DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20220982

Serum vitamin D level in newly detected tuberculosis-a case control study

Neethu Thambi, Achuthhan Vadakkedath, Muhammad Shafeekk, Manoj Dehandath Kottarath, Rajani Mavila, Padmanabhan Kadammar Veetil

Abstract


Background: Vitamin D has a significant role in host immune defence against Mycobacterium tuberculosis. It has been suggested that pulmonary tuberculosis may be associated with lower levels of vitamin D. Present study was undertaken to identify the association between vitamin D deficiency and tuberculosis.

Methods: A case-control study was conducted in a tertiary care hospital, including 25 adult newly diagnosed   tuberculosis patients as cases and 25 age and sex-matched healthy participants as control groups. All participants in the study group had undergone detailed clinical examination and routine laboratory investigations, including vitamin D level estimation. The clinical characteristics, investigations including vitamin D levels were analysed and compared with data obtained from healthy controls.

Results: Majority of the study population were in the age group of 40-50, with a mean age of 46.6±14.2. There were 20 pairs of males and 5 pairs of females. Out of the cases, 18 patients had pulmonary tuberculosis while 7 had extra pulmonary tuberculosis. Nine of the cases (36% of study population), 4 (16%) of the controls were underweight. The 15 (60%) of the cases and 20 (80%) of the controls were in the normal range and 1 case and 1 control were in the pre obese range. A total of 17 cases (68%), 8 controls (32%), had some degree of vitamin D deficiency (p=0.011) which is significant and suggests an association between the two.

Conclusions: The prevalence of vitamin D deficiency in pulmonary tuberculosis cases is very high.


Keywords


Pulmonary Tuberculosis, Mycobacterium Tuberculosis, Serum Vitamin-D Level

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References


Tiemersma EW, Van der Werf MJ, Borgdorff MWl. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative

patients: a systematic review. PLoS One. 2011;6:e17601.

Jagielski T, Minias A, Van Ingen J. Methodological and clinical aspects of the molecular epidemiology of Mycobacterium tuberculosis and other mycobacteria. Clin Microbiol Rev. 2016;29:239-90.

De Paus RA, Van Meijgaarden KE, Prins C. Immunological characterization of latent tuberculosis infection in a low endemic country. Tuberculosis. 2017;106:62-72.

Rook GW, Steele J, Fraher L. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology. 1986;57:159-63.

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.

Griffin MD, Xing N, Kumar R. Vitamin D and its analogs as regulators of immune activation and antigen presentation. Annu Rev Nutr. 2003;23:117-45.

Wilkinson RJ, Llewelyn M, Toossi Z. Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet. 2000;355:618-21.

Kramnik I, Dietrich WF, Demant P. Genetic control of resistance to experimental infection with virulent Mycobacterium tuberculosis. Proc Natl Acad Sci USA. 2000;97:8560-5.

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.

Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and nutrition examination survey. Am J Hypertens. 2007;20:713-9.

Mansoor S, Habib A, Ghani F. Prevalence and significance of vitamin D deficiency and insufficiency among apparently healthy adults. Clin Biochem. 2010;43:1431-5.

MoH. Tuberculosis, leprosy and TB. HIV prevention and control programme manual. 2008;5-7.

Holick MF. Vitamin D deficiency. N Eng J Med. 2007;6:266-81.

Sasidharan PK, Rajeev E, Vijayakumari V. Tuberculosis and vitamin D deficiency. J Asso Physicians India. 2009;50:554-8.

Chan TY, Poon P, Pang J, Swaminathan R, Chan CH, Nisar M et al. A study of calcium and vitamin D metabolism in Chinese patients with pulmonary tuberculosis. J Trop Med Hygiene. 1994;97(1):26-30.

Davies PD, Brown RC, Woodhead JS. Serum concentrations of vitamin D metabolites in untreated tuberculosis. Thorax. 1985;40:187-90.

Tuberculosis Research Centre, Chennai. Trends in the prevalence and incidence of tuberculosis in South India. Int J Tuberc Lung Dis. 2000;5:142.

Negin J, Abimbola S, Marais BJ. Tuberculosis among older adults 2013; time to take notice. Int J Infect Dis. 2016;32:135-7.

Chaimowicz F. Age transition of tuberculosis incidence and mortality in Brazil. Revista de Saúde Pública. 2001;35(1):81-7.

Sloan DJ, Mwandumba HC, Kamdolozi M, Shani D, Chisale B, Dutton J et al. Vitamin D deficiency in Malawian adults with pulmonary tuberculosis: risk factors and treatment outcomes. Int J Tuberculosis Lung Dis. 2015;19(8):904-11.

Mukherjee A, Saha I, Sarkar A, Chowdhury R. Gender differences in notification rates, clinical forms and treatment outcome of tuberculosis patients under the RNTCP. Lung India. 2012;29(2):120-22.

Holmes CB, Hausler H, Nunn P. A review of sex differences in the epidemiology of tuberculosis. Int J Tuberculosis Lung Dis. 2018;2(2):96-104.

Balasubramanian R, Garg R, Santha T, Gopi PG, Subramani R, Chandrasekaran V, Narayanan PR. Gender disparities in tuberculosis: report from a rural DOTS programme in south India. Int J Tuberculosis Lung Dis. 2004;8(3):323-32.

World Health Organization (WHO). Country profiles for 22 high burden countries. 2011. Available at: http://www.unfpa.org/sowmy/resources/docs/main_report/en_SOWMR_Part4.pdf. Accessed on 12 Jan, 2021.

Maurya V, Vijayan VK, Shah A. Smoking and tuberculosis: an association overlooked. Int J Tuberculosis Lung Dis. 2002;6(11):942-51.

Den Boon S, Van Lill SWP, Borgdorff MW, Verver S, Bateman ED, Lombard CJ et al. Association between smoking and tuberculosis infection: a population survey in a high tuberculosis incidence area. Thorax. 2005;60(7):555-7.

Bothamley GH. Smoking and tuberculosis: a chance or causal association? Thorax. 2005;60(7):527-8.

Wejse C, Olesen R, Rabna P, Kaestel P, Gustafson P, Aaby P, Andersen PL. Serum 25-hydroxyvitamin D in a West African population of tuberculosis patients and unmatched healthy controls. 2007;25(8):1376-83.

Iftikhar R, Kamran SM, Qadir A, Haider E, Bin Usman H. Vitamin D deficiency in patients with tuberculosis. Journal of the College of Physicians and Surgeons-Pakistan. JCPSP. 2013;23(10):780-3.

Al-Elq AH, Sadat-Ali M, Al-Turki HA, Al-Mulhim FA, Al-Ali AK. Is there a relationship between body mass index and serum vitamin D levels? Saudi Med J. 2009;30(12):1542-6.

Lagunova Z, Porojnicu AC, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res. 2009;29(9):3713-20.

Mashhadi SF, Rahman M, Azam N, Hashim R, Khan A, Fawad A. Association of vitamin D deficiency with tuberculosis in adult patients reporting to a tertiary care hospital of Rawalpindi. Pak Armed Forces Med J. 2014;64(3):479-83.