Activation of Th1 lymphocytes, IFN-gamma production and macrophage activation are crucial in defense against Mycobacteria. In developing countries, Th2 activation and
IL-4 production have been associated in vitro with
tuberculosis and with poor clinical outcome
after treatment. Serological markers of Th1 [soluble lymphocyte activation gene (LAG)-3] and Th2 (
IgE, solubleCD30, and CCL22/
macrophage-derived chemokine) activity were measured in 414 HIV-negative
tuberculosis patients from The Gambia and Guinée and in 414 healthy household and community controls. Measurements were repeated during treatment to assess the effect of
therapy on Th1/Th2 ratio. At diagnosis, sLAG-3 levels were lower in patients than in community controls (p<0.0001), but were higher in household controls exposed to contact with patients than in community controls (p<0.0001). In comparison with community controls, patients had consistently higher levels of
IgE, sCD30, and CCL22 (p<0.0001), whereas household controls had lower levels of indicators of Th2 activity (p<0.0001).
After treatment, cured patients had higher levels of Th1 (p<0.0001) and lower levels of Th2 (p<0.0001) activity than patients who were not successfully treated or interrupted
therapy. In Africa,
tuberculosis is associated with low Th1 and high Th2 activity in vivo, whereas close exposure to
tuberculosis is associated with a high Th1/Th2 ratio. Patients with favorable outcome
after treatment exhibit a higher Th1/Th2 ratio compared to patients with poor clinical outcome.