receptor on alveolar macrophages that recognizes Mycobacterium tuberculosis (Mtb). The expression of TLR2 depends, in part, on granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) signaling. Given our prior work demonstrating the suppression of GM‐CSF signaling following chronic alcohol ingestion, we hypothesized that alcohol impairs TLR2 expression via the suppression of GM‐CSF and thereby reduces the ability of the macrophage to recognize and phagocytose Mtb. Methods Primary alveolar macrophages were isolated from control‐fed and alcohol‐fed rats. Prior to cell isolation, some alcohol‐fed rats were treated with intranasal GM‐CSF and then endotracheally inoculated with an attenuated strain of Mtb. Primary macrophages were then isolated and immunofluorescence was used to determine phagocytic efficiency and TLR2 expression in the presence and absence of GM‐CSF treatment and phagocytic efficiency in the presence and absence of TLR2 neutralization. Results TLR2 expression and phagocytosis of Mtb were significantly lower in the alveolar macrophages of alcohol‐fed rats than control‐fed rats. In parallel, blocking TLR2 signaling recapitulated this decreased phagocytosis of Mtb. In contrast, intranasal GM‐CSF treatment restored TLR2 expression and Mtb phagocytosis in the alveolar macrophages of alcohol‐fed rats to levels comparable to those of control‐fed rats. Conclusions Chronic alcohol ingestion reduces TLR2 protein expression and phagocytosis of Mtb, likely due to impaired GM‐CSF signaling. GM‐CSF restores membrane‐bound TLR2 expression and phagocytic function.

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The Effect of Alcohol Use on the Clinical Presentation of Tuberculosis

Cited by 4 publications

References 7 publications

Alcohol use and tuberculosis clinical presentation at the time of diagnosis in Puducherry and Tamil Nadu, India

Alcohol use and tuberculosis clinical presentation at the time of diagnosis in Puducherry and Tamil Nadu, India

The Impact of Alcohol Use Disorder on Tuberculosis: A Review of the Epidemiology and Potential Immunologic Mechanisms

Alcohol impairs recognition and uptake of Mycobacterium tuberculosis by suppressing toll‐like receptor 2 expression

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