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American Journal of Infection Control

Volume 32, Issue 6 , October 2004, Pages 369-370

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doi:10.1016/j.ajic.2004.01.001
Copyright © 2004 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby,
Inc.

Letter to the Editor

Inhalational phytochemicals as possible treatment for

pulmonary tuberculosis: Two case reports
Eugene Sherry MDa, Max Reynolds PhDb, Sureshan Sivananthan MB, ChB,
MRCSc, Sakiusa Mainawalala Dip Med, Dip Surg, Dip Derm, Dip TBd and Patrick
H. Warnke MD, DMDe
a
Department of Orthopaedic Surgery, Sydney Private Hospital, Sydney, NSW, Australia;
b
Nicrosol Technology Pty Ltd, Springwood;
c
University of Malaya, Kuala Lumpur, Malaysia;
d
Lautoka Hospital, Fiji;
e
and University of Kiel, Kiel, Germany

Available online 27 September 2004.

Article Outline
Case 1
Case 2
References

To the Editor:

Mycobacterium tuberculosis infects more than 2 billion people in the world, and it has a
high mortality rate with 2 to 3 million people dying annually.1 Multi-drug resistant strains
of M tuberculosis have been reported in the majority of countries evaluated and are a
pandemic of major importance with control programs costing approximately US $1
billion per year globally.2. and 3. The development of new treatments is the major focus of
current tuberculosis research worldwide.4. and 5. We have previously described the use of
phytochemicals to treat methicillin-resistant staphylococcal infections 6., 7. and 8.
Phytochemicals may also offer an effective and cheaper alternative treatment for
tuberculosis. We report a chance finding where an inhaled phytochemical turned the
sputum negative in 2 patients with primary pulmonary tuberculosis and also produced a
clinical improvement.

Case 1
A 41-year-old Fijian female presented with cough, shortness of breath, fever, night
sweats, weight loss, and malaise. She had been unwell for 12 months. She weighed 84.5
kg. Abnormal laboratory results included a hemoglobin of 7.0 gm/dL and her erythrocyte
sedimentation rate (ESR) was 125. A sputum sample grew M tuberculosis (a nonresistant
strain). The patient's chest radiograph showed bilateral patchy consolidation, especially in
the right lower zone, with areas of cystic lucencies suggestive of cavitation in the right
upper zone. There were no known risk factors or previous clinical evidence of pulmonary
tuberculosis. The patient was married and had 2 children; none of whom was unwell.
Before starting the conventional tuberculosis medication (DOTS-rifampicin, isoniazid,
ethambutol, and pyrazinamide) she used the phytochemical to help with her irritating
cough. A consent was signed. She inhaled via a standard facemask with an adapter and a
single dose (3 mL per canister) of a new purified and concentrated tea tree oil (TTO)
(MEGABAC, Nicrosol Labs., Springwood, Queensland, Australia;
www.nicrosol.com.au). This TTO (patent and FDA approval pending) is a blend of
essential oils extracted from the native Australian plant, Melaleuca altenafolia, and
concentrated by use of a new patented room temperature extraction protocol. The aerosol
canisters used are propelled by nitrogen and deliver a droplet size of 10 microns (Fig 1).
The treatment was used for 10 days, while waiting to start her DOTS program. After 14
days, the patient reported less malaise, improved appetite, absent cough, weight gain, and
settled temperature. Sputum cultures at day 4 changed from positive to negative and chest
radiograph changes remained unchanged. The patient subsequently underwent her DOTS
program.

(27K)

Fig 1. Standard mask with adapter to hold the aerosol can, upon depressing the can releases the medication
in a 10 micron mist.

Case 2
A 33-year-old Fijian woman presented with a productive cough, pleuritic pain, shortness
of breath, fever, night sweats, 3-kg weight loss, and malaise. She had been unwell for 3
weeks. She weighed 51 kg. Abnormal laboratory results included a hemoglobin of
11.3gm/dL and her ESR was 80. Diabetes mellitus was diagnosed on admission and
glibenclamide (Daonil, Hoechst Marion Roussel, Kansas City, Mo) started (5 mg/day). A
sputum sample grew M tuberculosis (a nonresistant strain). The patient's chest radiograph
showed bilateral patchy infiltrates with a right pleural effusion. Her father was diagnosed
with tuberculosis 21 years ago and treated (he remains well). The patient was not married
and had no children. She used TTO to help with her irritating cough. A consent was
signed. She inhaled TTO for 5 days in the same manner as the patient in Case 1. She
reported no symptoms related to inhaling. At 5 days, her sputum culture was negative.
She also reported less malaise, improved appetite, absent cough, 1 kg weight gain, and
her temperature had settled. Chest radiograph showed the right pleural effusion to have
cleared. The patient then continued treatment with her DOTS program.

These 2 reports suggest the potential of this TTO as a phytochemical treatment for
pulmonary tuberculosis. Moreover, this purified TTO at these levels is nontoxic when
used topically, and there is evidence that it is nontoxic if inhaled [all the monoterpenes
have been stripped out of the base oil, reducing all of the potential irritation
components].6 Using phytochemicals in the treatment of such conditions could be cost-
effective, possibly not affected by multi-drug resistant organisms and an attractive option
for possible mass treatment of tuberculosis in the First and Third worlds.3 There were
limitations to this report in that there were no controls used, but this was not the intention
of this paper, it is a report of a chance finding observed when 2 patients inhaled a
phytochemical to treat an irritating cough before commencing a DOTS program. These
cases provide promising preliminary results and further clinical trials will assist in
determining the efficacy of this phytochemical in treating pulmonary tuberculosis.
Furthermore, clinical trials will be required to determine where this approach fits with
conventional oral medication for tuberculosis (DOTS) and whether it can be used for the
mass treatment of tuberculosis cases.

References
1. T.R. Frieden, T.R. Sterling, S.S. Munsiff, C.J. Watt and C. Dye, Tuberculosis, Lancet
362 (2003), pp. 887–899. Abstract | Full Text + Links | PDF (311 K)

2. T.R. Frieden and C.R. Driver, Tuberculosis control: past 10 years and future progress,
Tuberculosis 83 (2003), pp. 82–85. Abstract | Full Text + Links | PDF (69 K)

3. D. Walker and W. Stevens, The economics of TB control in developing countries, Exp

Opin Pharmacother 4 (2003), pp. 359–368.

4. K. Duncan, Progress in TB drug development and what is still needed, Tuberculosis 83

(2003), pp. 201–207. Abstract | Full Text + Links | PDF (90 K)

5. F. Christoph, P.M. Kaulfers and E. Stahl-Biskup, In vitro evaluation of the

antibacterial activity of beta-triketones admixed to Melaleuca oils, Planta Medica 67
(2001), pp. 768–771.

6. E. Sherry, P.H. Warnke and H. Boeck, Percutaneous treatment of chronic MRSA

osteomyelitis with a novel plant-derived antiseptic, BMC Surg 1 (2001) (1), p. 1.

7. E. Sherry, H. Boeck and P.H. Warnke, Topical application of a new formulation of

eucalyptus oil phytochemical clears methicillin-resistant Staphylococcus aureus
infection, Am J Infect Control 29 (2001), p. 346.

8. Sherry E, Warnke PH. Alternative for MRSA and tuberculosis (TB): eucalyptus and
tea-tree oils as new topical antibacterials. Poster presented at: American Academy of
Orthopaedic Surgeons meeting; February 2002; Dallas, Tex.
Max Reynolds owns Nicrosol Pty. Ltd. which makes MEGABAC, and Eugene Sherry
has a 12.5% financial interest in the same company.

American Journal of Infection Control

Volume 32, Issue 6 , October 2004, Pages 369-370 This Documen

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