A Clinical Study on Active Pulmonary Tuberculosis using Cancer Antigen - 125 as a Prognostic Tool in the Anti-Tuberculous Treatment

INTRODUCTION: Pulmonary tuberculosis (TB) is one of the leading causes of mortality worldwide and has become a global public health emergency. Determination of pulmonary TB activity is as important as early diagnosis of pulmonary TB in optimal treatment strategy. High serum levels of CA-125 are reported in patients with pulmonary and extra-pulmonary TB (PTB). Cancer antigen-125 (CA-125) tumor marker was also useful for the diagnosis of Tuberculosis. AIMS AND OBJECTIVES: CA 125 levels used as a prognostic tool to know the effect of Anti-tuberculous treatment in newly detected sputum positive pulmonary tuberculosis. To compare the levels of CA 125 at the start of the intensive phase and after two months of treatment in new diagnosed smear-positive pulmonary tuberculosis. MATERIALS AND METHODS: This prospective study was conducted on 40 patients admitted to Government Rajaji Hospital, Madurai Medical College, during the study period of six months from January 2019 to June 2019. Newly diagnosed sputum positive pulmonary tuberculosis patients were included in our study. Patients with COPD, Pyrexia of unknown origin, Rheumatic fever, Malignancies Cirrhosis of liver, Renal diseases, Gynecological tumors, Heart failure were excluded. DISCUSSION: In our study 40 patients had elevated pretreatment CA-125 levels. The cut off levels used was 35U/ml. The mean CA-125 levels before and after treatment were 60.86U/ml and 31.77U/ml. In our study CA- 125 levels were elevated with increased sputum positivity. The mean values with sputum positivity 3+, 2+, 1+, Negative were 29.86U/ml, 32.49U/ml, 33.70U/ml, 30.20U/ml. In our study 5 patients had elevated CA125 >35U/ml after 2 months of treatment. In our study, the sensitivity was 90.91%, specificity was 100%, positive predictive value was 90% and negative predictive value was 100% after excluding the other possible causes of elevated CA-125. CONCLUSION: Our study showed the CA 125 levels were higher at the diagnosis of pulmonary tuberculosis and reduced after 2 months of treatment. All these findings were found to be statistically significant. It is definitely useful in the monitoring of therapeutic responses to anti-tuberculosis drugs, predicting the prognosis and spotting those patients who are not going to respond to anti-tuberculousdrugs.