Levels of vitamin D in tuberculosis and comparison of vitamin D level in severe variant of tuberculosis like tubercular meningitis, miliary tuberculosis, disseminated tuberculosis with non severe variant of tuberculosis like pulmonary tuberculosis, tubercular lymphadenitis etc in paediatric age group

Authors

  • Pankaj Gupta Department of Paediatrics, GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India
  • Lalit Nainiwal Department of Paediatrics, GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20201637

Keywords:

Tuberculosis, Non severe variant (pulmonary tuberculosis, tubercular lymphadenitis), Severe variant (Tubercular meningitis, miliary tuberculosis, disseminated tuberculosis), Vitamin D

Abstract

Background: Tuberculosis is deadliest disease killing nearly 2 million people every year. Before the etiologic cause of TB was determined by Koch, cod liver oil and sunlight, both sources of vitamin D, were used in treatment of tuberculosis. After discovery of antibiotics, anti-infectious value of vitamin D was ignored until increasing cost of antibiotics and rise in resistance led to the need to search for alternative and antibiotic-independent therapeutic strategies. This study shed light on vitamin D, which is very safe and inexpensive by adding vitamin D to antibiotic treatment, immune system can be boosted to help body to clear TB, rather than relying on antibiotics.

Methods: A prospective, observational, comparative study in which 62 TB patients were taken and vitamin D level were estimated.

Results: The results of study show that out of total 62 patients, 31 (50.00%) had deficient(<20ng/ml) vitaminD,23(37.10%) had insufficient(20-30ng/ml) vitamin D, 8(12.90%) had sufficient (>30ng/ml) vitamin D level. Out of 62 patients, 10(62.13%) had severe variety of TB and 52(83.87%) had  nonsevere TB. Among the 52 patients, 24(46.2%) had deficient vitamin D, 20(38.5%) had insufficient vitamin D and 8(15.4%) had sufficient vitamin D. Among the 10 patients with severe TB, 7(70.00%) had deficient vitamin D, 3(30.00%) had insufficient vitamin D and none had sufficient vitamin D level.

Conclusions: Majority of children with tuberculosis demonstrated low serum levels of vitamin D (deficient and insufficient levels) suggest that vitamin D deficiency is  risk factor of tuberculosis and very low levels of vitamin D were noted in severe variant of TB then non severe suggest that in severe form of tuberculosis vitamin D levels were less compared to nonsevere variant.

References

Ghai OP, Gupta P. Paul VK. Ghai Essential Pediatrics. 8th edition. India: CBS Publishers & Distributors Pvt Ltd,; 2013:250.

Rook GA, Steele J, Fraher L, Barker S, Karmali R, O'riordan J, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunol. 1986 Jan;57(1):159-63.

Rockett KA, Brookes R, Udalova I, Vidal V, Hill AVS, Kwiatkowski D. 1,25-Dihydroxyvitamin D3 Induces Nitric Oxide Synthase and Suppresses Growth of Mycobacterium tuberculosis in a Human Macrophage-Like Cell Line. Infect Immunity. 1998;66(11):5314-21.

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 Biolog Chem. 2001;276(38):35482-93.

Coussens A, Timms PM, Boucher BJ, Venton TR, Ashcroft AT, Skolimowska KH, et al. 1α, 25‐dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunol. 2009 Aug;127(4):539-48.

Yuk JM, Shin DM, Lee HM, Yang CS, Jin HS, Kim KK, et al. Vitamin D3 Induces Autophagy in Human Monocytes/Macrophages via Cathelicidin. Cell Host Microbe. 2009;6(3):231-43.

Barlow PG, Svoboda P, Mackellar A, Nash AA, York IA, Pohl J, et al. Antiviral Activity and Increased Host Defense against Influenza Infection Elicited by the Human Cathelicidin LL-37. PLoS ONE. 2011;6(10).

Rivas-Santiago B, Santiago CER, Castañeda-Delgado JE, León–Contreras JC, Hancock RE, Hernandez-Pando R. Activity of LL-37, CRAMP and antimicrobial peptide-derived compounds E2, E6 and CP26 against Mycobacterium tuberculosis. Inter J Antimicrob Agents. 2012;41(2):143-8

Khandelwal D, Gupta N, Mukherjee A, Lodha R, Singh V, Grewal HM, et al. Vitamin D levels in Indian children with intrathoracic tuberculosis. The Indian J Med Res. 2014 Oct;140(4):531-7.

Gordon CM, Depeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of Vitamin D Deficiency Among Healthy Adolescents. Arch Pediatr Adolescent Med. 2004Jan;158(6):531-7.

Isa HM, Almaliki MS, Alsabea AS, Mohamed AM. Vitamin D deficiency in healthy children in Bahrain: do gender and age matter? Eastern Mediterranean Health J. 2019;2019

Singh G, Singh G, Brar H, Malik S. Vitamin D levels in preterm and term neonates at birth. Int J Contemp Pediatr. 2016;4(1):48-52.

Arora S, Goel P, Chawla D, Huria A, Arya A. Vitamin D Status in Mothers and Their Newborns and Its Association with Pregnancy Outcomes: Experience from a Tertiary Care Center in Northern India. J Obstetr Gynecol India. 2018;68(5):389-93.

Walli NZ, Munubhi EK, Aboud S, Manji KP. Vitamin D Levels in Malnourished Children under 5 Years in a Tertiary Care Center at Muhimbili National Hospital, Dar es Salaam, Tanzania-A Cross-sectional Study. J Tropic Pediatr. 2017;63(3):203-9.

Venturini E, Facchini L, Martinez-Alier N, Novelli V, Galli L, Martino MD, et al. Vitamin D and tuberculosis: a multicenter study in children. BMC Infect Dis. 2014;14(1).

Rizvi I, Garg RK, Jain A, Malhotra HS, Singh AK, Prakash S, et al. Vitamin D status, vitamin D receptor and toll like receptor-2 polymorphisms in tuberculous meningitis: a case–control study. Infect. 2016Oct20;44(5):633-40.

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Published

2020-04-24

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Original Research Articles