Özet:

The objective of the study was to assess the development of peripheral neuropathy in patients with newly diagnosed pulmonary tuberculosis during the treatment with first- and second-line antitubercular drugs, by studying the changes of plasma vitamin B1 and vitamin B12 levels. Materials and methods. The study involved 22 patients with drug-susceptible tuberculosis who received a standard four-component regimen that included isoniazid and 26 patients with drug-resistant tuberculosis whose treatment regimen included linezolid. Twenty matched control patients were included for baseline assessment comparison. Plasma vitamin B1 (thiamine) and plasma vitamin B12 (cyanocobalamin) levels were studied in all patients before treatment and after 30 days of antituberculosis therapy. To identify changes of the peripheral nervous system, we performed stimulation electroneuromyography (ENMG) on the lower limbs. The following factors were evaluated: motor nerve conduction velocity (MNCV), terminal motor latency (TML), sensory nerve conduction velocity (SNCV) and terminal sensory latency (TSL). Results. Patients with newly diagnosed pulmonary tuberculosis (ТВ) had lower initial plasma levels of vitamins B1 and B12, compared to age- and sex-matched healthy persons. We did not find significant changes in vitamin B status and electroneuromyography during the treatment with combinations of isoniazid and first-line anti-TB drugs. During the treatment with combinations of linezolid and second-line anti-TB drugs, we identified significant decreases of plasma vitamin B1 and B12 levels and worsening of electroneuromyography indices by sensory and motor fibers. Conclusions. The deficiency of vitamins B1 and B12 during treatment with linezolid can be considered as one of the pathogenetic mechanisms of progressive damage of peripheral nervous system in pulmonary tuberculosis patients, which must be taken into account during the course of antitubercular therapy. Keywords: pulmonary tuberculosis, vitamin B1, vitamin B12, peripheral neuropathy.

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