The Value of Neutrophil-to-Monocyte-Plus-Lymphocyte Ratio as a Marker for Discriminating Pulmonary Tuberculosis from Community Acquired Pneumonia

Abstract

Abstract Background Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. On the other hand, pneumonia is usually caused by viral or bacteria and less commonly by other microorganisms. Objectives To evaluate the value of Neutrophil to Monocyte plus lymphocyte ratio (NMLR) as a marker for discriminating pulmonary tuberculosis from community acquired pneumonia. Patients and Methods A case control study, was conducted at Abbassia Chest Hospital and included 60 patients with pulmonary infection (TB and community acquired pneumonia, 30 patients in each group) and 30 healthy controlled individuals. All patients subjected to full history, physical examination, Chest X-ray and 2 cc of blood sample was collected for total and differential peripheral leucocytic count before starting antibiotic therapy, Neutrophil-toMonocyte-Plus-Lymphocyte Ratio (NMLR) was calculated as the quotient of the absolute neutrophils, Monocyte and lymphocyte counts and Neutrophil-to-Lymphocyte Ratio (NLR) was calculated). Result The study involved 90 subjects; the mean of age of TB patients was (29±8.17) years, which significantly lower than other with community acquired pneumonia (40.4±16.81) years. Moreover, male sex was significantly associated with TB group. By blood analysis, NLR and NMLR were significantly higher in pneumonia than TB or control group, P value< 0.001 for both. Also, NLR > 2.96 and NMLR >2.385 cutoff values have sensitivity and specificity of 90% and 100% respectively for both. Conclusion We concluded that Cutoff value of NLR > 2.96 and NMLR >2.385 may use for prediction of pneumonia and T.B. the modified blood indices as NLR and NMLR had the capability to discriminate between inflammatory condition as pneumonia and TB and healthy condition as same as ordinary marker like CRP and ESR did.