Effects of zinc supplementation as adjunct therapy on the systemic immune responses in shigellosis.
What this study found
Adjunct zinc improved systemic humoral and cellular immune responses during acute shigellosis, but it did not improve rectal histopathology or tissue expression of innate mediators over the short term. Seroconversion to shigellacidal antibody was 52% (14 of 27) at day 7 and 73% (19 of 26) at day 30 in the zinc group versus 36% (9 of 25) at both time points in controls; the day 30 difference was significant (P=0.01). CD20+ cells and CD20+CD38+ cells were higher in the zinc group at day 7 (P=0.001 and P=0.007). The authors concluded that zinc may enhance systemic immune recovery during…
- Study & population
- Randomized adjunct-therapy study in Bangladesh among mildly to moderately malnourished children aged 12 to 59 months with Shigella flexneri shigellosis.
- Intervention
- Zinc acetate syrup providing 20 mg elemental zinc per 5 mL was given orally in 2 divided doses daily between meals for 14 days starting on the day of admission, as adjunct therapy to antibiotics.
- Key limitation
- The study was small, with only 28 participants per arm, and some day 30 analyses had fewer completers.
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Open PDFOriginal abstract
BACKGROUND Zinc is lost during diarrheal diseases, and zinc deficiency induces intestinal morphology-altering inflammatory responses that zinc supplementation can correct. OBJECTIVE We assessed the in vivo effect of zinc supplementation on systemic and mucosal responses in mildly to moderately malnourished (defined as <-1 but >-2 and <-2 but >-3 weight-for-height z scores, respectively, based on the National Center for Health Statistics growth reference) children with shigellosis. DESIGN A double-blind placebo-controlled trial was conducted in Shigella flexneri-infected children aged 12-59 mo. Daily for 14 d, elemental zinc (20 mg) and multivitamins (vitamins A and D, thiamine, riboflavin, and nicotinamide) plus calcium were given at twice the US recommended dietary allowance to the zinc group (n=28), and multivitamins plus calcium were given to the control group (n=28). All subjects received standard antibiotic therapy. RESULTS There was no significant interaction between zinc supplementation and time, but zinc supplementation showed a significant effect on serum zinc concentrations. With a >or=4-fold increase in serum shigellacidal antibody titers from baseline used as the cutoff, the proportion of children with shigellacidal antibody response was greater in the zinc group than in the control group (P<0.03). There was a significant (P=0.02) treatment x time interaction for the proportions of circulating CD20+ and CD20+CD38+ cells, which were higher on day 7 in the zinc group than in the control group (P<0.007). No effect was seen on histopathologic features or the expression of innate and inflammatory mediators in the rectum. CONCLUSION Adjunct therapy with zinc during acute shigellosis significantly improved seroconversion to shigellacidal antibody response and increased the proportions of circulating B lymphocytes and plasma cells.