Inour study, the level of CD4 cell count is significantly higher in the controlswhen compared with that of with that of newly diagnosed TB-patients. This is inagreement with previously literature. Evidencealso shown that a low CD4 cell count associated with TB disease and CD4 cellcount is substantially low in more advanced disease among HIV-negative TBpatients and more advanced disease was shown CD4 lympcytopenia (14). Because of protective immune response against this pathogenmediated by cellular immunity mediated by Th1 cells. This leads the patientsfor the progression of tuberculosis (3). More over most of TB cases show low BMI in ourstudy, which may play a great role for the decreasing of CD4 counts and theirfunctionality by reducing the transportation of differ co-factors and elementsthan controls with normal BMI value.
This Low level of CD4 cells play a greatfor the pathogenesis of TB disease, because it may be due to the low respond indelayed type immune response and due to low level of cell frequency may lead todecrease in granuloma formation, which is fundamental for proper immuneresponse.IFN-?is one of the Th1 cytokine where identified as the most important agents of antimycobacterialcytokine (15) by activate macrophage to enhanceintracellular killing (16)and enhance the production other cytokine (17).In our study the level of IFN-? was significantly higher in TB patientscompared with the control groups. The finding is consistent with other similarstudies on TB (18-20)and the level of this cytokine is decrease through and after treatment (20)The probable reason why INF- ? is higher in TB patients while CD4 cell are lowis that, may be due to IFN- ? comes out from both local production and spillover of it from the activated lymphocytes sequestered at the site of MTBinfection. This condition can able to contribute to the cytokine not be able toelicit downstream events involving in effective activation of macrophages andintracellular killing of MTB. All these conditions play a great role for thepathogenesis of MTB infections. Thelevel of IL- 6 in TB patients also higher than that of the controls, othersimilar studies had the result which is in line with our findings, done inhumans (21,22).
On the other hand also study showed that there is increased IL- 6 in active TBdisease condition when compared with that of the latent condition of TBinfection (23).In addition study showed that the concentration of IL-6 very high in TBpatients with pulmonary cavities than without cavities. This great indicationthat IL-6 plays it own role for the TB disease outcome (24).High level of IL-6 during TB infection can inhibit the type 1 interferonsignalling on macrophage and consequently lead to the disease progression (25).On the other hand of IL-6 levelcorrelated with disease severity, nutritional status has a great contributionfor the incereasement of IL-6 concentration (24),our studies support this because of the level of BMI in TB patients weresignificantly lower than that on health controls.The level of monceyt in the blood of TB patientsis higher than that of the controls and show significant association, one ofthe probable reason that the incensement of the monocyte during TB infection isthat during TB infection there is a production of pro-inflamatory cytokines andchemo attractant factors that direct the monocyte from the bone marrow to lymphnode and other infected tissue to act like macrophages. At this condition theremay be an increasment of monocyte in the vascular.
On the other hand cytokinesthat is produced by infected macrophages may have an impact on monocyte not tochange in to macrophages to go to the infected area. This high frequency ofmonocyet in TB patients may also contribute for the increasement of IL- 6 in TBpatients; they have high level than of the controls.