The Effect of Ramadan Fasting on Tuberculin Skin Test and Leukocyte Count

Document Type : Research Paper


1 Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran

2 Associate Professor, Department of Pediatrics, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran

3 Associate Professor, Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran

4 Assistant Professor, Islamic Medicine Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran


Introduction: Annually, many Muslims fast during the month of Ramadan worldwide. This practice has different favorable medical and physiological effects, such as improved serum lipid profile and blood glucose level due to changes in diet and sleep patterns. It has also been hypothesized that Ramadan fasting may affect the immune system. As reported, Ramadan fasting can influence the immunoglobulin and cytokine levels. Accordingly, tuberculin skin test or purified protein derivative (PPD) test, which is a delayed-type hypersensitivity of cellular immune response, may also be affected by Ramadan fasting. Regarding this, the present study aimed to investigate the alteration of PPD test during and after Ramadan. Methods: A total of 42 males (seminary students) who fasted during Ramadan in 2006 were included in the study; however, only 28 cases completed the study. For data collection, the participants underwent blood and tuberculin tests at the fourth week of Ramadan and three months after this month. The white blood cell (WBC) count and the tuberculin induration were recorded and compared between the two intervals to evaluate the changes. Results: According to the results of the study, the mean age of the participants was 19.21±3.83 years. Furthermore, the mean tuberculin induration was 9.3±5.4 mm (size range: 2-22 mm) on the fourth week of Ramadan, which increased to 9.79±6.8 mm (size range: 3-35 mm) three months after this month (P=0.501). The mean count of WBC decreased insignificantly from 5907±1879 mcL to 5601±1362 mcL after Ramadan (P=0.334). Additionally, the mean lymphocytes count decreased significantly from 2292±520/mcL to 2023±486/mcL after this month (P=0.003). Likewise, the lymphocyte (P=0.014) and mean neutrophil percentage also reduced significantly (P<0.001). However, there was no association between PPD test and WBC, lymphocyte, or neutrophil count (P>0.05). Conclusion: As the findings of the present study indicated, Ramadan fasting induce some changes in the immune status, including lymphocyte and neutrophil percentage and count; however, it does not affect the PPD results.


  1. Laway BA, Ashraf H. Basic rules of Ramadan: a medico-religious perspective. J Pak Med Assoc. 2015; 65(5 Suppl 1):S14-7.
  2. Trepanowski JF, Bloomer RJ. The impact of religious fasting on human health. Nutr J. 2010; 9(1):57.
  3. Azizi F. Islamic fasting and health. Ann Nutr Metab. 2010; 56(4):273-82.
  4. Meo SA, Hassan A. Physiological changes during fasting in Ramadan. J Pak Med Assoc. 2015; 65(5 Suppl 1):S6-14.
  5. World Health Organization. Global tuberculosis control: surveillance, planning, financing: WHO report 2006. Geneva: World Health Organization; 2006.
  6. Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis. 1993; 17(6):968-75.
  7. Hatemi G, Melikoglu M, Fresko I, Masatlioglu S, Tascilar K, Yazici H. Infliximab does not suppress the tuberculin skin test (purified protein derivative). J Rheumatol. 2007; 34(3):474-80.
  8. Latifynia A, Vojgani M, Abofazeli T, Jafarieh H. Circulating immune complex during Ramadan. J Ayub Med Coll Abbottabad. 2007; 19(2):15-8.
  9. Develioglu ON, Kucur M, Ipek HD, Celebi S, Can G, Kulekci M. Effects of Ramadan fasting on serum immunoglobulin G and M, and salivary immunoglobulin A concentrations. J Int Med Res. 2013; 41(2):463-72.
  10. Mohammed KI, Mahmood MM. Effect of Ramadan fasting on the levels of IL-1α, IL-2, IL-6 and IL-8 cytokines. Diyala J Pure Sci. 2010; 6:308-13.
  11. Chaouachi A, Coutts AJ, Wong DP, Roky R, Mbazaa A, Amri M, et al. Haematological, inflammatory, and immunological responses in elite judo athletes maintaining high training loads during Ramadan. Appl Physiol Nutr Metab. 2009; 34(5):907-15.
  12. Faris MA, Kacimi S, Al-Kurd RA, Fararjeh MA, Bustanji YK, Mohammad MK, et al. Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutr Res. 2012; 32(12):947-55.
  13. Rahmani M, Zarei M. the effect of holly fasting month of Ramadan on the delayed type hypersensitivity response to purified protein derivative. Sci J Hamadan Univ Med Sci Health Ser. 2003; 10(1):52-6. (Persian).
  14. Mackin LA. Screening for tuberculosis in the primary care setting. Lippincotts Prim Care Pract. 1997; 2(6):599-610.
  15. Yang H, Kruh-Garcia NA, Dobos KM. Purified protein derivatives of tuberculin-past, present, and future. FEMS Immunol Med Microbiol. 2012; 66(3):273-80.
  16. Maughan RJ, Leiper JB, Bartagi Z, Zrifi R, Zerguini Y, Dvorak J. Effect of Ramadan fasting on some biochemical and haematological parameters in Tunisian youth soccer players undertaking their usual training and competition schedule. J Sports Sci. 2008; 26(Suppl 3):S39-46.
  17. Sarraf-Zadegan N, Atashi M, Naderi GA, Baghai AM, Asgary S, Fatehifar MR, et al. The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors. Ann Saudi Med. 2000; 20(5-6):377-81.
  18. Nematy M, Alinezhad-Namaghi M, Rashed MM, Mozhdehifard M, Sajjadi SS, Akhlaghi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J. 2012; 11(1):69.
  19. Askari V, Alavinezhad A, Boskabady M. The impact of “Ramadan fasting period” on total and differential white blood cells, haematological indices, inflammatory biomarker, respiratory symptoms and pulmonary function tests of healthy and asthmatic patients. Allergol Immunopathol (Madr). 2016; 44(4):359-67.