International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 10, Issue 2, pp: (1-6), Month: October 2022 - March 2023, Available at: www.researchpublish.com
Meta-analysis: MLR (Monocyte Lymphocyte Ratio) as the Examination of Choice in Diagnosing Tuberculosis 1
Agus Wahyu Permana, 2Dewi Arimas Ni Made Cinical Pathology Laboratory Buleleng District General Hospital, Bali, Indonesia DOI: https://doi.org/10.5281/zenodo.7138946
Published Date: 03-October-2022
Abstract: Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis. Indonesia ranks third in the world as the country with the most tuberculosis cases. Bacteriology is the standard of examination for the diagnosis of tuberculosis. Culture examination takes a long time, TCM must use a sputum sample and special examination tools. Interferon-γ release assays immunological examination (IGRA) is quite expensive and requires special equipment. Hematological examination can be used as an option for supporting examination in establishing the diagnosis of tuberculosis by immunology. The purpose of this study is a journal review to identify the potential (MLR) Monocyte Lymphocyte Ratio as a support in diagnosing tuberculosis. Article searches were conducted online from the NCBI, PubMed and Science Direct databases. Sorting articles using the PRISMA flow. Finally, eligible articles were selected based on the criteria for patient, intervention, comparison, outcome, and study (PICOS), namely tuberculosis patients, MLR, tuberculosis diagnosis, and the original study. The results of this study obtained seven articles from the initial number of 9,234 articles found from key words. Two of the seven articles stated that MLR could be used as a support for the diagnosis of tuberculosis. Two articles stated that monocytes and lymphocytes could be markers of bacterial infections including tuberculosis. One article mentions the association of tuberculosis with decreased production of monocyte and lymphocyte cytokines. Two articles stated that MLR was not associated with tuberculosis cases. One article mentions the MLR value limit of 0.378 to support the diagnosis of tuberculosis. Observational research on MLR to support the diagnosis of tuberculosis in Indonesia still needs to be done, especially the assessment of the MLR value limit. Keywords: Diagnosis, hematology, lymphocytes, monocytes, MLR, tuberculosis.
1. INTRODUCTION Tuberculosis is an infectious disease that is mostly found in the lungs, but can also be found in other organs. Mycobacterium tuberculosis (M. tuberculosis) is the bacterium that causes tuberculosis.1 Most tuberculosis cases were found in Asia, namely 44% in 2018. India ranks first with the most tuberculosis cases in the world and Indonesia ranks third with the most tuberculosis cases in the world.2 Currently, bacteriology and immunology are the most commonly used methods for diagnosing tuberculosis. Bacteriological diagnosis using BTA, TCM and bacterial culture, and immunologically using interferon-γ release assays (IGRA) and TST. TCM examination is fast and accurate, but requires sputum as a sample and requires special reagents. BTA sputum is less sensitive and bacterial culture takes a long time, which is more than one day, and the IGRA examination is expensive. Therefore, it is necessary to have a fast, accurate and low-cost supporting examination in diagnosing tuberculosis. 2 Analysis of the ratio of monocytes and lymphocytes has the potential to be used as a supporting examination in diagnosing tuberculosis. Research by Sibley et al.3 on monkeys in 2019 showed that the Monocyte Lymphocyte Ratio (MLR) increased when infected with tuberculosis. The research was conducted on the Indian genotype (RM), Chinese genotype (CCM), and Mauritian genotype (MCM). RM and MCM were vulnerable groups in this study, and CCM was used as a control. MLR in MCM and RM before M. tuberculosis infection was higher than CCM. This study showed a significant increase in MLR in the group of monkeys infected with M. tuberculosis. These changes in MLR in the MCM and RM groups indicate that MLR can be a tuberculosis biomarker.1
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