Tuberculosis alters pancreatic enzymes in the absence of pancreatitis

BACKGROUND Lipases and phospholipases are thought to contribute to the pathogenesis of Mycobacterium tuberculosis (MTB) infection. Genes coding for lipases, phospholipases and amylase are present in MTB, enabling the bacteria to produce these enzymes. OBJECTIVE To compare serum lipase and amylase activity levels in patients with tuberculosis (TB) against those of healthy controls. METHODS Serum lipase and amylase activity levels were measured in 99 patients and 143 healthy controls using the Vitros 250 Chemistry analyser. Reference ranges for serum lipase and amylase were 23-300 U/L and 30-110 U/L, respectively. RESULTS Lipase was higher in patients with MTB than in controls (81.5 IU/L versus 66.5 IU/L, p = 0.006). Similarly, amylase was higher in the MTB patient group (76 IU/L versus 60 IU/L, p < 0.001). The Pearson correlation coefficient for lipase versus amylase (R) was higher in the controls (R = 0.351, p < 0.0001) compared with MTB patients (R = 0.217, p = 0.035). Amongst MTB patients, lipase activity correlated positively with erythrocyte sedimentation rate (ESR) (R = 0.263, p = 0.013), but not with haemoglobin concentration or treatment duration. A weak inverse correlation was noted between ESR and treatment duration (R = -0.222, p = 0.028). CONCLUSION Pancreatic enzyme levels differ between MTB patients and normal controls; however, this difference still lies within the normal range. The concomitant increase of lipase with ESR, an inflammatory marker, could conceivably suggest a causal relationship. Further research is necessary to characterise MTB-derived enzymes for diagnostic and therapeutic utility.