Potential Role of Vitamins A, B, C, D and E in TB Treatment and Prevention: A Narrative Review

Hematochemical hallmarks as markers of pulmonary TB severity: A multicenter cross-sectional study

Background

Identifying accessible and reliable biomarkers for tuberculosis (TB) severity is crucial for improving patient management. This study evaluates hematological findings as potential indicators of TB severity in a large multicenter Italian cohort.

Methods

This retrospective, multicenter, cross-sectional study analyzed hematological parameters (hemoglobin, white blood cells, inflammatory indices, hepatorenal function, albuminuria) in 577 TB patients from 10 Italian centers (2018-2023). Severe TB was defined by at least two criteria: TIMIKA score > 60, sputum conversion time > 21 days, or need for oxygen supplementation. Statistical analyses included receiver operating characteristic curve (AUC) evaluation, calibration curves, and clinical utility.

Results

Of the patients, 30.3 % were classified as severe, 60.2 % as non-severe, and 9.5 % as uncertain. AUC values for predicting severe TB ranged from 0.51 to 0.56 across hematological variables. Anemia and elevated CRP demonstrated sensitivities of 0.71 and 0.74, respectively. Models using continuous or categorical hematological variables achieved AUCs of 0.61 and 0.65, showing poor calibration and limited clinical utility in the 30-60 % threshold range.

Conclusions

Hematological markers, while rapid and cost-effective, demonstrated limited discriminative ability for TB severity. Further studies are required to develop reliable predictive models, integrating additional clinical and molecular data.

Nutritional Factors and Food and Nutrition Insecurity in Patients with Tuberculosis

Background/Objectives: Brazil has a high incidence of new tuberculosis cases influenced by socioeconomic factors. Inadequate housing, limited access to health services, and insufficient food increase vulnerability to the disease. This study aimed to identify sociodemographic, nutritional, and anthropometric factors associated with active pulmonary tuberculosis. Methods: This case-control study was conducted at the tuberculosis (TB) Referral Hospital in São Luís, Maranhão, Brazil, from 2022 to 2024. It included 65 patients with active pulmonary TB and 73 comparison individuals. Sociodemographic and nutritional data were collected using an adapted semi-quantitative questionnaire with 77 items, based on the validated ELSA-BRASIL questionnaire for adults, to assess the consumption of calcium, phosphorus, iron, zinc, vitamin B3, vitamin B6, vitamin C, vitamin E, and vitamin D. The Brazilian Food Insecurity Scale (EBIA) was used to analyze food and nutrition security or insecurity. Body Mass Index (BMI) was calculated based on weight and height measurements. Results: The TB patients were predominantly men (73.8%), of mixed ancestry (69.4%), with low education levels (73.4%), and had a mean age of 39 years. Furthermore, 26.2% of the patients were underweight, and 64% experienced some degree of food and nutrition insecurity. The variables education level, vitamin D, and BMI were associated with the outcome in the final model. Conclusions: The study identified a high prevalence of food insecurity and vitamin E deficiency in individuals with active tuberculosis, in addition to associating low educational levels, inadequate vitamin D intake, and overweight with a higher risk of TB. Although it has limitations, such as the cross-sectional design and sample size, the results highlight the importance of these determinants and point to the need for longitudinal research to confirm and expand the evidence.

Hypercoagulability in Tuberculosis: Pathophysiological Mechanisms, Associated Risks, and Advances in Management-A Narrative Review

Tuberculosis (TB) induces a hypercoagulable state characterized by systemic inflammation, endothelial dysfunction, and alterations in the coagulation and fibrinolytic pathways. This review explores the pathophysiological mechanisms underlying hypercoagulability in TB, including increased pro-inflammatory cytokine release, endothelial damage, platelet activation, and reduced anticoagulant and fibrinolytic activity. These factors contribute to an elevated risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), which complicate TB prognosis and treatment. The potential role of adjunctive anti-inflammatory therapies, such as vitamin D, NSAIDs, corticosteroids, and anti-platelet agents, is highlighted as a strategy to mitigate systemic inflammation and reduce thrombotic risks in patients with TB. The challenges of anticoagulation therapy, particularly in managing the interactions between anti-TB medications and traditional anticoagulants, are discussed, along with the potential of novel oral anticoagulants (NOAs) as alternatives. We also address therapy of hypercoagulability in TB within resource-limited settings which requires low-cost diagnostics, accessible anticoagulation options, adjunctive therapies, and preventive strategies integrated into existing healthcare systems. Effective risk stratification and individualized management strategies are vital for reducing the morbidity and mortality associated with thrombotic complications in TB.

Role of Vitamin D Level in Tuberculosis Radiology and Laboratory Findings

BACKGROUND

Despite advances in treatment, tuberculosis (TB) remains a significant public health issue. Vitamin D is crucial for the host's immune response against Mycobacterium tuberculosis.

AIM

This study aimed to investigate the relationship between vitamin D levels and factors determining TB clinical course.

METHODS

We examined 91 patients with TB admitted to Yedikule Chest Diseases Hospital from 2021 to 2022. We investigated the association between vitamin D levels and the prevalence of radiological lesions, duration to sputum and culture conversion, resistance to isoniazid and rifampicin, and patients' age.

RESULTS

Results showed that 84.60% had low vitamin D levels (<20 ng/mL), particularly in those with radiologically progressive pulmonary TB (P = 0.002). As the age increased, vitamin D levels were observed to be lower (P = 0.002). However, no significant associations were found between vitamin D levels and resistance to isoniazid and rifampicin (P = 0.327 and Pp = 0.150, respectively), or between pulmonary and extrapulmonary TB (P = 0.607). No significant relationship was found between sputum and culture conversion time and vitamin D levels (P = 0.509 and P = 0.671, respectively). We identified no critical correlation between the duration of sputum and culture conversion and vitamin D levels (P = 0.509 and P = 0.671, respectively).

CONCLUSION

In the study, vitamin D levels were consistently low among our patients with TB, and this was particularly associated with widespread radiological lesions. Our study is a real-world investigation highlighting the vitamin D deficiency in TB and underscores the significance of vitamin D in treatment outcomes.

Vitamin C and Tuberculosis: Examining the Relationship Between Antioxidant Defense and Disease Severity-Preliminary Findings from a Southwestern Romanian Study

Background/Objectives: This study explored the relationship between serum vitamin C levels, antioxidant defense mechanisms, and the severity of pulmonary tuberculosis (TB) among Romanian patients. Methods: This study enrolled 53 patients with bacteriologically confirmed pulmonary tuberculosis at Victor Babes University Hospital in Craiova between January 2023 and August 2024. Participants were stratified into two groups based on their serum vitamin C levels: 26 patients with normal levels and 27 patients with low levels. Clinical, demographic, and biological parameters, including inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were assessed at baseline and after 60 days of TB treatment. Serum vitamin C levels were measured using ELISA. The persistence of Mycobacterium tuberculosis (MTB) was evaluated using sputum smear microscopy and culture at baseline and after 2 months of treatment. Results: The results showed that patients with low vitamin C levels had significantly higher baseline ESR (92.63 ± 27.69 mm/h) and CRP (43.89 ± 12.00 mg/L) levels compared to those with normal levels (ESR: 65.11 ± 13.27 mm/h, CRP: 31.19 ± 9.76 mg/L). After 60 days, 66.67% of patients with low vitamin C levels remained culture-positive compared to 26.92% in the normal vitamin C group (p = 0.004). Multivariate analysis indicated that vitamin C deficiency was significantly associated with a higher TB culture load. Conclusions: These findings suggest that vitamin C deficiency may contribute to the persistence of MTB and highlight the potential role of vitamin C supplementation as an adjunct to standard TB treatment, particularly in the context of global efforts to eradicate the disease by 2035.

Synergistic Power of Piceatannol and/or Vitamin D in Bleomycin-Induced Pulmonary Fibrosis In Vivo: A Preliminary Study

Oxidative stress and epigenetic alterations, including the overexpression of all class I and II histone deacetylases (HDACs), particularly HDAC2 and HDAC4, have been identified as key molecular mechanisms driving pulmonary fibrosis. Treatment with piceatannol (PIC) or vitamin D (Vit D) has previously exhibited mitigating impacts in pulmonary fibrosis models. The present study investigated the effects of PIC, Vit D, or a combination (PIC-Vit D) on the expression of HDAC2, HDAC4, and transforming growth factor-beta (TGF-β) in the lungs; the phosphatidylinositide-3-kinase (PI3K)/AKT signaling pathway; and the antioxidant status of the lungs. The objective was to determine if the treatments had protective mechanisms against pulmonary fibrosis caused by bleomycin (BLM) in rats. Adult male albino rats were given a single intratracheal dosage of BLM (10 mg/kg) to induce pulmonary fibrosis. PIC (15 mg/kg/day, oral (p.o.)), Vit D (0.5 μg/kg/day, intraperitoneal (i.p.)), or PIC-Vit D (15 mg/kg/day, p.o. plus 0.5 μg/kg/day, i.p.) were given the day following BLM instillation and maintained for 14 days. The results showed that PIC, Vit D, and PIC-Vit D significantly improved the histopathological sections; downregulated the expression of HDAC2, HDAC4, and TGF-β in the lungs; inhibited the PI3K/AKT signaling pathway; decreased extracellular matrix (ECM) deposition including collagen type I and alpha smooth muscle actin (α-SMA); and increased the antioxidant capacity of the lungs by increasing the levels of glutathione (GSH) that had been reduced and decreasing the levels of malondialdehyde (MDA) compared with the BLM group at a p-value less than 0.05. The concomitant administration of PIC and Vit D had a synergistic impact that was greater than the impact of monotherapy with either PIC or Vit D. PIC, Vit D, and PIC-Vit D exhibited a notable protective effect through their antioxidant effects, modulation of the expression of HDAC2, HDAC4, and TGF-β in the lungs, and suppression of the PI3K/AKT signaling pathway.

The dawn of repurposing vitamins as potential novel antimicrobial agents: A call for global emergency response amidst AMR crisis

Amidst, the global pandemic of antimicrobial resistance (AMR), the rate at which AMR increases overwhelms the increased efforts to discover new effective antimicrobials. There is a persistent need for alternative treatment modalities so as to keep up with the pace. AMR is the leading cause of death in the world and its health and economic consequences suggest the urgent need for sustainable interventions. Vitamins have consistently proven to have antimicrobial activity as well as slowing down the AMR rate by influencing the AMR genes even towards extensive multidrug resistant strains. Evidences suggest that the use of some vitamins on their own or in combination with existing antimicrobial agents could be a breakthrough towards combating AMR. This will widen the antimicrobial agents' options in the treatment arena, preserve the antimicrobial agents susceptible to develop resistant so that they can be used in severe infections only, reduce the tension and burden of the AMR crisis significantly and give enough room for development of new antimicrobial agents. Moreover, almost all viral, fungal, parasitic and bacterial resistant strains of concern as listed by World Health Organization have been found to be sensitive to several vitamins either synergistically with other antimicrobials or independently. Considering their widened spectrum of immunomodulatory and antimicrobial effect, some vitamins can further be repositioned as prophylactic antimicrobial agents in clinical situations like in presurgeries prophylaxis so as to avoid unnecessary use of antimicrobials especially antibiotics. Various relevant AMR stakeholders should invest in clinical trials and systematic reviews with available data to enable quick repositioning of some potential vitamins as antimicrobial agents as an emergency rapid response towards AMR Crisis. This includes the preparation of guidelines containing specificity of which vitamin to be used for treatment of which type of infection.

A pro-oxidant property of vitamin C to overcome the burden of latent Mycobacterium tuberculosis infection: A cross-talk review with Fenton reaction

Tuberculosis (TB), caused by the bacillus M. tuberculosis, is one of the deadliest infectious illnesses of our day, along with HIV and malaria.Chemotherapy, the cornerstone of TB control efforts, is jeopardized by the advent of M. tuberculosis strains resistant to many, if not all, of the existing medications.Isoniazid (INH), rifampicin (RIF), pyrazinamide, and ethambutol are used to treat drug-susceptible TB for two months, followed by four months of INH and RIF, but chemotherapy with potentially harmful side effects is sometimes needed to treat multidrug-resistant (MDR) TB for up to two years. Chemotherapy might be greatly shortened by drugs that kill M. tuberculosis more quickly while simultaneously limiting the emergence of drug resistance.Regardless of their intended target, bactericidal medicines commonly kill pathogenic bacteria (gram-negative and gram-positive) by producing hydroxyl radicals via the Fenton reaction.Researchers have concentrated on vitamins with bactericidal properties to address the rising cases globally and have discovered that these vitamins are effective when given along with first-line drugs. The presence of elevated iron content, reactive oxygen species (ROS) generation, and DNA damage all contributed to VC's sterilizing action on M. tb in vitro. Moreover, it has a pleiotropic effect on a variety of biological processes such as detoxification, protein folding - chaperons, cell wall processes, information pathways, regulatory, virulence, metabolism etc.In this review report, the authors extensively discussed the effects of VC on M. tb., such as the generation of free radicals and bactericidal mechanisms with existing treatments, and their further drug development based on ROS production.

The Role of Folic Acid in SARS-CoV-2 Infection: An Intriguing Linkage under Investigation

BACKGROUND

SARS-CoV-2 is a life-threatening RNA virus that may cause an acute respiratory syndrome associated with extremely high morbidity and mortality rates. Folic acid (FA), also known as folate, is an essential vitamin vital for human homeostasis, participating in many biochemical pathways, and its deficiency has been associated with viral infection vulnerability. In this review, we investigated the association between FA intake and SARS-CoV-2 infection, along with the existence of any potential impact of FA on the health outcome of patients suffering from this new viral infection.

METHODS

Studies included were patients' and in silico and molecular docking studies.

RESULTS

Data from in silico studies and molecular docking support that FA inhibits SARS-CoV-2 entry into the host and viral replication, binding at essential residues. Accordingly, in patients' studies, a protective role of FA supplementation against SARS-CoV-2 infection is indicated. However, contradictory data from observational studies indicate that FA supplementation, often linked to deficits during systemic inflammation due to SARS-CoV-2, increases the risk of post-infection mortality.

CONCLUSIONS

Future randomized controlled trial studies, including the FA pharmacological group, are needed to better understand the role of FA as a potential protective or mortality risk indicator in COVID-19 patients.

Malnutrition is Associated with an Increased Risk of Death in Hospitalized Patients with Active Pulmonary Tuberculosis: A Propensity Score Matched Retrospective Cohort Study

BACKGROUND

This study aimed to investigate whether nutrition levels in patients with active pulmonary tuberculosis (TB) affect their risk of all-cause mortality during hospitalization and to further evaluate the predictive ability of Geriatric Nutritional Risk Index (GNRI) and Body Mass Index (BMI) for risk of all-cause mortality.

METHODS

Patients from January 1, 2020 to December 31, 2021 were retrieved, and a total of 1847 were included. The primary outcome was all-cause mortality. Propensity score matching (PSM) was performed for risk adjustment, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive ability of GNRI and BMI for all-cause mortality.

RESULTS

Malnourished TB patients were older, had more congestive heart failure, and had more chronic obstructive pulmonary disease or asthma. Under the nutrition level grouping defined by GNRI, the all-cause mortality in the malnourished group did not appear to reach a statistical difference compared with the nonmalnourished group (P = 0.078). When grouped by level of nutrition as defined by BMI, the all-cause mortality was higher in the malnourished group (P = 0.009), and multivariate logistic regression analysis revealed that malnutrition was an independent risk factor for all-cause mortality. After propensity score matching, the results showed that the all-cause mortality was higher in the malnutrition group, regardless of BMI or GNRI defined nutrition level grouping, compared with the control group (both P < 0.001). The ROC curve analysis revealed that the area under the curve (AUC) was 0.811 ([95% confidence interval (CI) 0.701-0.922], P < 0.001) for GNRI and 0.728 ([95% CI 0.588-0.869], P = 0.001) for BMI.

CONCLUSION

In the clinical treatment of patients with active TB, more attention should be paid to the management of nutritional risk. GNRI may be a highly effective and easy method for predicting short-term outcomes in patients with active pulmonary TB.

Efficacy and safety of vitamin D in tuberculosis patients: a systematic review and meta-analysis

BACKGROUND

Evidence from the basic research and epidemiological studies indicates a beneficial effect of vitamin D in the treatment of tuberculosis (TB). However, the evidence from randomized controlled trials (RCTs) is inconsistent.

OBJECTIVES

This systematic review and meta-analysis was performed to synthesize evidence regarding role of vitamin D versus placebo for the management of TB.

MATERIALS AND METHODS

We searched PubMed and Cochrane Clinical Trial Registry for RCTs comparing vitamin D versus placebo for the treatment of TB. RCTs enrolling adult patients with TB receiving vitamin D in addition to standard treatment were included. Data were pooled using random effects model. The study was conducted according to PRISMA guidelines and protocol was registered with PROSPERO (CRD42016052841).

RESULTS

Of 605 identified references, 12 RCTs were included. The overall risk of bias in included studies was low or unclear. There was no significant difference between vitamin D and placebo group for any outcomes of efficacy (time to culture conversion, time to smear conversion, rate of culture conversion, and rate of smear conversion) or safety (mortality, serious adverse events, and nonserious adverse events).

CONCLUSION

Vitamin D administered with standard treatment has no beneficial effect in the TB patients as compared to the placebo.

Impact of Vitamin D in Prophylaxis and Treatment in Tuberculosis Patients

Vitamin D plays a crucial role in many infectious diseases, such as tuberculosis (TB), that remains one of the world’s top infectious killers with 1.5 million deaths from TB in 2021. Vitamin D suppresses the replication of Mycobacterium tuberculosis in vitro and showed a promising role in TB management as a result of its connection with oxidative balance. Our review encourages the possible in vivo benefit of a joint administration with other vitamins, such as vitamin A, which share a known antimycobacterial action with vitamin D. However, considering the low incidence of side effects even at high dosages and its low cost, it would be advisable to assess vitamin D level both in patients with active TB and high-risk groups and administer it, at least to reach sufficiency levels.

Angiotensin Converting Enzyme Inhibitors May Increase While Active Vitamin D May Decrease the Risk of Severe Pneumonia in SARS-CoV-2 Infected Patients with Chronic Kidney Disease on Maintenance Hemodialysis

The group most at risk of death due to COVID-19 are patients on maintenance hemodialysis (HD). The study aims to describe the clinical course of the early phase of SARS-CoV-2 infection and find predictors of the development of COVID-19 severe pneumonia in this population. This is a case series of HD nonvaccinated patients with COVID-19 stratified into mild pneumonia and severe pneumonia group according to the chest computed tomography (CT) pneumonia total severity score (TSS) on admission. Epidemiological, demographic, clinical, and laboratory data were obtained from hospital records. 85 HD patients with a mean age of 69.74 (13.19) years and dialysis vintage of 38 (14-84) months were included. On admission, 29.14% of patients had no symptoms, 70.59% reported fatigue followed by fever-44.71%, shortness of breath-40.0%, and cough-30.59%. 20% of the patients had finger oxygen saturation less than 90%. In 28.81% of patients, pulmonary parenchyma was involved in at least 25%. The factors associated with severe pneumonia include fever, low oxygen saturation and arterial partial pressure of oxygen, increased C-reactive protein and ferritin serum levels, low blood count of lymphocytes as well as chronic treatment with angiotensin converting enzyme inhibitors; while the chronic active vitamin D treatment was associated with mild pneumonia. In conclusion, even though nearly one-third of the patients were completely asymptomatic, while the remaining usually reported only single symptoms, a large percentage of them had extensive inflammatory changes at diagnosis with SARS-CoV-2 infection. We identified potential predictors of severe pneumonia, which might help individualize pharmacological treatment and improve clinical outcomes.