Vitamin D among Patients of Pulmonary and Extrapulmonary Tuberculosis: A Prospective Case-control Study

Author(s): Doaa Gadallah*, Ahmed Sedky, Hend Mohamed Esmaeel

Journal Name: Current Respiratory Medicine Reviews

Volume 16 , Issue 1 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Vitamin D has an essential role in enhancing the immune system to fight and destroy bacteria. People with vitamin D deficiency are highly liable to develop active pulmonary and extrapulmonary tuberculosis.

Objective: To evaluate the serum level of vitamin D among patients with pulmonary and extrapulmonary tuberculosis.

Patients and Methods: A case-control prospective study was conducted among patients with pulmonary and extrapulmonary tuberculosis and asymptomatic persons (controls). The study included 80 participants, 50 were TB patients, while 30 were controls. Vitamin D {1, 25(OH)} assay was done for all.

Results: Vitamin D assay of the included subjects revealed that 52 patients were vitamin D deficient, 7 patients had insufficient vitamin D and 21 had normal serum levels. Of the extrapulmonary TB patients, 35 (100%) had vitamin D deficiency, in pulmonary TB patients, 15 (100%) were vitamin D deficient. While 2 study subjects (6.7%) in the control group were deficient of vitamin D, 7 (23.3%) had insufficient vitamin D and 21cases had normal vitamin D levels. There was a statistically significant relationship between pulmonary and extrapulmonary TB cases and vitamin D deficiency (P< 0.001).

Conclusion: Vitamin D deficiency was found among pulmonary and extrapulmonary tuberculosis patients especially among female patients and patients in rural residence. The current study needs additional work to evaluate the value of adding vitamin D to the TB treatment regimen.

Keywords: Calcitriol, extrapulmonary tuberculosis, human monocytes, immunological tolerance, pulmonary tuberculosis, vitamin D deficiency.

[1]
Crowle AJ, Ross EJ, May MH. Inhibition by 1, 25 (OH) 2- vitamin D3 of the multiplication of virulent tubercle bacilli in cultured human macrophages. Infect Immun 1986; 55(12): 2945-50.
[2]
Rook GA, Steele J, Fraher L, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immun 1986; 57(1): 159-63.
[PMID: 3002968]
[3]
Compston JE. Vitamin D deficiency: time for action. Evidence supports routine supplementation for elderly people and others at risk. BMJ 1998; 317(7171): 1466-7.
[http://dx.doi.org/10.1136/bmj.317.7171.1466] [PMID: 9831568]
[4]
Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357(3): 266-81.
[http://dx.doi.org/10.1056/NEJMra070553] [PMID: 17634462]
[5]
Rockett KAR, Brookes R, Udalova I, Vidal V, Hill AV, Kwiatkowski D. 1,25-Dihydroxyvitamin D3 induces nitric oxide synthase and suppresses growth of Mycobacterium tuberculosis in a human macrophage-like cell line. Infect Immun 1998; 66(11): 5314-21.
[http://dx.doi.org/10.1128/IAI.66.11.5314-5321.1998] [PMID: 9784538]
[6]
Sly LM, Lopez M, Nauseef WM, Reiner NE. 1α,25-Dihydroxyvitamin D3-induced monocyte antimycobacterial activity is regulated by phosphatidylinositol 3-kinase and mediated by the NADPH-dependent phagocyte oxidase. J Biol Chem 2001; 276(38): 35482-93.
[http://dx.doi.org/10.1074/jbc.M102876200] [PMID: 11461902]
[7]
Coussens A, Timms PM, Boucher BJ, et al. 1 alpha,25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology 2009; 127(4): 539-48.
[http://dx.doi.org/10.1111/j.1365-2567.2008.03024.x] [PMID: 19178594]
[8]
Hewison M. Vitamin D and the immune system: new perspectives on an old theme. Rheum Dis Clin North Am 2012; 38(1): 125-39.
[http://dx.doi.org/10.1016/j.rdc.2012.03.012] [PMID: 22525848]
[9]
Coussens AK, Wilkinson RJ, Hanifa Y, et al. Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment. Proc Natl Acad Sci USA 2012; 109(38): 15449-54.
[http://dx.doi.org/10.1073/pnas.1200072109] [PMID: 22949664]
[10]
Penna G, Adorini L. 1 Alpha, 25-dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol 2000; 164(5): 2405-11.
[http://dx.doi.org/10.4049/jimmunol.164.5.2405] [PMID: 10679076]
[11]
Roth DE, Soto G, Arenas F, et al. Association between vitamin D receptor gene polymorphisms and response to treatment of pulmonary tuberculosis. J Infect Dis 2004; 190(5): 920-7.
[http://dx.doi.org/10.1086/423212] [PMID: 15295697]
[12]
Selvaraj P, Chandra G, Jawahar MS, Rani MV, Rajeshwari DN, Narayanan PR. Regulatory role of vitamin D receptor gene variants of Bsm I, Apa I, Taq I, and Fok I polymorphisms on macrophage phagocytosis and lymphoproliferative response to mycobacterium tuberculosis antigen in pulmonary tuberculosis. J Clin Immunol 2004; 24(5): 523-32.
[http://dx.doi.org/10.1023/B:JOCI.0000040923.07879.31] [PMID: 15359111]
[13]
Arai H, Miyamoto K, Taketani Y, et al. A vitamin D receptor gene polymorphism in the translation initiation codon: effect on protein activity and relation to bone mineral density in Japanese women. J Bone Miner Res 1997; 12(6): 915-21.
[http://dx.doi.org/10.1359/jbmr.1997.12.6.915] [PMID: 9169350]
[14]
Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 2008; 37(1): 113-9.
[http://dx.doi.org/10.1093/ije/dym247] [PMID: 18245055]
[15]
G R Gupta A . Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients 2014; 6(2): 729-75.
[http://dx.doi.org/10.3390/nu6020729] [PMID: 24566435]
[16]
Martineau AR, Wilkinson KA, Newton SM, et al. IFN-gamma- and TNF-independent vitamin D-inducible human suppression of mycobacteria: the role of cathelicidin LL-37. J Immunol 2007; 178(11): 7190-8.
[http://dx.doi.org/10.4049/jimmunol.178.11.7190] [PMID: 17513768]
[17]
Ralph AP, Kelly PM, Anstey NM. L-arginine and vitamin D: novel adjunctive immunotherapies in tuberculosis. Trends Microbiol 2008; 16(7): 336-44.
[http://dx.doi.org/10.1016/j.tim.2008.04.003] [PMID: 18513971]
[18]
Chandra G, Selvaraj P, Jawahar MS, Banurekha VV, Narayanan PR. Effect of vitamin D3 on phagocytic potential of macrophages with live Mycobacterium tuberculosis and lymphoproliferative response in pulmonary tuberculosis. J Clin Immunol 2004; 24(3): 249-57.
[http://dx.doi.org/10.1023/B:JOCI.0000025446.44146.52] [PMID: 15114055]
[19]
Chan TY. Vitamin D deficiency and susceptibility to tuberculosis. Calcif Tissue Int 2000; 66(6): 476-8.
[http://dx.doi.org/10.1007/s002230010095] [PMID: 10821887]
[20]
Workineh M, Mathewos B, Moges B, et al. Vitamin D deficiency among newly diagnosed tuberculosis patients and their household contacts: a comparative cross-sectional study. Arch Public Health 2017; 75: 25.
[http://dx.doi.org/10.1186/s13690-017-0195-7] [PMID: 28638616]
[21]
Tessema B, Moges F, Habte D, et al. Vitamin D deficiency among smear positive pulmonary tuberculosis patients and their tuberculosis negative household contacts in Northwest Ethiopia: a case-control study. Ann Clin Microbiol Antimicrob 2017; 16(1): 36.
[http://dx.doi.org/10.1186/s12941-017-0211-3] [PMID: 28490367]
[22]
Huang SJ, Wang XH, Liu ZD, et al. Vitamin D deficiency and the risk of tuberculosis: a meta-analysis. Drug Des Devel Ther 2016; 11: 91-102.
[http://dx.doi.org/10.2147/DDDT.S79870] [PMID: 28096657]
[23]
Rook GA. The role of vitamin D in tuberculosis. Am Rev Respir Dis 1988; 138(4): 768-70.
[http://dx.doi.org/10.1164/ajrccm/138.4.768] [PMID: 2849343]
[24]
Dangeti GV, Mailankody S, Neeradi C, et al. Vitamin D deficiency in patients with tuberculous meningitis and its relationship with treatment outcome. Int J Tuberc Lung Dis 2018; 22(1): 93-9.
[http://dx.doi.org/10.5588/ijtld.17.0304] [PMID: 29297432]
[25]
Sharma V, Mandavdhare HS, Kumar A, et al. Prevalence and clinical impact of vitamin D deficiency on abdominal tuberculosis. Ther Adv Infect Dis 2017; 4(3): 83-6.
[http://dx.doi.org/10.1177/2049936117709722] [PMID: 28634538]
[26]
Aliasghar F, Farshideh DS, Aghmorad S. The effect of vitamin D on clinical outcomes in tuberculosis. Egypt J Chest Dis Tuberc 2017; 66(3): 419-23.
[http://dx.doi.org/10.1016/j.ejcdt.2017.01.004]
[27]
Talat N, Perry S, Parsonnet J, Dawood G, Hussain R. Vitamin D deficiency and tuberculosis progression. Emerg Infect Dis 2010; 16(5): 853-5.
[http://dx.doi.org/10.3201/eid1605.091693] [PMID: 20409383]
[28]
Elsafi SSMS, Nour BM, Abakar AD, Omer IH, Almugadam BS. Vitamin D level and it is association with the severity of pulmonary tuberculosis in patients attended to Kosti Teaching Hospital, Sudan. AIMS Microbiol 2020; 6(1): 65-74.
[http://dx.doi.org/10.3934/microbiol.2020004] [PMID: 32226915]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 16
ISSUE: 1
Year: 2020
Published on: 15 September, 2020
Page: [59 - 65]
Pages: 7
DOI: 10.2174/1573398X16999200626160349
Price: $65

Article Metrics

PDF: 13
HTML: 1