Immunopathology of tuberculosis paradoxical upgrading reactions
Research type
Research Study
Full title
Immunopathology of tuberculosis paradoxical upgrading reactions (TB PUR)
IRAS ID
365479
Contact name
Graeme Meintjes
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Tuberculosis (TB) is the leading cause of death from infectious diseases worldwide, and East London has one of the highest rates of TB in the UK. Most people improve once they start TB treatment. However, some patients (about 10-20%) experience a 'paradoxical upgrading reaction' (PUR), where their symptoms get worse during treatment. Paradoxical reactions can delay recovery and sometimes require extra treatment. We do not currently understand why PUR happens or who is most at risk.
This study aims to improve understanding of why PUR happens during TB treatment. We will follow adults who have recently been diagnosed with TB and are starting treatment at Barts Health and Homerton Healthcare NHS Trusts. The study is non-interventional, meaning it does not affect usual care of patients. Participants will be seen at their routine visits over their 6 months of treatment, with extra research visits if they develop PUR.
At each research visit, we will ask about symptoms, take a small blood sample, and review routine clinical information. We will study the immune system to see how it changes over time and how it differs between people who do and do not experience PUR.
We will also invite a small number of healthy volunteers to provide one small blood sample, for comparison.
The findings may help doctors understand what causes PUR, identify people at higher risk, and eventually improve support and treatment for patients with TB. The study is funded by Barts Charity and sponsored by Queen Mary University of London. About 300 people with TB and 30-45 healthy volunteers will take part.
REC name
East of Scotland Research Ethics Service REC 1
REC reference
26/ES/0015
Date of REC Opinion
20 Feb 2026
REC opinion
Further Information Favourable Opinion