To Compare the Competency of Prognostic Markers- ESR, CRP against ZN Staining in Determining Pulmonary Tuberculosis Cases

  • Rashmi Chandragouda Meti Associate Professor, Department of Microbiology, Kamineni Institute of Medical Sciences, Narketpalli, Nalgonda, Telangana, India
  • Anand Nagalikar Associate Professor, Department of Pathology, ESIC Medical College, Gulburga, Karnataka, India.
Keywords: Pulmonary tuberculosis, AFB positive, CRP, ESR, ZN staining


Background: Tuberculosis (TB) is a highly prevalent chronic infectious disease caused by Mycobacterium tuberculosis an aerobic intracellular binding bacterium (bacillus). Active TB disease can be fatal if left untreated. The disease today is considered curable and preventable. This retrospective study was undertaken to compare and analyzed the relationship between acute phase reactant proteins CRP (quantitative) and ESR in sputum smear positive for AFB patients and to evaluate their diagnostic and prognostic significance. Methods: The present prospective study was carried on a randomly selected study group comprising of 180 cases of pulmonary TB patients who were sputum smear positive for AFB and 25 normal healthy (sputum smear negative for AFB) individual were taken as control. The cases of  PTB group was further categorized on the basis of recommendation of RNTCP grading system of AFB in Sputum ZN staining into four subgroups AFB – 3+, AFB – 2+, AFB –1+ and scanty. The control groups were negative for the Acid Fast bacilli in sputum. Results: In our study showed that the maximum patients seen in grade III (36.11%) followed by grade II (31.66%), grade I (19.44%) and 12.77% scanty according to RNTCP grading system of ZN staining of sputum for acid fast bacilli.  The   distribution of mean values of CRP, ESR in different grades of ZN staining of sputum in AFB positive patients as well as controls. CRP mean value was 55.4, 40.8 & 22.9 in grade III, grade II & grade I respectively and ESR was 48.1, 38.8 & 23 respectively in different grading significantly higher (p vol < 0.0001) in group II there were no serious adverse reactions in either group. Conclusions: Our study concluded that during the compression of values of CRP and ESR along with the grading of sputum AFB positive patients, the CRP raised more significantly as compare to ESR; with markedly raised values in all the grades of sputum AFB positive patients.


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1. Cohen T, Murray M, Wallengren K, Alvarez G, Samuel E, et al. (2010) The Prevalence of drug-sensitive and drug-resistant tuberculosis among patients dying in hospital in KwaZulu-Natal, South Africa. PLoS Med7:e1000296.doi:10.1371/journal.pmed.1000296 Am J Clin Pathol 2002, 118:787–793.
2. Yonghong Feng, Hongyun Yin, Guangliang Mai, Ling Mao, Jun Yue, Heping Xiao, and Zhongyi Hu “Elevated Serum Levels of CCL17 Correlate with Increased Peripheral Blood Platelet Count in Patients with Active Tuberculosis in China” CLINICAL AND VACCINE IMMUNOLOGY, Apr. 2011, p. 629–632,1556-68.
3. TARIK M. HUSAIN, M.D. AND DAVID H. KIM, M.D. “C-Reactive Protein and Erythrocyte Sedimentation Rate in Orthopaedics”. The University of Pennsylvania Orthopaedics Journal.2009; 15: 13–16.
4. SAHIRATMADJA, E. et al. Dynamic changes in pro- and anti-inflammatory cytokine profiles and gamma interferon receptor signaling integrity correlate with tuberculosis disease activity and response to curative treatment. Infect Immun,2007; 75(2), p. 820-9.
5. Cegielski JP, Chin DP, Espinal MA, et al. The global tuberculosis situation: progress and problems in the 20th century, prospects for the 21st century. Infect Dis Clin North Am 2002; 16:1–58.
6. Toriola AT, Grankvist K, Agborsangaya CB, Lukanova A, Lehtinen M, Surcel HM. Changes in pre-diagnostic serum C-reactive protein concentrations and ovarian cancer risk: a longitudinal study. Ann. Oncol.2011; 22:1916-1921.
7. Glickman, M.S. and W.R. Jacobs (2001). "Microbial pathogenesis of Mycobacterium tuberculosis: dawn of a discipline." Cell 104(4): 477-85.
8. Mohammd abaker saeed mohammed “some hematological parameters among patients with pulmonary tuberculosis –Khartonm state” Sch.J.App.Med.Sci,2016:4(18):9-11.
9. Mohammad Shameem, Nazish Fatima, Abida Malik, Asrar Ahmad, Qayyum Husain “ Correlation of Serum C-Reactive Protein with Disease Severity in Tuberculosis Patients” Published Online November 2012 (
10. Bing Sun, Yaqin Yang, Fang Ren, Qingjiang Wang, Junwei Cui, Jinhe Shi and Xiuqin Cui. Relationship among C-reactive protein, iron status, oxidative stress, and pulmonary tuberculosis” African Journal of Pharmacy and Pharmacology. 2012; Vol. 6(42): pp. 2945-2949.
11. Muhammad Yousuf, Salih Bin Salih, Sameera Al-Johani, Adel Alothman. “Erythrocyte sedimentation rate at diagnosis in culture positive cases of active tuberculosis” Pak J Med Sci January - March 2012 Vol. 28 No. 1 87-90.
12. Sarkar K, Baraily S, Dasgupta S. Erythrocyte sedimentation rate may be an indicator for screening of tuberculosis patients for underlying HIV infection, particularly in resource-poor settings: An experience from India. J Health Popul Nutr 2004;22:220-221.
How to Cite
Meti R, Nagalikar A. To Compare the Competency of Prognostic Markers- ESR, CRP against ZN Staining in Determining Pulmonary Tuberculosis Cases. International Archives of BioMedical and Clinical Research [Internet]. 20Mar.2018 [cited 26Apr.2018];4(1):11-3. Available from: