The role of Mycobacterium tuberculosis lineages on lung tissue damage and TNF-α level among tuberculosis patients, Indonesia

Background: Mycobacterium tuberculosis (MTB) is divided into ancient and modern lineage. Both lineages have different virulence property and therefore associated with different immune responses and disease severity in tuberculosis (TB) patients. The aim of this study was to determine the association between MTB lineages and the level of tumor necrosis factor alpha (TNF-α), and lung tissue damage among Indonesian TB patients. Methods: Thirty new and active TB patients were recruited randomly from Dr. Soewandhie Hospital, Surabaya, Indonesia. MTB isolates were isolated from bronchoalveolar lavage fluid (BALF) and their lineages were determined by primer-specific PCR targeting TbD1 and RD9 region gene. The degree of lung tissue damage was assessed and classified using NICE Scoring System and TNF-α level of BALF was measured by ELISA. Results: MTB were detected in all patients in which 17 and 13 isolates were classified as modern and ancient lineage, respectively. Modern lineage was associated with the degree of lung damage (odds ratio [OR]: 3.97; 95% CI: 1.57–6.37), p < 0.001). This lineage was also associated with high TNF-α level (OR: 2.06; 95% CI: 1.31–47.00, p=0.026). In addition, the level of TNF-α was higher in severe compared to mild lung damage cases (p = 0.001). Conclusion: Modern lineage is likely associated with high TNF-α level and increases the risk of having severe lung damage three times among TB patients from Indonesia. Therefore, laboratory test to determine MTB lineages might crucial to be integrated in National Tuberculosis Control Program in the country.