ISRAEL JOURNAL OF
VETERINARY MEDICINE
THERAPEUTIC VALUE OF CAMEL MILK AS A NUTRITIONAL
SUPPLEMENT FOR MULTIPLE DRUG RESISTANT (MDR)
TUBERCULOSIS PATIENTS
1
Mal G., 1Suchitra Sena D., 2Jain V.K. and 1Sahani M.S.
1. National Research Centre on Camel, PB No. 07, Bikaner, Rajasthan- 334001, India
2. Department of TB and Chest Diseases, S.P. Medical College, Bikaner, Rajasthan-334001, India
Summary
A cohort of 14 male in-patients who suffered from tuberculosis for the past 7-8
years and who did not receive regular treatment were divided into two groups, T1
and T0 of 8 and 6 patients, respectively. T1 patients were given a diet
supplemented with raw camel milk at 1 kg/day, while T0 patients were given dairy
milk through 10 weeks. Both groups received an almost similar treatment with
regular meals from the TB hospital. The clinical symptoms, bacteriological,
radiological, haemato-biochemical, immunoglobulins, Mantoux test and body
weight were recorded before and at the completion of the experiment. At the end
of the experiment there was no cough, expectoration, breathlessness and chest pain
in the T1 group. Furthermore, the acid fast bacillus (AFB) status was found to be
negative in T1 group, whereas it remained positive in the T0 group. Mantoux test
was negative in T1 group at the end of the trial. Reduction in the radiological
reflections was more pronounced in T1 group as seen by X-ray. Haematological
findings revealed significantly (P<0.01) higher hemoglobin (Hb), reduction in
erythrocyte sedimentation rate (ESR) and total leucocyte count (TLC) among the
camel milk supplemented patients. An increase in appetite and body weight was
seen in the patients supplemented with camel milk. The activity of lactate
dehydrogenase (LDH) and creatine phosphokinase (CPK) was significantly
(P<0.01) reduced in T1 group. A significant (P<0.01) increase in micro-mineral
contents of zinc (Zn) and iron (Fe) was found in the T1 group. Percent decrease in
IgA and IgG was 45.18 and 65.25 respectively in T1 group, while it was 34.98 and
41.55 in T0 group. These results suggest that there was a positive benefit of camel
milk supplementation in TB patients.
Introduction
Tuberculosis remains a chronic emaciating disease affecting socio-economically
deprived populations. The tuberculosis bacillus lowers the immune defense
mechanism of the body thus exposing the infected persons to an increased risk of
developing other diseases. MDR tuberculosis is increasing in developing and
industrial countries, seen as cases of endemic infection. Tuberculosis has become an
increasingly important public health problem, and new and innovative approaches for
the identification and treatment of these patients are urgently needed (1, 2). There are
about 16-20 million tuberculosis cases in the world and nearly 8 million cases are
added each year (3). At the same level of treatment, it is predicted that about 3.5
million deaths may occur by 2005 (4). Camel milk has medicinal properties (5)
suggesting that it contains protective proteins, which may have a possible role for
enhancing the immune defense mechanism. Antibacterial and antiviral activities of
these camel milk proteins have been studied (6), and camel milk destroys
Mycobacterium tuberculosis (7). The inhibition of pathogenic bacteria by camel milk
was also observed (8). Camel milk is used for treating dropsy, jaundice, spleen
ailments, tuberculosis, asthma, anemia and piles (9). In USSR, camel milk was used
in sanitoria for treating tuberculosis (10). Patients suffering from chronic hepatitis
acquired improved liver functions after drinking camel milk (11). The present work
was conducted to study the effect of camel milk on multiple drug resistance patients
with tuberculosis.
Material and Methods
Selection of patients
Fourteen male in–patients belonging to Departments of TB and Chest Diseases, S.P.
Medical College, Bikaner who suffered from tuberculosis over the past 7-8 years and
who did not receive regular treatment were divided in two groups, T1 and T0 of 8 and
6 patients respectively. The age of patients ranged from 35 to 60 years old. All
patients were negative for HIV antibodies. The patients of group T1 were
supplemented with raw camel milk at 1kg/day, while the patients of group T0 were
given dairy milk at a similar rate thrice a day through 10 weeks. Otherwise both
groups were subjected to an almost similar treatment.
Collection of samples
Data on clinical symptoms, bacteriological, radiological, haemato-biochemical,
immunological status and body weight were recorded prior to the start (day 0) and at
the end (after 10 weeks) of the trial. The clinical symptoms included cough,
expectoration, breathlessness, haemoptysis, chest pain, fever and reduced appetite.
The status of acid fast bacilli (AFB) was recorded in bacteriological parameters.
Radiological parameter included the study of X-rays. Blood samples were collectes in
sterile tubes by adding disodium EDTA (1mg/ml) for estimation of haematological
parameters: hemoglobin content (Hb), erythrocyte sedimentation rate (ESR) and total
leucocyte count (TLC). Blood was also collected in sterile tubes without anticoagulant
for separation of serum and was used for the estimation of biochemical parameters:
alkaline phosphatase (ALP), glutamate oxaloacetate transaminase (GOT), glutamate
pyruvate transaminase (GPT), lactate dehydrogenase (LDH), creatine phosphokinase
(CPK), protein, albumin, glucose, triglycerides, magnesium (Mg), zinc (Zn), iron (Fe)
and copper (Cu).
Estimation of samples
Haemoglobin was estimated by Sahli’s haemoglobinometer method. The ESR was
determined by Westergen’s method. TLC was done with the Neubeur counting
chamber. The haematological estimations were made on the day of collection of blood
samples. The biochemical parameters were estimated with diagnostic kits supplied by
Transasia Chemicals Ltd., Mumbai. Serum IgG, IgM and IgA were estimated against
A60 antigen by commercially available multiwell microtitration plate ELISA kit from
ANDA Biologicals, Strasbourg, Cedex –France.
Data analysis
The data was analyzed statistically by using t-test for significance (12).
Comparative therapeutic utility
The therapeutic outcomes in patients of both groups were assessed based on the
improvements in their clinical attributes, bacteriological, radiological, body weight,
haemato-biochemical and immunological status.
Results and Discussion
The important clinical symptoms and bacteriological attributes are presented in Table
1. After therapy the T0 patients presented with persistence of cough and
breathlessness, whereas T1 patients exhibited no clinical signs. Increase in appetite
was noticed among T1 patients compared to T0. T1 group was negative for AFB after
supplementation. Radiological examination revealed haziness in the pulmonary region
of the patients, which indicated improvement in both the groups after therapy, but the
reduction in the radiological reflections was more pronounced in T1 compared with
T0, as visualized by X-rays. The hematological parameters and the body weights prior
to and after supplementation of camel milk are presented in Table 2. Haematological
observations revealed an improvement in the Hb%, and decreases in ESR and TLC.
T1 showed significant (P<0.01) changes in the Hb content, while both groups
exhibited significant (P<0.01) differences between ESR. A 29.52% and 34.41%
increase in Hb content was seen in T0 and T1. The reduction in ESR observed was
51.57% and 57.27% and TLC decrease was 10.29% and 20.46% in T0 and T1
respectively. The body weight revealed an improvement of 3.38% in T0 group,
whereas the improvement was 9.21% in T1 group.
The biochemical parameters are presented in Table 3 and indicated non-significant
changes in GOT, GPT, protein, albumin and Mg between the two groups at the end of
the trial. Significant increases in ALP (P<0.05), Zn and Fe (P<0.01) were observed in
T1 group. Significant (P<0.05) decreases in LDH, CPK, TRG and Cu were seen in T1
group. The decrease in the enzymatic activity of LDH was 28.31% and 40.56% in T0
and T1 respectively. Decrease in the level of triglycerides was 32.09% and 60.56% in
T0 and T1 respectively. Increase in the serum Zn concentration was 10.79% and
28.53% in T0 and T1 respectively. Increase in the serum Fe concentration was 6.98%
and 14.92% in T0 and T1 respectively. Decrease in the Cu level was 21.54% and
50.25 % in T0 and T1 respectively. The levels of infection as specified by IgG and
IgA in the patients of T1 group also decreased compared to T0 group. As regards to
IgM status, 62.50% patients of T1 group were found to be negative, however the T0
group remained positive at the end of trial. Decrease in the level of IgA was 34.98%
and 45.18% in T0 and T1 respectively. Decrease in the level of IgG was 41.55% and
65.25 % in T0 and T1 respectively.
Improvement in clinical, bacteriological and radiological attributes were more
pronounced in the camel milk supplemented group probably due to its higher content
of protective proteins as evident from the literature. There was an improvement in
haemato-biochemical changes of both groups indicating possible clinical recovery in
both of them. The increase in TLC may be due to chronic infection in the initial
phase, which was reduced by the end of the trial. ESR is accelerated in many diseases
including pulmonary TB (13). The activities of GOT, GPT, ALP, protein, albumin,
glucose, Mg were in the normal physiological range. Decrease in ALP and proteins
levels and an increase in triglycerides is observed in chronic emaciating diseases,
which might be due to stress on the immune mechanism, and which showed an
improvement at the end of the trial. Initially the activity of LDH was elevated in T0 as
well as in the camel milk supplemented group. LDH is an intracellular enzyme that is
widely distributed in the tissues of kidney, heart, brain, liver and lungs. Increase in the
reported value usually indicates cellular death and leakage of the enzyme from the
cell. The activity of GOT, GPT were initially higher. Any disease that causes a
change in the metabolic activity results in the rise. Zn was increased at the end of
experiment in the camel milk supplemented patients. The rapidly dividing cells of the
immune system are sensitive to Zn deficiency. The role of Zn in the development and
maintenance of a normally functioning immune system is well established (14).
The decrease in appetite has been noticed in cases of Zn deficiency (15). The level of
Cu that is elevated in chronic and acute illness was reduced at the end of trial in T1
patients. Increase in the level of Cu may be due to reduction in the level of Fe at the
start of experiment reflecting the role of Cu in the utilization of Fe. This improvement
is also confirmed by the increased body weight of the patients supplemented with
camel milk. Almost similar findings were observed in empyema and fresh pulmonary
TB patients after supplementation of raw camel milk (16). It is concluded from this
study that camel milk can act as an adjuvant nutritional supplement in multiple drug
resistant (MDR) patients.
Table 1: Clinical and Bacteriological findings in Multiple Drug Resistant TB patients
After 10 weeks
Day 0
Group
+
++
T0
-
++
T1
++
++
T0
-
++
T1
+/-ve
++
T0
-
++
T1
-
-
T0
-
-
T1
+/-
++
T0
-
++
T1
-
++
T0
-
++
T1
Fair
Poor
T0
Increased
Poor
T1
+
++
T0
-
+
T1
17.2+0.91B
21.8+0.82A
T0
B
A
T1
9.77+0.51
16.0+1.15
Parameters
Cough
Expectoration
Breathlessness
Haemoptysis
Chest pain
Fever
Appetite
Status of AFB
Mantoux test (mm)
T0 control group (supplemented with dairy milk)
T1 supplemented with camel milk
A, B refers to P<0.01
Table 2: Haematological parameters and body weight changes in Multiple Drug
Resistant TB patients
After 10 weeks
Day 0
Groups
10.75+0.90
8.30+0.41
T0
11.56+0.68B
8.60+0.50A
T1
52.40+3.63B
108.2+8.72A
T0
42.60+4.15B
99.70+6.60A
T1
8085+519.20
9012+763.14
T0
7210+366.11B
9065+459.70A
T1
48.25+2.64
46.67+2.66
T0
49.80+2.40
45.60+1.53
T1
Parameters
Hb (gm %)
ESR (mm/hr)
TLC (/Cmm)
Body wt. (kg)
T0 control group (supplemented with dairy milk)
T1 supplemented with camel milk
A, B refers to P<0.01
parameters in Multiple Drug Resistant TB patients Biochemical :Table 3
After 10 weeks
270.63+32.32
295.81+32.91b
24.99+2.29
19.67+2.50
10.09+0.94
12.18+1.51
220.60+22.36b
195.86+12.61B
140.29+5.65b
70.12+10.57B
7.90+0.49
6.76+0.64
2.98+0.30
2.87+0.20
99.62+3.19
95.10+2.93B
52.72+5.39b
25.65+2.92B
1.26+0.12
1.42+0.07
58.61+2.27
69.50+1.88B
52.05+1.35
58.15+1.14B
200.12+14.76b
135.67+28.62B
Day 0
185.56+26.01
207.15+15.95a
22.94+2.24
25.49+2.11
14.37+1.80
14.91+2.94
307.72+31.96a
329.49+20.22A
170.51+8.21a
108.11+29.28A
8.61+0.62
8.36+1.05
3.22+0.22
3.72+0.36
106.52+4.90
132.10+5.62A
77.64+8.04a
65.03+2.71A
1.24+0.16
1.61+0.22
52.90+2.11
54.07+1.49A
48.65+1.16
50.60+1.65A
255.07+17.91a
272.73+22.69A
Groups
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
T0
T1
Parameters
ALP(IU/L)
GOT(IU/L)
GPT(IU/L)
LDH (IU/L)
CPK (IU/L)
Protein (g/dl)
Albumin (g/dl)
Glucose (mg/dl)
Triglycerides (mg/dl)
Mg (meq/L)
Zn (g/dl)
Fe (g/dl)
Cu (g/dl)
T0 control group (supplemented with dairy milk)
supplemented with camel milk 1T
0.01<refers to P A, B
0.05<refers to P a, b
Table 4: Immunoglobulin status in Multiple Drug Resistant TB patients
After 10 weeks
Day 0
Groups
391.70+37.31b(+)
606.00+91.50a(+)
T0
370.00+42.81B(+)
675.00+78.26A(+)
T1
754.00+134.12B(+)
1290.0+89.57A(+)
T0
B
A
Parameters
IgA (U/ml)
417.00+114.49 (+)
1200.0+163.39 (+)
T1
+ve
+ve
T0
-ve/+ve
+ve
T1
IgG(U/ml)
IgM
T0 control group (supplemented with dairy milk)
T1 supplemented with camel milk
A, B refers to P<0.01
a, b refers to P<0.05
Acknowledgements
The authors are thankful to Dr. B.B. Mathur (Assoc. Prof.), Dr. Manak C. Gujrani
(Asst. Prof.), Dept. of TB and Chest Diseases, S.P. Medical College, Bikaner for the
kind cooperation. Thanks are also due to Sh. Ram Avtar, (Senior Compounder) and
Sh. Nand Kishore (T-1-3) for the technical assistance provided.
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