Tuberculosis, Artemisia afra, alcohol

African medical doctors have discovered that infusions of Artemisia afra administered during 20 days definitely and totally cured tuberculosis, even for patients where drugs administred in conformity with the WHO protocol had failed. We quote one of their papers hereafter, but they have run dozens of similar successfull treatments in several countries of the region of the Great Lakes in Africa. Daddy B, Lutgen P, Gisenya P. Breakthrough against tuberculosis: high efficacy of Artemisia afra infusions. Pharm Pharmacol Int J. 2021;9(2):58‒62. DOI:10.15406/ppij.2021.09.0032 But for two of the patients the treatment initially seemed to fail. Finally it took several more weeks to achieve the same positive results. Both patients were heavy drinkers. Alcohol consumption has controversial effects in several diseases. In malaria its effects appears even to be positive. Lutgen P. Alcohol and malaria. Pharm Pharmacol Int J. 2018;6(4):310-311. DOI: 10.15406/ppij.2018.06.00193 However a literature search clearly revealed that in the world 17% of all newly reported TB cases and 15% of all deaths during anti-tuberculosis treatment are attributed to excessive alcohol use. Alcohol consumption, particularly heavy consumption is an important risk factor for tuberculosis. A meta-analysis conducted which included studies published up to 2007, indicated that alcohol consumption of more than 40 g of ethanol per day or a diagnosis of an alcohol use disorder resulted in a nearly three-fold increase in the risk of tuberculosis. Based on these reviews, alcohol consumption is a major contributor to the tuberculosis burden, particularly in the African Region. Once infected, persons who consume excessive alcohol are nearly three times as likely to progress to active disease than those who do not consume alcohol Imtiaz S, Shield KD, Roerecke M, et al. Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease. Eur Respir J 2017; 50: 1700216. doi.org/10.1183/13993003.00216-2017 Chaulk CP, Moonan PK. Over the limit: tuberculosis and excessive alcohol use. Int J Tuberc Lung Dis. 2020;24(1):3-4. doi:10.5588/ijtld.19.0325 Rehm, J., Samokhvalov, A.V., Neuman, M.G. et al. The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health 9, 450 (2009). https://doi.org/10.1186/1471-2458-9-450 And this is well documented since 1997. Szabo G, et al. Alcohol and susceptibility to tuberculosis. Alcohol Health Res World 1997; 21: 39–41. Acute ingestion of alcohol [ethanol (ETOH)] adversely affects the immunocompetence of both naive individuals as well as chronic alcohol abusers. An increased incidence and severity of tuberculosis is found in chronic alcohol abusers. Nitric oxide (NO) produced by alveolar macrophages plays a key role in the in killing of Mycobacterium tuberculosis. In immunocompetent persons. More than 90% of inhaled M. tuberculosis bacteria are eradicated from the body by alveolar macrophages. Rimland D. Mechanisms of ethanol-induced defects of alveolar macrophage function. Alcohol Clin Exp Res. 1984 Jan-Feb;8(1):73-6. PMID: 6324608. Greenberg S, Xie J, Kolls J, Nelson S, Didier P, Mason C. Ethanol suppresses Mycobacteria tuberculosis-induced mRNA for nitric oxide synthase in alveolar macrophages, in vivo. Alcohol Clin Exp Res. 1995 Apr;19(2):394-401. doi: 10.1111/j.1530-0277.1995.tb01521.x. PMID: 7542849. Bermudez LE, Wu M, Martinelli J, Young LS. Ethanol affects release of TNF and GM-CSF and membrane expression of TNF receptors by human macrophages. Lymphokine Cytokine Res. 1991 Oct;10(5):413-9. PMID: 1662988. Rimland D. Mechanisms of ethanol-induced defects of alveolar macrophage function. Alcohol Clin Exp Res. 1984 Jan-Feb;8(1):73-6. PMID: 6324608. Alcohol also has an influence on the pharmacokinetics and pharmacodynamics and the intestinal absorption of TB drugs. Merino V, Martin-Algarra RV, Rocher A, Garrigues TM, Freixas J, Polache A. Effects of ethanol on intestinal absorption of drugs. I. In situ studies with ciprofloxacin analogs in normal and chronic alcohol-fed rats. Alcohol Clin Exp Res. 1997 Apr;21(2):326-33. doi: 10.1097/00000374-199704000-00022. PMID: 9113271. Alcohol exposure, and particularly chronic heavy drinking, affects all components of the adaptive immune system. Studies both in humans and in animal models determined that chronic alcohol abuse reduces the number of peripheral T cells, disrupts the balance between different T-cell types, influences T-cell activation, impairs T-cell functioning, and promotes T-cell apoptosis. Chronic alcohol exposure also seems to cause loss of peripheral B cells. Pasala S, Barr T, Messaoudi I. Impact of Alcohol Abuse on the Adaptive Immune System. Alcohol Res. 2015;37(2):185-97. PMID: 26695744; PMCID: PMC4590616. Already in 1991 in a Russian team studied T and B immunity systems in 60 alcoholic patients suffering from pulmonary tuberculosis. The patients with that combined pathology demonstrated marked immunodeficiency as regards the T system. Aliev NA, Guseĭnov ShG, Khavinson VKh, Seryĭ SV. Immunologicheskiĭ status bol'nykh alkogolizmom, stradaiushchikh tuberkulezom legkikh [Immunologic status of alcoholic patients with pulmonary tuberculosis]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(10):53-7. Russian. PMID: 1665653. Fiske CT, Hamilton CD, Stout JE. Alcohol use and clinical manifestations of tuberculosis. J Infect. 2009;58(5):395-401. doi:10.1016/j.jinf.2009.02.015 Leukocytopenia (white blood cell count), and thrombocytopenia (platelet count) are common in tuberculosis patients. Alcohol consumption further reduces these counts including. neutropenia (neutrophil count) Ethanol affects activation, recruitment, phagocytosis and killing functions of neutrophils, causing susceptibility to pulmonary infections. Alcohol also increases the inflammatory cytokines Malacco NLSO, Souza JAM, Martins FRB, Rachid MA, Soriani FM. Chronic ethanol consumption compromises neutrophil function in acute pulmonary Aspergillus fumigatus infection. Elife. 2020 Jul 23;9:e58855. doi: 10.7554/eLife.58855. PMID: 32701055; PMCID: PMC7398701. According to the Department of Tuberculosis, WHO Country Office for India, New Delhi, survival rate is much much lower for multi-drug resistant patients if they consume alcohol. Kaplan-Meier survival curve of time survival versus alcohol usage during multidrug-resistant tuberculosis (MDR-TB) treatment in 179 patients in Kerala, India. The P value reflects the results of the log-rank test of the equality of the two survival curves. Survival is measured in months after starting MDR-TB treatment. Duraisamy K, Mrithyunjayan S, Ghosh S, et al. Does Alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome?. A population-based study in Kerala, India. Ann Am Thorac Soc. 2014;11(5):712-718. doi:10.1513/AnnalsATS.201312-447OC