346 J Contemp Med Sci | Vol. 7, No. 6,  November-December 2021: 346–348

Original

Effects of Anti-Tuberculosis Drugs on the Level of some Nutritional 
Factors among Patients with Tuberculosis
Zainab Adil Ghani Chabuck1*, Sarah Hashim Alhelli2, Saade Abdalkareem Jasim3

1College of Medicine, University of Babylon, Babylon, Iraq.
2Biomedical Engineering Department, Al-Mustaqbal University College, 51001 Hillah, Babil, Iraq.
3Medical Laboratory Techniques Department, Al-Maarif University College, Anbar, Iraq.
*Correspondence to: Zainab Adil Ghani Chabuck (E-mail: zainabibz@gmail.com)

Abstract
Objectives: The study aimed to assess changes in the level of some nutritional elements including zinc and copper for tuberculosis patients 
before, during and after anti- tuberculosis therapy. 
Methods: Whole blood samples are collected from 120 tuberculosis patients who are admitted to specialist clinic of the respiratory diseases 
in Babylon province, within a period from November 2020 to January 2021. 
Results: Out of whole TB patients, (66) ones were males and the remaining (54) were females, the age of patients ranging from (13–70) 
years. Sixty, apparently healthy control groups who had no Tuberculosis history were chosen. Using spectrophotometer for estimating the 
level of Zinc and copper. In TB patients the zinc level was increased during and after anti-tuberculosis therapy, but the level of zinc lower in 
patients after therapy compared with controls. The level of copper was decreased during and after the course of anti-tuberculosis, but the 
level of copper higher in patients after therapy compared with controls. 
Conclusion: These parameters could be used in follow-up as the achievement of TB therapy success.
Keywords: Copper, zinc, M. tuberculosis, anti-tuberculosis

ISSN 2413-0516

Introduction
Tuberculosis (TB) is one of the primary considerable causes of 
sickness and mortality. As along many decades, the numbers 
of TB cases had been increased significantly worldwide. 
Human immune response has a potential implication in the 
control and prevention of TB disease, thus it is so essential  
to comprehend its regulation; especially the cell-mediated 
immune response that influenced the main response of the 
host against M. tuberculosis, in which important role is attrib-
uted to cytokine and T helper-1 cells.1

Many factors can affect this response, one of them is the 
micronutrients, copper, and zinc have a vital role in the 
growth, differentiation, and proliferation of cells of acquired 
and innate immunity. Both these nutrients play a crucial role 
in the resistance of the human body to certain infections as 
tuberculosis. 

As an influence of reduced zinc level, which causes 
shifting in the function of macrophage and reduces the pro-
duction of interferon-γ (INF-γ) and tumor necrosis factor 
(TNF-α). This reduced zinc concentration may be also respon-
sible for the reduction of the differentiation and proliferation 
of B and T lymphocytes. The changes in the immunity 
dynamics would be the first line in the presentation of the 
immune system to protect against active tuberculosis. Addi-
tionally, a quick cure of adult patients with active TB could be 
achieved by supplementation of zinc and vitamin A as they 
allow thorough elimination of Mycobacterium.2 Vemula et al. 
showed that micronutrients deficiency enhances the ability of 
mycobacterium to produce M. tuberculosis Zinc metallopro-
tease-1 (Zmp1), which is crucial for their pathogenesis and 
intracellular survivals with immunogenic potential.3

Regarding copper, it has a role in the biological systems 
due to its existence in the composition of many active biolog-
ical enzymes that act in reductive and oxidative reactions, as 

metallothioneins lysyl oxidase, ceruloplasmin, cytochrome 
oxidase, and SOD. In spite of its biological and physiological 
assistances, its excessive level is toxic and might cause inhibi-
tion of M. tuberculosis growth.4

Materials and Methods
The population of study-involved tuberculosis (TB) patients 
admitted to specialist clinics of the respiratory diseases in Bab-
ylon province, within a period from November 2020 to 
January 2021. Out of whole TB patients, (66) ones were males 
and the remaining (54) were females, the age of patients 
ranging from 13 to 70 years. The exclusion criteria: Any 
patients have Diabetic Mellitus, malignancy, allergic and preg-
nant women left out from the study. As well, sixty apparently 
healthy groups who had no Tuberculosis previously. 

The Sample Collection 
For serological studies the serum was separated; three ml of 
the blood sample was allowed to clot for about fifteen min. 
After that loosed the clot from a wall of the tube, at room tem-
perature. Then, the sample centrifuged for 10 min at 2500 
rpm. As a final point the serum transported to another tube 
for storage at –20°C.

Methods
Using spectrophotometer for estimating the level of Zinc and 
copper (LTA-Italy).

Statistical Analysis 
This study used a statistical analysis that included the calcula-
tion of mean values and SD. For P value used independent 
samples t-tests, and the level P < 0.05 is significant. The statis-
tical analysis used (SPSS Inc., Chicago, USA) version 18. 

(Submitted: 16 September 2021 – Revised version received: 12 October 2021 – Accepted: 29 October 2021 – Published online: 26 December 2021)



347J Contemp Med Sci | Vol. 7, No. 6,  November-December 2021: 346–348

Z.A.G. Chabuck et al.
Original

Effects of Anti-Tuberculosis Drugs on the Level of some Nutritional Factors among Patients with Tuberculosis 

Results 

A- Level of Zinc during and after Therapy for TB 
Patients and Controls
The mean and SD of zinc for untreated TB patients (35.507 ± 
9.876) μg/dl then (55.162 ± 9.941) μg/dl during therapy and 
(63.212 ± 8.752) μg/dl after complete course of anti- 
tuberculosis therapy. While (74.350 ± 7.260) μg/dl for control 
groups, Table 1.

Also, this study found that the means of zinc no signifi-
cantly lower in patients after therapy (63.212 ± 8.752) μg/dl 
compared with control group (74.350 ± 7.260) μg/dl, Table 2. 

B- Level of Copper during and after Therapy for 
TB Patients and Controls
The mean and SD of copper for untreated TB patients (158.518 
± 28.561) μg/dl then (119.527 ± 22.026) μg/dl during therapy 
and (109.871 ± 26.547) μg/dl after a complete course of 
anti-tuberculosis therapy, Table 3.

Also, in this study found that the means of copper signifi-
cantly higher in TB patients after therapy (109.871 ± 26.547) 
μg/dl compared with control groups (85.277 ± 7.907) μg/dl, 
Table 4. 

Discussion
Zinc is a micronutrient that is necessary for the typical activi-
ties of the immune system.5 Zinc aids in the bacterial destruc-
tion by the immune system cells, such as tubercle bacilli. Thus 
reduced Zinc level enhances infections; in TB and TB-HIV 
infected patients there were decreased levels of zinc in their 
blood samples. This regulation can occur at the transcriptional 
level, via DNA-binding metal-responsive transcriptional 
repressors which are responsible for the regulation of the tran-
scription process as in many bacteria as M. tuberculosis.4

From the results was found the means of zinc increased 
gradually during anti-tuberculosis and after therapy. The result 
was in agreement with a study of 6 who found that a lessened 
concentration level of serum Zn at the initial stage of treat-
ment when compared to control, in men and in women  
(P < 0.05). After the course of treatment, it was showed a sig-
nificant increment in the level of serum Zn when it compared 
to untreated patients. This could occur due to change in the 
distribution of zinc flowing through out further tissues 
including the liver; this is due to a reduced production of α-2- 
macroglobulin in the liver; this protein carry zinc in the blood, 

to get advantage of high production of this protein, it carries 
zinc to the liver.6

The result was matched with the study of 6 who found that 
no significant difference in the mean Zinc (P = 0.415) levels 
between Tuberculosis patients who have completed Anti- 
Tuberculosis Treatment 80.48 and Healthy groups 86.42. 
Another study was showed lower concentration of zinc was 
observed when compared to normal values.6

From the results was found the means of copper decreased 
gradually during anti-tuberculosis and after therapy. The result 
was matched with the study of 7 who mentioned that the serum 
level of copper in the patients under anti TB treatment was 
significantly decreased. The result was matched with8 who 
showed that a lower concentration of copper in TB patients 
was observed when it compared to normal values.

The high concentration of copper in TB patients could be 
explained logically. As the decrement in levels of zinc, which 
occurs in TB patients, could prevent the entering of the copper 
into the tissues, and this may lead to the elevation in the level 
of serum copper. While increment in the levels some metals as 
cadmium or copper leads to poorer absorption of serum iron 
that is in agreement with this study.9 

Table 1. Zinc level in the serum for TB patients

Untreated patients During therapy After therapy

35.507 ± 9.876 55.162 ± 9.941 63.212 ± 8.752

Table 2. Level of zinc in TB patients and controls

Studied groups Mean ± SD P value

After therapy patients 63.212 ± 8.752
0.434

Controls group 74.350 ± 7.260

Table 3. Copper level in the serum of TB patients

Untreated patients During therapy After therapy

158.518 ± 28.561 119.527 ± 22.026 109.871 ± 26.547

Table 4. Level of copper in TB patients and controls

Studied groups Mean ± SD P value

After therapy patients 109.871 ± 26.547
0.002

Controls group 85.277 ± 7.907

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348 J Contemp Med Sci | Vol. 7, No. 6,  November-December 2021: 346–348

Effects of Anti-Tuberculosis Drugs on the Level of some Nutritional Factors among Patients with Tuberculosis
Original

Z.A.G. Chabuck et al.

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