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Eletreby R, Elsharkawy A, Mohamed R, Hamed M, Kamal Ibrahim E, Fouad R. Prevalence of vitamin D deficiency and the effect of vitamin D3 supplementation on response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis. BMC Infect Dis 2024; 24:681. [PMID: 38982373 PMCID: PMC11232269 DOI: 10.1186/s12879-024-09367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/29/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND We aimed to assess serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in extrapulmonary tuberculosis (EPTB) patients and to evaluate the effect of vitamin D3 supplementation on their treatment course. METHODS Serum 25(OH)D3concentrations were measured in 47 newly diagnosed EPTB patients and 42 controls. Vitamin D-deficient EPTB patients were randomly assigned to receive 50,000 IU of vitamin D3 (cholecalciferol) orally once a week for 6 weeks (total 300,000 IU), followed by maintenance doses of 1000 IU a day besides anti-TB drugs or the first line anti-TB treatment only. Follow up serum 25(OH)D3 concentrations were measured after 3 months of starting vitamin D3 supplementation. Both groups were evaluated for clinical, laboratory, and radiological outcomes after treatment. RESULTS Serum 25(OH)D3 concentrations were significantly lower among TB cases (17.1 ± 5.5 nmol/L) compared to healthy controls (51.8 ± 27.3 nmol/L), and vitamin D deficiency was observed in all EPTB patients (n = 47). Patients in VD3 supplementation group had significantly higher weight gain and serum albumin level at 2 months and end of treatment, higher hemoglobin concentration at the end of treatment, significantly lower CRP and ESR at 2 months and at the end of treatment. In cases with TB pleurisy, a significant higher rate of full resolution of pleural fluid after 6 months of anti-TB treatment and shorter treatment duration were noted compared to the other group. CONCLUSIONS Vitamin D deficiency is prevalent in EPTB patients, in whom, vitamin D supplementation is a useful adjunctive therapy to anti-TB drugs and improves treatment course.
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Affiliation(s)
- Rasha Eletreby
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aisha Elsharkawy
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rahma Mohamed
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mai Hamed
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Kamal Ibrahim
- Pulmonology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rabab Fouad
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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2
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Mamadapur VK, Nagaraju S, Prabhu MM. Comparative Study of Vitamin D Levels in Newly Diagnosed Tuberculosis and a Normal Population. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:685. [PMID: 38792867 PMCID: PMC11122980 DOI: 10.3390/medicina60050685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Tuberculosis (TB) is an ancient disease caused by Mycobacterium tuberculosis, a member of the Mycobacterium tuberculosis complex. It contributes to significant morbidity and mortality. Treatment of TB poses a considerable challenge because of emerging drug resistance and the longer duration of therapy. Various past studies, both in vitro and in vivo, have established the role of vitamin D in the pathogenesis and treatment of TB. Results of in vivo studies are inconsistent, and this study aims to determine vitamin D levels and their association with newly diagnosed TB (pulmonary and extrapulmonary) cases and normal populations. Material and Methods: A Prospective Case-Control study with 116 subjects (58 cases and 58 controls) was conducted over two years. 29 cases of pulmonary TB and 29 cases of extrapulmonary TB constituted 58 cases of TB. Vitamin D levels were measured and compared in both the cases and controls. Data analysis was carried out using SPSS software 22.0. Results: The prevalence of vitamin D deficiency was 68.96% in the cases, while it was 51.72% in the controls. The reported median and quartile of serum vitamin D levels were 14.35 ng/mL (8.65, 25.48) in the TB group and 19.08 ng/mL (13.92, 26.17) in the control group. There was a significant statistical difference between the TB and non-TB populations with a p-value of 0.029 on the Mann-Whitney test. Conclusion: Vitamin D deficiency was more prevalent in individuals with TB than those without TB.
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Affiliation(s)
| | - Shreesha Nagaraju
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - Mukhyaprana M. Prabhu
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
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3
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Parivakkam Mani A, K S, K DK, Yadav S. Assessment of Lipid Profile in Patients With Pulmonary Tuberculosis: An Observational Study. Cureus 2023; 15:e39244. [PMID: 37342750 PMCID: PMC10277210 DOI: 10.7759/cureus.39244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Mycobacterium tuberculosis causes tuberculosis (TB), an infectious lung disease. There is mounting evidence linking low lipid levels to a variety of human diseases, including TB. Cholesterol, mainly due to its involvement in heart disease, gets more attention in recent years. The objectives of the study were to look into the link that connects hypolipidemia to the existence of pulmonary/extrapulmonary TB; we have tried to find the link in relation to patients who have been recently diagnosed with TB as well as in those who are having TB in the long term. MATERIALS AND METHODS An observational study was performed on TB patients attending respiratory medicine at the Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India, from February 2021 to January 2022, and their lipid levels were tested from patients with consent and correlated. Student's t-test was applied to the obtained data. To convey quantitative data, measurements such as mean along with standard deviation were applied, and a p-value of 0.05 was considered statistically significant. RESULTS This research included 80 subjects, 40 of whom were diagnosed with TB, and the rest (40 controls) were deemed healthy. The age group with the highest low lipid levels in pulmonary TB was 40-50 years. A chi-square test of association was conducted; this test revealed that the fraction of TB patients having lower than normal levels of total cholesterol (p = 0.0001), triglyceride level (p = 0.006), high-density lipoprotein (p = 0.009), low-density lipoprotein (p = 0.006), and body mass index (p = 0.000) was statistically significantly higher in contrast to the control group. Thus, there was a significant correlation between a higher prevalence of hypolipidemia in patients with pulmonary tuberculosis (PTB) and normal healthy individuals. CONCLUSIONS We observed a strong relationship between hypolipidemia and TB, indicating that patients with low lipid levels tend to have severe inflammation as compared to patients with normal lipid levels.
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Affiliation(s)
| | - Shanmugapriya K
- Respiratory Medicine, Sri Lalithambigai Medical College and Hospital, Dr. M.G.R. Educational and Research Institute, Chennai, IND
| | - Deepak Kanna K
- Respiratory Medicine, Tamil Nadu Government Multisuperspeciality Hospital, Chennai, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Cai L, Hou S, Huang Y, Liu S, Huang X, Yin X, Jiang N, Tong Y. The Potential Role of Vitamin D in the Development of Tuberculosis in Chinese Han Population: One Case-Control Study. Front Med (Lausanne) 2022; 9:849651. [PMID: 35957850 PMCID: PMC9358990 DOI: 10.3389/fmed.2022.849651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims:Spinal serum 25-hydroxyvitamin D [25[OH]D] status plays an important role in mediating innate immune responses by acting as a cofactor for induction of antimycobacterial activity and is thus involved in the development of Tuberculosis (TB). Results reported regarding the association of vitamin D with TB remained controversial. We aimed to identify any common association between 25[OH]D status and TB in the Chinese Han population.Methods280 subjects (70 TB patients and 210 matched controls) were recruited. TB cases were diagnosed based on the presence of acid-fast bacilli on smears from sputum and MTB isolation. Healthy controls were randomly selected from four local community-based populations. 25[OH]D was detected by electrochemiluminescence immunoassay (ECLIA) on Roche Elecsys before the initial treatment. Multivariable logistic regression analysis was used to examine the association of Vitamin D with TB.ResultsThere was no significant difference in the serum vitamin D level between total cases and controls, but we found a strong tendency toward a higher serum vitamin D level in male population (P < 0.05) with TB but not in females. High serum vitamin D increased the risk of TB in the Chinese Han population (OR = 1.035, 95%CI: 1.001–1.070, P < 0.05). The serum vitamin D level was significantly decreased with age increasing in cases and controls (all P < 0.001).ConclusionsHigh serum vitamin D may be an independent risk factor for TB in the Chinese Han population.
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Affiliation(s)
- Li Cai
- Wuhan Center for Disease Control and Prevention, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
| | - Shuangyi Hou
- Center for Disease Control and Prevention, Wuhan, China
| | - Yadong Huang
- Center for Disease Control and Prevention, Wuhan, China
| | - Shuang Liu
- Center for Disease Control and Prevention, Wuhan, China
| | - Xibao Huang
- Center for Disease Control and Prevention, Wuhan, China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Nan Jiang
| | - Yeqing Tong
- Center for Disease Control and Prevention, Wuhan, China
- *Correspondence: Yeqing Tong
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White HA, Okhai H, Kirwan P, Rafeeq SH, Dillon H, Hefford P, Wiselka MJ, Pareek M. Tuberculosis incidence in country of origin is a key determinant of the risk of active tuberculosis in people living with HIV: Data from a 30-year observational cohort study. HIV Med 2021; 23:650-660. [PMID: 34939299 DOI: 10.1111/hiv.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION People living with HIV (PLWH) are at high risk of active tuberculosis (TB) but this risk in the era of antiretroviral treatment (ART) remains unclear. It is critical to identify the groups who should be prioritised for latent TB (LTBI) screening. In this study we identified the risk factors associated with developing incident TB disease, by analysing a 30-year observational cohort. METHODS We evaluated PLWH in Leicester, UK, between 1983 and 2017 to ascertain those who developed active TB and the timing of this in relation to HIV diagnosis; whether before, concurrently with, or more than 3 months after the diagnosis of HIV (incident TB). Predictors of incident TB were ascertained using Cox proportional hazards models. RESULTS In all, 325 out of 2158 (15.1%) PLWH under care had had active TB; 64/325 (19.7%) prior to HIV diagnosis, 161/325 (49.5%) concurrently with/within 3 months of HIV diagnosis and 100/325 (30.8%) had incident TB. Incident TB risk was 4.57/1000 person-years. Increased TB incidence in the country of birth was associated with an increased risk of developing incident TB [50-149/100 000 population, adjusted hazard ratio (AHR) = 3.10, 95% CI: 0.94-10.20; 150-249/100 000 population, AHR = 7.14, 95% CI: 3.46-14.74; 250-349/100 000 population, AHR = 5.90, 95% CI: 2.32-14.99; ≥ 350/100 000 population, AHR = 3.96, 95% CI: 1.39-11.26]. CONCLUSIONS Tuberculosis risk remains high among PLWH and is related to TB incidence in the country of birth. Further work is required to determine whether specific groups of PLWH should be targeted for programmatic LTBI screening, and whether it will result in high uptake and completion of chemoprophylaxis and is cost-effective for widespread implementation.
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Affiliation(s)
- Helena A White
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hajra Okhai
- Institute for Global Health, University College London, London, UK
| | - Peter Kirwan
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, Public Health England, London, UK
| | - Sonia H Rafeeq
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, Public Health England, London, UK
| | - Helen Dillon
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Phillip Hefford
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin J Wiselka
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Butt MF, Younis S, Wu Z, Hadi SH, Latif A, Martineau AR. The relationship between seasonality, latitude and tuberculosis notifications in Pakistan. BMC Infect Dis 2021; 21:210. [PMID: 33632152 PMCID: PMC7905850 DOI: 10.1186/s12879-021-05899-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Pakistan ranks amongst the top 20 highest burden tuberculosis (TB) countries in the world. Approximately 369,548 cases of TB (all forms) were notified in 2018, with an estimated incidence of 265 per 100,000 people per year. In other settings, TB has been shown to demonstrate seasonal variation, with higher incidence in the spring/summer months and lower incidence in the autumn/winter; the amplitude of seasonal variation has also been reported to be higher with increasing distance from the equator. Methods Notifications of newly-diagnosed pulmonary and extrapulmonary TB cases were obtained for 139 districts in Pakistan from 2011 to 2017. Data were provided by the Pakistan National TB Control Programme, Islamabad, Pakistan. Statistical analyses were performed to determine whether there was seasonal variation in TB notifications in Pakistan; whether the amplitude of seasonal variation in TB notifications varied according to latitude; whether the amplitude of seasonal variation of TB in Pakistan differed between extrapulmonary TB vs. pulmonary TB. To assess the quarterly seasonality of TB, we used the X-13-ARIMA-SEATS seasonal adjustment programme from the United States Census Bureau. The mean difference and corresponding 95% confidence intervals of seasonal amplitudes between different latitudes and clinical phenotype of TB were estimated using linear regression. Results TB notifications were highest in quarter 2, and lowest in quarter 4. The mean amplitude of seasonal variation was 25.5% (95% CI 25.0 to 25.9%). The mean seasonal amplitude of TB notifications from latitude 24.5°N- < 26.5°N was 29.5% (95% CI 29.3 to 29.7%) whilst the mean seasonal amplitude of TB notifications from latitude 34.5°N - < 36.5°N was 21.7% (95% CI 19.6 to 23.9%). The mean seasonal amplitude of TB notifications across Pakistan between latitudes 24.5°N to 36.5°N reached statistically significant difference (p < 0.001). The amplitude of seasonal variation was greater for extrapulmonary TB (mean seasonal amplitude: 32.6, 95% CI 21.4 to 21.8%) vs. smear positive pulmonary TB mean seasonal amplitude: 21.6, 95% CI 32.1 to 33.1%), p < 0.001. Conclusion TB notifications in Pakistan exhibit seasonal variation with a peak in quarter 2 (April–June) and trough in quarter 4 (October–December). The amplitude of seasonality decreases with increasing latitude, and is more pronounced for extrapulmonary than for pulmonary TB. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05899-x.
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Affiliation(s)
- Mohsin F Butt
- The Wingate Institute of Neurogastroenterology, Centre for Neuroscience, Trauma and Surgery, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, Whitechapel, London, E1 2AJ, UK. .,Department of Respiratory Medicine, Royal Free Hospital, Royal Free NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, UK.
| | - Sidra Younis
- Department of Biological Sciences, National University of Medical Sciences (NUMS), Abid Majeed Road, Rawalpindi, Pakistan.,Institute of Population Health Sciences, Yvonne Carter Building, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, Whitechapel, London, E1 2AB, UK
| | - Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Syed H Hadi
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - Abdullah Latif
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - Adrian R Martineau
- Institute of Population Health Sciences, Yvonne Carter Building, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, Whitechapel, London, E1 2AB, UK
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Soleimani A, Dehghan Tarzejani MH, Hakimi SS, Alishiri N, Torabizadeh R. The Assessment of Vitamin D Serum Level in Patients With Pulmonary and Extra-Pulmonary Tuberculosis in Karaj, Iran, During 2017-2018. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2020. [DOI: 10.34172/ijep.2020.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: It is important to determine the type of tuberculosis and its related factors in order for effectively treating a disease and reducing its side effects in the society. Objective: This study aimed to determine vitamin D level in patients with pulmonary and extra-pulmonary tuberculosis in Karaj, Iran in 2017-2018. Materials and Methods: In this observational study, 102 patients suffering from pulmonary and extra-pulmonary tuberculosis disease were availably selected in Karaj, Iran in 2017-2018. They were examined and, then, their vitamin D level were assessed and compared according to the type of tuberculosis. Results: The study results showed that vitamin D level was normal in 39.2% of the case study population, but it was abnormal in 60.8% of it (18.6% deficiency and 42.2% insufficiency). Vitamin D deficiency was 15.8% in pulmonary tuberculosis patients and it was 22.2% in extra-pulmonary tuberculosis ones, showing no significant difference (P>0.05) statistically. Conclusion: According to the obtained results, hypovitaminosis-D was detected in more than half of the patients with pulmonary and extra pulmonary tuberculosis, which was not associated with the type of tuberculosis. Seemingly, the patients needed the same amount of – or even more – food, medical supplements, sports, and sunlight compared to healthy people.
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Affiliation(s)
- Alireza Soleimani
- Department of Infectious Disease, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Niloofar Alishiri
- Alborz University of Medical Sciences, School of Medicine, Karaj, Iran
| | - Roya Torabizadeh
- Alborz University of Medical Sciences, Dietary Supplements and Probiotic Research Center, Karaj, Iran
- Alborz University of Medical Sciences, School of Medicine, Karaj, Iran
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Maruthai K, Sankar S, Subramanian M. Methylation Status of VDR Gene and its Association with Vitamin D Status and VDR Gene Expression in Pediatric Tuberculosis Disease. Immunol Invest 2020; 51:73-87. [PMID: 32847384 DOI: 10.1080/08820139.2020.1810702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Deficiency in circulatory vitamin D level and vitamin D receptor DNA methylation could be associated with weakened innate immune response and increased susceptibility to tuberculosis (TB) disease in children. Therefore, we aimed to study the effect of vitamin D receptor (VDR) gene methylation on plasma vitamin D level and the expression of the VDR gene in children with active-TB disease. A cross-sectional comparative study was conducted in 43 children with active-TB and 33 healthy control children (HC). The vitamin D level was measured in plasma, while the levels of VDR gene promoter methylation and VDR gene expression were measured in peripheral blood. Children with active-TB showed a significantly lower median vitamin D level than HC [Cases 17.18 ng/mL (IQR, 8.3-18.6 ng/mL); HC 41.34 ng/mL (IQR, 40.2-43.49 ng/mL) (p<0.0001)] and decreased mRNA expression level of VDR gene [Cases 0.51 (IQR, 0.40-0.70); HC 1.06 (IQR, 0.8-1.2) (p<0.0001)] and increased VDR DNA methylation [Cases 75% (IQR, 50-75%); HC 10% (IQR, 10-25%) (p<0.0001)]. The VDR hypermethylation is significantly associated with reduced vitamin D level and decreased expression level of VDR gene. Therefore this inverse association could be involved in the impairment in the VDR mediated cytolytic and antimicrobial effector cell response in pediatric TB disease.
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Affiliation(s)
- Kathirvel Maruthai
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saranya Sankar
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mahadevan Subramanian
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Mondoni M, Centanni S, Sotgiu G. New perspectives on difficult-to-treat tuberculosis based on old therapeutic approaches. Int J Infect Dis 2020; 92S:S91-S99. [PMID: 32114204 DOI: 10.1016/j.ijid.2020.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
Tuberculosis (TB) is an important clinical and public health issue worldwide. Despite improved treatment success rates following the introduction of antibiotics in daily clinical practice, the expected decline in incidence has been hampered by HIV epidemics and multi- and extensively drug-resistant TB. During the pre-antibiotic era, TB therapies were mainly based on improving hygiene conditions, strengthening the immune system, and targeting the rest of the affected lungs with invasive techniques. Detailed knowledge of old non-pharmacological therapies might support physicians and researchers in the identification of new solutions for difficult-to-treat patients. We performed a narrative literature review on the main old therapeutic options prescribed for patients with TB. The main recommendations and contraindications of sanatorium therapies (i.e., bed rest, fresh air, sunlight) and pulmonary collapse techniques are reviewed, evaluating their physiological basis and their impact on patient outcomes. We report studies describing new interventional pulmonary and surgical techniques and assess new perspectives based on old medical and surgical treatments, whose potential implementation could help complicated patients.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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10
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Balinda IG, Sugrue DD, Ivers LC. More Than Malnutrition: A Review of the Relationship Between Food Insecurity and Tuberculosis. Open Forum Infect Dis 2019; 6:ofz102. [PMID: 30949541 PMCID: PMC6441779 DOI: 10.1093/ofid/ofz102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Despite a significant reduction in tuberculosis (TB) mortality over the past decade, TB remains a leading cause of death worldwide. Food insecurity-through pathways such as malnutrition, mental health impact, and high-risk health behaviors-affects the risk of TB disease, treatment failure, and mortality. We searched the literature for studies reporting on the links between food insecurity and TB. In contrast to the well-documented interactions between food insecurity and HIV/AIDS, we found that the association between food insecurity and TB remains largely understudied-this is especially true with regard to non-nutritional correlations. Mental health and behavioral linkages between TB and food insecurity deserve further attention. An improved understanding of the pathways through which food insecurity impacts TB is crucial to inform evidence-based integration of interventions such as psychological counseling, psychiatric care, harm reduction programs, and efforts to address social determinants of disease within current TB programs.
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Affiliation(s)
- Ingabire G Balinda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Louise C Ivers
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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11
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Drivers of Seasonal Variation in Tuberculosis Incidence: Insights from a Systematic Review and Mathematical Model. Epidemiology 2019; 29:857-866. [PMID: 29870427 DOI: 10.1097/ede.0000000000000877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seasonality in tuberculosis incidence has been widely observed across countries and populations; however, its drivers are poorly understood. We conducted a systematic review of studies reporting seasonal patterns in tuberculosis to identify demographic and ecologic factors associated with timing and magnitude of seasonal variation. METHODS We identified studies reporting seasonal variation in tuberculosis incidence through PubMed and EMBASE and extracted incidence data and population metadata. We described key factors relating to seasonality and, when data permitted, quantified seasonal variation and its association with metadata. We developed a dynamic tuberculosis natural history and transmission model incorporating seasonal differences in disease progression and/or transmission rates to examine magnitude of variation required to produce observed seasonality in incidence. RESULTS Fifty-seven studies met inclusion criteria. In the majority of studies (n=49), tuberculosis incidence peaked in spring or summer and reached a trough in late fall or winter. A standardized seasonal amplitude was calculated for 34 of the studies, resulting in a mean of 17.1% (range: 2.7-85.5%) after weighting by sample size. Across multiple studies, stronger seasonality was associated with younger patients, extrapulmonary disease, and latitudes farther from the Equator. The mathematical model was generally able to reproduce observed levels of seasonal case variation; however, substantial variation in transmission or disease progression risk was required to replicate several extreme values. CONCLUSIONS We observed seasonal variation in tuberculosis, with consistent peaks occurring in spring, across countries with varying tuberculosis burden. Future research is needed to explore and quantify potential gains from strategically conducting mass screening interventions in the spring.
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12
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Vitamin D₃ Status and the Association with Human Cathelicidin Expression in Patients with Different Clinical Forms of Active Tuberculosis. Nutrients 2018; 10:nu10060721. [PMID: 29867045 PMCID: PMC6024873 DOI: 10.3390/nu10060721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
Low vitamin D (vitD₃) is one of the most common nutritional deficiencies in the world known to be associated with numerous medical conditions including infections such as tuberculosis (TB). In this study, vitD₃ status and its association with the antimicrobial peptide, human cathelicidin (LL-37), was investigated in Ethiopian patients with different clinical forms of TB. Patients with active TB (n = 77) and non-TB controls (n = 78) were enrolled in Ethiopia, while another group of non-TB controls (n = 62) was from Sweden. Active TB included pulmonary TB (n = 32), pleural TB (n = 20), and lymph node TB (n = 25). Concentrations of 25-hydroxyvitamin D₃ (25(OH)D₃) were assessed in plasma, while LL-37 mRNA was measured in peripheral blood and in samples obtained from the site of infection. Median 25(OH)D₃ plasma levels in active TB patients were similar to Ethiopian non-TB controls (38.5 versus 35.0 nmol/L) and vitD₃ deficiency (.
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13
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Abstract
Tuberculosis (TB) has troubled mankind for millennia, but current treatment strategies are long and complicated and the disease remains a major global health problem. The risk of Mycobacterium tuberculosis (Mtb) infection or progression of active TB disease is elevated in individuals with vitamin D deficiency. High-dose vitamin D was used to treat TB in the preantibiotic era, and in vitro experimental data show that vitamin D supports innate immune responses that restrict growth of Mtb. Several randomized controlled trials have tested whether adjunctive vitamin D supplementation enhances the clinical and microbiological response to standard antimicrobial chemotherapy for pulmonary TB. The effects have been modest at best, and attention is turning to the question of whether vitamin D supplementation might have a role in preventing acquisition or reactivation of latent Mtb infection. In this article, we describe the effects of vitamin D on host immune responses to Mtb in vitro and in vivo and review the results of clinical trials in the field. We also reflect on the findings of clinical trials of vitamin D supplementation for the prevention of acute respiratory tract infections, and discuss how these findings might influence the design of future trials to evaluate the role of vitamin D in the prevention and treatment of TB.
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Affiliation(s)
- S Brighenti
- Department of Medicine, Center for Infectious Medicine (CIM), Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - P Bergman
- Department of Laboratory Medicine (LABMED), Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A R Martineau
- Blizard Institute, Centre for Immunobiology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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14
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Tebruegge M, Curtis N, Clifford V, Fernandez-Turienzo C, Klein N, Fidler K, Mansour S, Elkington P, Morris-Jones S. Seasonal variation in the performance of QuantiFERON-TB Gold In-Tube assays used for the diagnosis of tuberculosis infection. Tuberculosis (Edinb) 2018; 110:26-29. [PMID: 29779769 DOI: 10.1016/j.tube.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 11/20/2022]
Abstract
This study aimed to determine whether there are seasonal changes in the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) assays, an interferon-gamma release assay widely used for the diagnosis of tuberculosis infection. Results of 31,932 QFT-GIT assays performed at a large independent, accredited diagnostic service provider in London, UK over a 4.5-year-period were analysed. The proportion of positive results was significantly lower in autumn (14.8%) than in spring (16.0%; p = 0.0366) and summer (17.5%; p < 0.0001), but similar to winter (15.2%; p = 0.4711). The proportion of indeterminate results was significantly higher in autumn (8.2%) than in spring (6.2%; p < 0.0001), summer (4.8%; p < 0.0001), and winter (6.2%; p < 0.0001). The highest proportions of indeterminate results were observed in October (8.4%) and November (8.8%), the lowest in June (4.5%). Our data show that significant seasonal variation occurs in the performance of QFT-GIT assays in a temperate climate setting. Potential underlying mechanisms, including host and environmental factors, are discussed.
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Affiliation(s)
- Marc Tebruegge
- Academic Unit of Clinical and Experimental Sciences Faculty of Medicine & Global Health Research Institute, University of Southampton, Tremona Road, Southampton, UK; UCL Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, Lambeth Palace Road, London, UK; Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Australia.
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Flemington Road, Parkville, Australia
| | - Vanessa Clifford
- Department of Paediatrics, The University of Melbourne, Flemington Road, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Flemington Road, Parkville, Australia
| | | | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guildford Street, London, UK; Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Katy Fidler
- Academic Department of Paediatrics, Brighton and Sussex Medical School, Biology Road, Brighton, UK
| | - Salah Mansour
- Academic Unit of Clinical and Experimental Sciences Faculty of Medicine & Global Health Research Institute, University of Southampton, Tremona Road, Southampton, UK
| | - Paul Elkington
- Academic Unit of Clinical and Experimental Sciences Faculty of Medicine & Global Health Research Institute, University of Southampton, Tremona Road, Southampton, UK; Department of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Stephen Morris-Jones
- Division of Infection and Immunity, University College London, Gower Street, London, UK; Department of Microbiology, University College London Hospitals NHS Trust, Euston Road, London, UK
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15
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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/17/2022] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with
Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John's College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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16
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Hayward S, Harding RM, McShane H, Tanner R. Factors influencing the higher incidence of tuberculosis among migrants and ethnic minorities in the UK. F1000Res 2018; 7:461. [PMID: 30210785 PMCID: PMC6107974 DOI: 10.12688/f1000research.14476.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 09/04/2023] Open
Abstract
Migrants and ethnic minorities in the UK have higher rates of tuberculosis (TB) compared with the general population. Historically, much of the disparity in incidence between UK-born and migrant populations has been attributed to differential pathogen exposure, due to migration from high-incidence regions and the transnational connections maintained with TB endemic countries of birth or ethnic origin. However, focusing solely on exposure fails to address the relatively high rates of progression to active disease observed in some populations of latently infected individuals. A range of factors that disproportionately affect migrants and ethnic minorities, including genetic susceptibility, vitamin D deficiency and co-morbidities such as diabetes mellitus and HIV, also increase vulnerability to infection with Mycobacterium tuberculosis (M.tb) or reactivation of latent infection. Furthermore, ethnic socio-economic disparities and the experience of migration itself may contribute to differences in TB incidence, as well as cultural and structural barriers to accessing healthcare. In this review, we discuss both biological and anthropological influences relating to risk of pathogen exposure, vulnerability to infection or development of active disease, and access to treatment for migrant and ethnic minorities in the UK.
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Affiliation(s)
- Sally Hayward
- St John’s College, University of Oxford, Oxford, OX1 3JP, UK
| | | | - Helen McShane
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
| | - Rachel Tanner
- The Jenner Institute, University of Oxford, Oxford, OX1 3PS, UK
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17
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Bastos HN, Osório NS, Gagneux S, Comas I, Saraiva M. The Troika Host-Pathogen-Extrinsic Factors in Tuberculosis: Modulating Inflammation and Clinical Outcomes. Front Immunol 2018; 8:1948. [PMID: 29375571 PMCID: PMC5767228 DOI: 10.3389/fimmu.2017.01948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/18/2017] [Indexed: 12/30/2022] Open
Abstract
The already enormous burden caused by tuberculosis (TB) will be further aggravated by the association of this disease with modern epidemics, as human immunodeficiency virus and diabetes. Furthermore, the increasingly aging population and the wider use of suppressive immune therapies hold the potential to enhance the incidence of TB. New preventive and therapeutic strategies based on recent advances on our understanding of TB are thus needed. In particular, understanding the intricate network of events modulating inflammation in TB will help to build more effective vaccines and host-directed therapies to stop TB. This review integrates the impact of host, pathogen, and extrinsic factors on inflammation and the almost scientifically unexplored complexity emerging from the interactions between these three factors. We highlight the exciting data showing a contribution of this troika for the clinical outcome of TB and the need of incorporating it when developing novel strategies to rewire the immune response in TB.
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Affiliation(s)
- Helder Novais Bastos
- Department of Pneumology, Centro Hospitalar do São João, Porto, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Nuno S Osório
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Sebastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Iñaki Comas
- Institute of Biomedicine of Valencia (IBV-CSIC), Valencia, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Margarida Saraiva
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Biologia Molecular e Celular (IBMC), University of Porto, Porto, Portugal
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18
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Tang L, Liu S, Bao YC, Gao RX, Han CF, Sun XC, Zhang WL, Feng SQ. Study on the relationship between vitamin D deficiency and susceptibility to spinal tuberculosis. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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19
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Wang Q, Liu Y, Ma Y, Han L, Dou M, Zou Y, Sun L, Tian H, Li T, Jiang G, Du B, Kou T, Song J, Kok FJ, Schouten EG. Severe hypovitaminosis D in active tuberculosis patients and its predictors. Clin Nutr 2017; 37:1034-1040. [PMID: 28514999 DOI: 10.1016/j.clnu.2017.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Tuberculosis (TB) patients have a significant vitamin D deficiency (VDD) endemic, which may be closely related to the onset and progress of the disease. The comorbidity of diabetes (DM) and TB has posed an increasing challenge in recent years. However, the influence of DM on TB and the possible mechanism are still uncertain. We carried out this study to identify the nutritional status of vitamin D (VD) in TB patients in a northern city in China (latitude 36° N) and investigate the possible predictors of severe vitamin D deficiency (SVDD). METHODS A cross-sectional study including 461 active TB patients (192 with and 269 without DM) were randomly selected from Qingdao Chest Hospital from June 2015 to August 2016. We measured serum 25 hydroxyvitamin D [25(OH)D], and investigated the association between sociodemographic, dietary intake, DM, body mass index (BMI), severity of initial TB signs and symptoms (TB score) and VD status. Multivariate logistic regression analysis was used to define the possible predictors of SVDD. RESULTS The median serum 25(OH)D concentration was 8.50 ng/mL. Of the 461 TB patients included, 383 (83.1%) had VDD [25(OH)D < 20 ng/mL], and 217 (47.1%) had SVDD [25(OH)D < 8 ng/mL]. The variables associated with serum 25(OH)D concentrations were DM, outdoor activity level, TB score and BMI (p < 0.05). Patients with severe TB score had nearly 5 fold higher risk of having SVDD compared with those in mild subgroup [OR (95% CI) = 4.919 (2.644-9.150), p < 0.001]. Low outdoor activity level also increased the odds of SVDD, while DM and high fish consumption showed protect effects. CONCLUSIONS Severe hypovitaminosis D is prevalent in active TB patients, and the main predictors of SVDD were severe TB score, low outdoor activity, inadequate fish consumption. Lowered serum 25(OH)D may be associated with increased risk of TB in DM.
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Affiliation(s)
- Qiuzhen Wang
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China.
| | - Yufeng Liu
- Qingdao Chest Hospital, Chongqing Middle Road, Qingdao, China
| | - Yan Ma
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Lei Han
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mei Dou
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Yue Zou
- Qingdao Chest Hospital, Chongqing Middle Road, Qingdao, China
| | - Limei Sun
- Qingdao Chest Hospital, Chongqing Middle Road, Qingdao, China
| | - Hong Tian
- Qingdao Chest Hospital, Chongqing Middle Road, Qingdao, China
| | - Tongxia Li
- Qingdao Chest Hospital, Chongqing Middle Road, Qingdao, China
| | - Guofeng Jiang
- Qingdao Chest Hospital, Chongqing Middle Road, Qingdao, China
| | - Baoli Du
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Tingyan Kou
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Jiaqi Song
- Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
| | - Frans J Kok
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Evert G Schouten
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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20
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Balcells ME, García P, Tiznado C, Villarroel L, Scioscia N, Carvajal C, Zegna-Ratá F, Hernández M, Meza P, González LF, Peña C, Naves R. Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts. PLoS One 2017; 12:e0175400. [PMID: 28403225 PMCID: PMC5389794 DOI: 10.1371/journal.pone.0175400] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/24/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Vitamin D (VD) enhances the immune response against Mycobacterium tuberculosis in vitro, and VD deficiency has been described in patients with active tuberculosis (TB). However, the role of hypovitaminosis D in the pathogenesis of early TB infection acquisition is unclear. We aimed to evaluate the association of VD deficiency, season of the year, and latent TB infection in household contacts (HHC), given that this is a potentially modifiable condition often related to nutritional deficiencies and lack of sun exposure. METHODS We prospectively enrolled new pulmonary TB cases (n = 107) and their HHC (n = 144) over a 2-year period in Santiago, Chile. We compared plasma 25-hydroxycholecalciferol (25OHD) levels and examined the influence of season, ethnic background, living conditions, and country of origin. RESULTS Over 77% of TB cases and 62.6% of HHC had VD deficiency (<20 ng/ml). Median 25OHD concentration was significantly lower in TB cases than in HHC (11.7 vs. 18.2 ng/ml, p<0.0001). Migrants HHC had lower 25OHD levels than non-migrants (14.6 vs. 19.0 ng/ml, p = 0.026), and a trend towards a higher burden of latent TB infection (52.9% vs. 35.2%, p = 0.066). Multivariate analysis found VD deficiency in HHC was strongly associated with being sampled in winter/spring (adOR 25.68, 95%CI 7.35-89.7), corresponding to the seasons with lowest solar radiation exposure. Spring enrollment-compared with other seasons-was the chief risk factor for latent TB infection in HHC (adOR 3.14, 95%CI 1.28-7.69). CONCLUSIONS Hypovitaminosis D was highly prevalent in TB cases and also in HHC. A marked seasonality was found for both VD levels and latent TB in HHC, with winter being the season with lowest VD levels and spring the season with the highest risk of latent TB infection.
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Affiliation(s)
- María Elvira Balcells
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricia García
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Tiznado
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Scioscia
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Carvajal
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francesca Zegna-Ratá
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariluz Hernández
- Programa de Microbiología y Micología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Paulina Meza
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis F. González
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Carlos Peña
- Servicio de Respiratorio, Hospital San Borja Arriarán, Santiago, Chile
| | - Rodrigo Naves
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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21
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Choi R, Jeong BH, Koh WJ, Lee SY. Recommendations for Optimizing Tuberculosis Treatment: Therapeutic Drug Monitoring, Pharmacogenetics, and Nutritional Status Considerations. Ann Lab Med 2017; 37:97-107. [PMID: 28028995 PMCID: PMC5204003 DOI: 10.3343/alm.2017.37.2.97] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/04/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
Abstract
Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host. These factors should be considered for effective tuberculosis control. Therefore, therapeutic drug monitoring (TDM), which is individualized drug dosing guided by serum drug concentrations during treatment, and pharmacogenetics-based personalized dosing guidelines of anti-tuberculosis drugs could reduce the incidence of adverse drug reactions and increase the likelihood of successful treatment outcomes. Moreover, assessment and management of comorbid conditions including nutritional status could improve anti-tuberculosis treatment response.
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Affiliation(s)
- Rihwa Choi
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Soo Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Clinical Pharmacology & Therapeutics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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22
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Boillat-Blanco N, Bovet P, Ramaiya KL, Mganga M, Minja LT, Saleh L, Imboden M, Schindler C, Gagneux S, Daubenberger C, Reither K, Probst-Hensch N. Association between tuberculosis, diabetes and 25 hydroxyvitamin D in Tanzania: a longitudinal case control study. BMC Infect Dis 2016; 16:626. [PMID: 27809789 PMCID: PMC5096317 DOI: 10.1186/s12879-016-1960-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022] Open
Abstract
Background Vitamin D level is inversely associated with tuberculosis (TB) and diabetes (DM). Vitamin D could be a mediator in the association between TB and DM. We examined the associations between vitamin D, TB and DM. Methods Consecutive adults with TB and sex- and age-matched volunteers were included in a case-control study in Dar es Salaam, Tanzania. Glycemia and total vitamin D (25(OH)D) were measured at enrolment and after TB treatment in cases. The association between low 25(OH)D (<75 nmol/l) and TB was evaluated by logistic regression adjusted for age, sex, body mass index, socioeconomic status, sunshine hours, HIV and an interaction between low 25(OH)D and hyperglycemia. Results The prevalence of low 25(OH)D was similar in TB patients and controls (25.8 % versus 31.0 %; p = 0.22). In the subgroup of patients with persistent hyperglycemia (i.e. likely true diabetic patients), the proportion of patients with low 25(OH)D tended to be greater in TB patients (50 % versus 29.7 %; p = 0.20). The effect modification by persistent hyperglycemia persisted in the multivariate analysis (pinteraction = 0.01). Conclusions Low 25(OH)D may increase TB risk in patients with underlying DM. Trials should examine if this association is causal and whether adjunct vitamin D therapy is beneficial in this population. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1960-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noémie Boillat-Blanco
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,Department of Sciences, University of Basel, Basel, Switzerland. .,Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Kaushik L Ramaiya
- Shree Hindu Mandal Hospital and Muhimbili University of Health Sciences, Dar es Salaam, United Republic of Tanzania
| | - Maliwasa Mganga
- Kinondoni Municipal Council, National Tuberculosis Program, Dar es Salaam, United Republic of Tanzania
| | - Lilian T Minja
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Lanja Saleh
- Institute of Clinical Chemistry, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Klaus Reither
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Sciences, University of Basel, Basel, Switzerland
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23
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Pilarski A, Penn N, Ratnakumar S, Barker RD, Milburn HJ. Variation in vitamin D deficiency among tuberculosis patients by ethnic group and geographical region of birth: evidence from a diverse south London population. Eur Respir J 2016; 48:1507-1510. [PMID: 27799393 DOI: 10.1183/13993003.00057-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 07/16/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Adam Pilarski
- King's College London School of Medicine, London, UK
| | - Nicole Penn
- King's College London School of Medicine, London, UK
| | | | - Richard D Barker
- Dept of Respiratory Medicine, King's College Hospital, London, UK
| | - Heather J Milburn
- King's College London School of Medicine, London, UK .,Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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24
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Ray AD, Personius KE, Williamson DL, Dungan CM, Dhillon SS, Hershberger PA. Vitamin D3 intake modulates diaphragm but not peripheral muscle force in young mice. J Appl Physiol (1985) 2016; 120:1124-31. [PMID: 26968027 DOI: 10.1152/japplphysiol.00643.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/09/2016] [Indexed: 12/16/2022] Open
Abstract
Recent data support an important role for vitamin D in respiratory health. We tested the hypothesis that dietary vitamin D3 (VD3) intake modulates diaphragm (DIA) strength. Four-week-old female A/J mice (n = 10/group) were randomized to receive diets containing 100 IU VD3/kg (low), 1,000 IU VD3/kg (reference), or 10,000 IU VD3/kg (pharmacologic). After 6 wk of dietary intervention, plasma 25-hydroxyvitamin D3 (25D3) levels, DIA and extensor digitorum longus (EDL) in vitro contractile properties, and fiber cross-sectional area (CSA) were measured. Myosin heavy chain (MHC) composition and Akt/Foxo3A growth signaling were studied in the DIA and tibialis anterior. Mice fed the low, reference, and pharmacologic diets had average 25D3 levels of 7, 21, and 59 ng/ml, respectively. Maximal DIA force, twitch force, and fiber CSA were reduced 26%, 28%, and 10% (P < 0.01), respectively, in mice receiving the low-VD3 diet compared with the reference and pharmacologic diets. EDL force parameters were unaltered by diet. Effects of VD3 intake on DIA force were not observed in mice that began dietary intervention at 12 wk of age. VD3 intake did not alter the MHC composition of the DIA, indicating that decreases in force and CSA in young mice were not due to a switch in fiber type. Paradoxically, low VD3 intake was associated with activation of anabolic signaling in muscle (hyperphosphorylation of Akt and Foxo3A and decreased expression of autophagy marker LC3). These studies identify a potential role of dietary VD3 in regulating DIA development and insulin sensitivity.
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Affiliation(s)
- Andrew D Ray
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York;
| | | | - David L Williamson
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Cory M Dungan
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Samjot S Dhillon
- Department of Medicine, Thoracic Oncology, Roswell Park Cancer Institute, Buffalo, New York; and
| | - Pamela A Hershberger
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Buffalo, New York
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