Details
Category: Volume 06 Issue 01 January 2018
Hits: 1581

Title: A Study of Serum Vitamin D Levels in Newly Diagnosed Pulmonary Tuberculosis

Authors: Dr V Ramkumar, Dr M Kumar Raja, Dr S R Subramaniam, Dr R Shankar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.93

Abstract

Background: Vitamin D was used in tuberculosis management in the pre-antibiotic era. Vitamin D deficiency has been implicated in activation of TB. A meta-analysis published has shown the association of vitamin D deficiency with two-fold higher risk of active TB and certain studies had also demonstrated that vitamin D supplementation in TB patients is associated with faster clinical and radiological improvement and sputum smear conversion.

Aim: To assess the serum vitamin D levels among the patients with pulmonary tuberculosis and its association with the severity of the disease.

Methodology: A cross-sectional study was conducted for a period of one year in Government medical college hospital, Salem. A total of 300 patients with pulmonary tuberculosis confirmed by sputum AFB were included in the study. The vitamin D status of study participants was interpreted based on the serum 25-(OH) Vitamin D concentration following the manufacturer’s instructions as deficient (<20 ng/ml), insufficient (20–29 ng/ml), sufficient (30–100 ng/ml) and potential toxicity (>100 ng/ml).

Results: Vitamin D levels were found to be normal in 34% of the subjects and it was insufficient in 11% and found to be deficit in 55% of the study subjects. Multi-logistic regression analysis was applied to identify the factors influencing deficiency of vitamin D among the patients with tuberculosis among males and females. It was proved that age more than 30 years , female gender, sputum results showing 1+ or more, BMI <18.5 and patients with various co-morbidities found to have statistical significant association with reduction in the vitamin D levels among patients with tuberculosis.

Conclusion: Considering the high prevalence of vitamin D deficiency, the present study implicates that further follow-up studies are warranted to determine whether vitamin D supplementation can have a role in the prevention and treatment of tuberculosis.

Keywords: vitamin D, pulmonary tuberculosis, prevalence, multi-logistic regression.

References

  1. Magnitude of TB in India. Annual report of TB India 2017. Central TB Division. Directorate General of Health Services. Ministry of Health and Family welfare. Nirman Bhavan. tbcindia.gov.in
  2. Nardell EA. Environmental control of tuberculosis. Med Clin North Am. 1993;77:1315–34. doi: 10.1016/S0025-7125(16)30196-1.
  3. Borkow G, Weisman Z, Leng Q, Stein M, Kalinkovich A, et al. Helminths, human immunodeficiency virus and tuberculosis. Scand J Infect Dis. 2001;33:568–71. doi: 10.1080/00365540110026656.
  4. Kramnik I, Dietrich WF, Demant P, Bloom BR. Genetic control of resistance to experimental infection with virulent Mycobacterium tuberculosis. Proc Natl AcadSci U S A. 2000;97:8560–5. doi: 10.1073/pnas.150227197.
  5. Rook GA, Zumla A. Advances in immune-pathogenesis of pulmonary tuberculosis. CurrOpinPulm Med. 2001;7:116–23. doi: 10.1097/00063198-200105000-00002.
  6. Holick Michael F. Vitamin D physiology, molecular biology and clinical applications. Springer science and business media ; 2010, 2nd edition ,p748-757.
  7. Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll like Receptor triggering of a vitamin D–mediated human antimicrobial Response. Science. 2006; 311:1770–3. DOI: 10.1126/science.1123933.
  8. R. Martineau, K.A. Wilkinson, S.M. Newton. IFN-γ- and TNF-independent vitamin D-inducible human suppression of mycobacteria: the role of cathelicidin LL-37. J. Immunol., 178 (2007), pp 7190-7198
  9. Selvaraj P, Anand SP, Harishankar M, et al. Plasma 1, 25 dihydroxy vitamin D(3) level and expression of vitamin d receptor and cathelicidin in pulmonary tuberculosis. J ClinImmunol 2009;29(4):470-8.
  10. Martineau AR, Wilkinson RJ, Wilkinson KA, et al. A single dose of vitamin D enhances immunity to mycobacteria. Am J RespirCrit Care Med 2007;176(2):208-13.
  11. Morcos MM, Gabr AA, Samuel S, et al. Vitamin D administration to tuberculous children and its value. Boll Chim Farm 1998;137(5):157-64.
  12. E. Nnoaham, A. ClarkeLow serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int. J. Epidemiol., 37 (2008), pp. 113-119
  13. Wejse, V.F. Gomes, P. RabnaVitamin D as supplementary treatment for tuberculosis: a double-blind, randomized, placebo controlled trial. Am. J. Respir. Crit. Care Med., 179 (2009), pp. 843-850
  14. W. Nursyam, Z. Amin, C.M. Rumende The effect of vitamin D as supplementary treatment in patients with moderately advanced pulmonary tuberculous lesion. Acta Med. Indonesia, 38 (2006), pp. 3-5
  15. Moreau E, Bacher S, Mery S, Le Goff C, Piga N, Vogeser M, Hausmann M, Cavalier E. Performance characteristics of the VIDAS® 25-OH Vitamin D Total assay comparison with four immunoassays and two liquid chromatography-tandem mass spectrometry methods in a multi-centric study. ClinChem Lab Med.
  16. Selvaraj P, Anand SP, Harishankar M, et al. Plasma 1, 25 dihydroxy vitamin D(3) level and expression of vitamin d receptor and cathelicidin in pulmonary tuberculosis. J ClinImmunol 2009;29(4):470-8.
  17. Sasidharan PK, Rajeev E, Vijayakumari V. Tuberculosis and vitamin D deficiency. J Assoc Physicians India 2002;50:554-8.   
  18. Yuvaraj B, Sridhar MG, Vinod KS, et al. Association of serum vitamin D levels with bacterial load in pulmonary tuberculosis patients. TubercRespir Dis (Seoul) 2016;79(3):153–7.
  19. Khandelwal D, Gupta N, Mukherjee A, et al. Vitamin D levels in Indian children with intrathoracic tuberculosis. Indian J Med Res 2014;140(4):531-7.
  20. Daley P, Jagannathan V, John KR, et al. Adjunctive vitamin D for treatment of active tuberculosis in India: a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2015;15(5):528-34.
  21. Talat N, Perry S, Parsonnet J, et al. Vitamin D deficiency and tuberculosis progression. Emerg Infect Dis 2010;16(5):853-5.
  22. Gao WW, Wang Y, Zhang XR, et al. Levels of 1, 25(OH)2D3 for patients with pulmonary tuberculosis and correlations of 1,25(OH)2D3 with the clinical features of TB. J Thorac Dis 2014;6(6):760-4.
  23. Ho-Pham L, Nguyen D, Nguyen TT, et al. Association between vitamin D insuffici-ency and tuberculosis in a vietnamese population. BMC Infect Dis 2010;10:306.
  24. Friis H, Range N, Pedersen M. Hypovitaminosis D is common among pulmonary tuberculosis patients in Tanzania but is not explained by the acute phase response. J Nutr. 2008;138:2474–80. doi: 10.3945/jn.108.094979.
  25. Davis K, Edrisa M, Richard S, William W. Vitamin D deficiency among adult patients with tuberculosis: a cross sectional study from a national referral hospital in Uganda. BMC Res Notes. 2013;6:293. doi: 10.1186/1756-0500-6-293.
  26. Banda R, Mhemedi B, Allain T. Prevalence of vitamin D deficiency in adult tuberculosis patients at a central hospital in Malawi. Int J Tuberc Lung Dis. 2010;15(3):408–10.
  27. Rowle AJ, Ross EJ. Inhibition by 1,25(OH)2-vitaminD3 of the multiplication of virulent tubercle bacilli in cultured human macrophages. Infect Immun. 1987;55:2945–50.
  28. Liu PT, Stenger S, Li H. Toll-like receptor triggering of a vitamin D mediated human antimicrobial response. J Immunol. 2007; 179:2060–3. doi: 10.4049/jimmunol.179.4.2060.
  29. Martineau A. Old wine in new bottles: vitamin D in the treatment and prevention of tuberculosis. Proc Nutr Soc. 2012; 71:84–9. doi: 10.1017/S0029665111003326.
  30. Nielsen NO, Skifte T, Andersson M, Wohlfahrt J, Soborg B, Koch A. Both high and low serum vitamin D concentrations are associated with tuberculosis: a case-control study in Greenland. Br J Nutr. 2010;104:1487–91. doi: 10.1017/S0007114510002333.
  31. Ustianowskia A, Shaffera R, Collinb S, Wilkinsona RJ, Davidsona RN. Prevalence and associations of vitamin D deficiency in foreign-born persons with tuberculosis in London. J Infect. 2005;50:432–7. doi: 10.1016/j.jinf.2004.07.006.
  32. Martineau AR, Nhamoyebonde S, Oni T, Rangaka MX, Marais S, et al. Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in Cape Town, South Africa. ProcNatlAcadSci U S A. 2011;108(47):19013–7. doi: 10.1073/pnas.1111825108.

Corresponding Author

Dr M Kumar Raja

Assistant Professor, Dept of Medicine

Government Mohan Kumaramangalam Medical College, Salem