[Circulating immune complexes as a depot of conservation of mycoplasma cell components]

AIM

Study the possibility of prolonged conservation in macroorganism of antigens, mycoplasma cell DNA and live pathogen cells as part of CIC against the background of persisting antigen biostructures.

MATERIALS AND METHODS

Aggregate-hemagglutination, direct immunofluorescence reactions and PCR method were used to determine antigens and DNA. Circulating immune complexes from blood sera samples were isolated by M. Digeon et al., mycoplasma isolation from CIC was carried out in SP-4 medium, species identity of the isolated mini-colonies was confirmed by real-time PCR method.

RESULTS

In patients with urogenital and respiratory pathology the frequency of detection of Mycoplasma hominis, Ureaplasma urealyticum and Mycoplasma pneumoniae in free state was 63.3, 53.1 and 80.82% of cases, respectively. Specific CIC in patients with verified respiratory mycoplasmosis 1 month after the onset of the disease were registered in patients with severe course of the disease, bronchitis and diseases of upper respiratory tract--in 92.5, 74.7 and 25.7% of cases, respectively. In children, bronchial asthma patients the frequency of detection of antigens and DNA of M. pneumoniae cells in free state was 72.6 and 12.33%, as part of CIC--in 60.27 and 43.8% of cases, respectively. Antigens and DNA of M. hominis in blood of this group of patients were detected in 32.9 and 26.02%, as part of CIC--in 53.42 and 52.05% of cases, respectively. During repeated examination of 12 children after etiotropic therapy execution (generally in 1.5 - 6 months) in 75% of cases antigens of both M. pneumoniae and M. hominis were detected in free state and as part of CIC. DNA of cells of these mycoplasma species were detected in 20 and 33%, as part of CIC--in41.6 and 50% of cases, respectively. In 5 patients after 6 months (after 1 year in 1 case) mycoplasma antigens and DNA were identified in CIC or in blood sera. During cultivation of CIC components precipitated from 5 blood samples of patients of this group containing M. hominis DNA, culture of M. hominis mini-colonies were isolated in 4 cases.

CONCLUSION

The possibility of prolonged persistence of antigens, DNA and whole mycoplasma cells in both free state and as part of CIC in patients with respiratory and urogenital pathology was shown. CIC are thus a peculiar depot, a place of conservation of not only various mycoplasma cell components, but also live cells.

Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections

CLINICAL QUESTION

In patients with respiratory tract infection, is measurement of procalcitonin to guide antibiotic prescriptions associated with reduced antibiotic exposure without increases in all-cause mortality or treatment failure?

BOTTOM LINE

The measurement of procalcitonin to guide initiation and duration of antibiotic treatment in patients with respiratory tract infections of varying severity is associated with lower antibiotic exposure without increasing all-cause mortality or treatment failure.

Can serum procalcitonin levels help interpret indeterminate chest radiographs in patients hospitalized with acute respiratory illness?

BACKGROUND

Clinical diagnosis of pneumonia is difficult and chest radiographs often indeterminate, leading to incorrect diagnoses and antibiotic overuse.

OBJECTIVE

To determine if serum procalcitonin (ProCT) could assist in managing patients with respiratory illness and indeterminate radiographs.

DESIGN

Subjects were prospectively enrolled during 2 consecutive winters.

SETTING

A 520-bed hospital in Rochester, NY.

PATIENTS

Five hundred twenty-eight adults admitted with acute respiratory illness were enrolled.

MEASUREMENTS

Serum ProCT, admission diagnoses, and chest radiographic findings were used to derive receiver operating characteristics curves to assess predictive accuracy of ProCT for the presence of infiltrates.

RESULTS

Subjects with pneumonia had higher ProCT (median 0.27 ng/ml) than those with exacerbations of chronic obstructive pulmonary disease (0.08 ng/ml), acute bronchitis (0.09 ng/ml), or asthma (0.06 ng/ml). ProCT had moderate accuracy for the presence of infiltrates (area under curve [AUC] 0.72), when indeterminate radiographs were independently classified as infiltrates by a pulmonologist evaluating patients.

CONCLUSIONS

ProCT may be useful in diagnosing pneumonia when chest radiographs are indeterminate.

[Correction of immunity dysbalance in children with frequent recurrent respiratory infection]

Children with frequent recurrent acute respiratory infections represent an actual medical and social problem. Frequent respiratory infections provoke the host lower immunity, disturbance of the compensatory-adaptative mechanisms, impairment of the physical and neuropsychic development of the child, the social disadaptation, chronic pathologic processes in the respiratory organs. High efficacy of cycloferon in correction of the immune and interferon responses in the frequently ill children was noted.

[Pharmacological treatment of hemorheological disorders in children with acute respiratory viral infection]

This article presents the results of monitoring in a group of children with severe forms of acute respiratory viral infection and toxic encephalopathy. Hemorheological disorder in the form of hyperviscosity syndrome has been detected in all patients with severe forms of acute respiratory viral infection. It was suggested the inclusion of cytoflavin in the complex therapy for correcting the hemorheological status. The administration of cytoflavin led to reduction of erythrocyte aggregation and general improvements in rheological indices of children with severe forms of acute respiratory viral infection and toxic encephalopathy.

A prospective analysis of disseminated intravascular coagulation in patients with infections

OBJECTIVE

Disseminated intravascular coagulation (DIC) is often associated with infection and a poor outcome. In this study, useful markers for predicting poor outcomes were examined.

METHODS

The frequency of DIC and organ failure, outcomes and hemostatic markers were prospectively evaluated in 242 patients with infections.

RESULTS

Seventy-seven patients were diagnosed with DIC, 36 of whom recovered from the condition. The rate of DIC or resolution of DIC was highest in the patients with sepsis and lowest in the patients with respiratory infections. Mortality tended to be high in the patients with respiratory infections. The DIC score, sepsis-related organ failure assessment (SOFA) score, prothrombin time (PT) ratio and thrombin-antithrombin complex level were significantly high in the patients who did not recover from DIC. The age, DIC score, SOFA score, PT ratio and levels of thrombomodulin and plasminogen activator inhibitor (PAI)-I were significantly high in the non-survivors. Factors related to a poor outcome included resolution of DIC, the SOFA score, age and the PT ratio. Factors related to resolution of DIC included the SOFA score and age, while factors related to the SOFA score included the levels of PAI-I, leukocytes, fibrinogen, D-dimer and platelets.

CONCLUSION

The outcomes of septic patients primarily depend on the SOFA score and the resolution of DIC, which are related to organ failure.

[The efficiency of reamberinum in infusion therapy of acetonemic syndrome in children]

The current paper presents the results of monitoring of 69 patients with acute respiratory viral infection, acetonemic syndrome. It was shown the effectiveness of inclusion of Reamberinum into complex therapy as a means for reduction of with acetonemic syndrome and for detoxic effect.

[Acute respiratory viral infection in children: clinical pattern, hemorheology disorders, methods of therapy]

Clinical and laboratory indices of intoxication and hemorheology disorders that arise during acute viral infection in children have been studied. It is established for the first time that reamberine is capable of reducing the plasma and blood viscosity and can be used in the program of infusion therapy of high blood viscosity syndrome in children with acute respiratory viral infections. One of the positive mechanisms of reamberin clinical performance is its positive impact on microcirculation and hemorheology. Thus, reamberin can be considered as a means of pathogenetic therapy in acute period of infectious toxicosis during acute respiratory viral infections in children.

Evaluation of peripheral blood mononuclear cell processing and analysis for Survival Motor Neuron protein

OBJECTIVES

Survival Motor Neuron (SMN) protein levels may become key pharmacodynamic (PD) markers in spinal muscular atrophy (SMA) clinical trials. SMN protein in peripheral blood mononuclear cells (PBMCs) can be quantified for trials using an enzyme-linked immunosorbent assay (ELISA). We developed protocols to collect, process, store and analyze these samples in a standardized manner for SMA clinical studies, and to understand the impact of age and intraindividual variability over time on PBMC SMN signal.

METHODS

Several variables affecting SMN protein signal were evaluated using an ELISA. Samples were from healthy adults, adult with respiratory infections, SMA patients, and adult SMA carriers.

RESULTS

Delaying PBMCs processing by 45 min, 2 hr or 24 hr after collection or isolation allows sensitive detection of SMN levels and high cell viability (>90%). SMN levels from PBMCs isolated by EDTA tubes/Lymphoprep gradient are stable with processing delays and have greater signal compared to CPT-collected samples. SMN signal in healthy individuals varies up to 8x when collected at intervals up to 1 month. SMN signals from individuals with respiratory infections show 3-5x changes, driven largely by the CD14 fraction. SMN signal in PBMC frozen lysates are relatively stable for up to 6 months. Cross-sectional analysis of PBMCs from SMA patients and carriers suggest SMN protein levels decline with age.

CONCLUSIONS

The sources of SMN signal variability in PBMCs need to be considered in the design and of SMA clinical trials, and interpreted in light of recent medical history. Improved normalization to DNA or PBMC subcellular fractions may mitigate signal variability and should be explored in SMA patients.

Vitamin D status in healthy Romanian caregivers and risk of respiratory infections

OBJECTIVES

To investigate the vitamin D status during winter of a healthy population of hospital employees and to assess the correlation between vitamin D status and risk of infections in the upper respiratory tract.

DESIGN

One hundred and ten healthy volunteers answered a questionnaire on their solar exposure habits and vitamin D intake and delivered one blood sample for quantification of vitamin D level (serum 25-hydroxyvitamin D (25(OH)D) concentration) during December 2007-January 2008. At the end of the winter we screened for the occurrence of respiratory infections and sought associations with vitamin D status.

SETTING

Bucharest, Romania, 45°N.

SUBJECTS

One hundred and ten healthy hospital employees.

RESULTS

Eighty per cent of participants were vitamin D deficient (25(OH)D level below 50 nmol/l). The main determinant of serum 25(OH)D was sun exposure during the summer previous to the study (P = 0·02 in multivariate analysis). Intake of vitamin D, BMI and age played no significant role for the level of 25(OH)D. Overall we found a non-significant negative correlation between 25(OH)D level and new cases of infection (Spearman correlation coefficient of -0·12, P = 0·2).

CONCLUSIONS

Vitamin D status is alarmingly poor in active, relatively young women residing in Romania. If our results are reproduced by other investigations, action to improve vitamin D status at the population level is necessary. We were not able to show a statistically significant relationship between vitamin D status and infection risk in our material.

Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections

BACKGROUND

Acute respiratory infections (ARIs) comprise a large and heterogeneous group of infections including bacterial, viral and other aetiologies. In recent years, procalcitonin - the prohormone of calcitonin - has emerged as a promising marker for the diagnosis of bacterial infections and for improving decisions about antibiotic therapy. Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with acute respiratory infections and different settings ranging from primary care to emergency departments (EDs), hospital wards and intensive care units (ICUs).

OBJECTIVES

The aim of this systematic review based on individual patient data was to assess the safety and efficacy of using procalcitonin for starting or stopping antibiotics over a large range of patients with varying severity of ARIs and from different clinical settings.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to May 2011) and EMBASE (1974 to May 2011) to identify suitable trials.

SELECTION CRITERIA

We included RCTs of adult participants with ARIs who received an antibiotic treatment either based on a procalcitonin algorithm or usual care/guidelines. Trials were excluded if they exclusively focused on paediatric patients or if they used procalcitonin for another purpose than to guide initiation and duration of antibiotic treatment.

DATA COLLECTION AND ANALYSIS

Two teams of review authors independently evaluated the methodology and extracted data from primary studies. The primary endpoints were all-cause mortality and treatment failure at 30 days. For the primary care setting, treatment failure was defined as death, hospitalisation, ARI-specific complications, recurrent or worsening infection, and patients reporting any symptoms of an ongoing respiratory infection at follow-up. For the ED setting, treatment failure was defined as death, ICU admission, re-hospitalisation after index hospital discharge, ARI-associated complications, and recurrent or worsening infection within 30 days of follow-up. For the ICU setting, treatment failure was defined as death within 30 days of follow-up. Secondary endpoints were antibiotic use (initiation of antibiotics, duration of antibiotics and total exposure to antibiotics (total amount of antibiotic days divided by total number of patients)), length of hospital stay for hospitalised patients, length of ICU stay for critically ill patients, and number of days with restricted activities within 14 days after randomisation for primary care patients.For the two co-primary endpoints of all-cause mortality and treatment failure, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable hierarchical logistic regression. The hierarchical regression model was adjusted for age and clinical diagnosis as fixed-effect. The different trials were added as random-effects into the model. We fitted corresponding linear regression models for antibiotic use. We conducted sensitivity analyses stratified by clinical setting and ARI diagnosis to assess the consistency of our results.

MAIN RESULTS

We included 14 trials with 4221 participants. There were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared to 134 deaths in 2126 control patients (6.3%) (adjusted OR 0.94, 95% CI 0.71 to 1.23). Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting, or ARI diagnosis. These results proved robust in various sensitivity analyses. Total antibiotic exposure was significantly reduced overall (median (interquartile range) from 8 (5 to 12) to 4 (0 to 8) days; adjusted difference in days, -3.47, 95% CI -3.78 to -3.17, and across all the different clinical settings and diagnoses.

AUTHORS' CONCLUSIONS

Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARI was not associated with higher mortality rates or treatment failure. Antibiotic consumption was significantly reduced across different clinical settings and ARI diagnoses. Further high-quality research is needed to confirm the safety of this approach for non-European countries and patients in intensive care. Moreover, future studies should also establish cost-effectiveness by considering country-specific costs of procalcitonin measurement and potential savings in consumption of antibiotics and other healthcare resources, as well as secondary cost savings due to lower risk of side effects and reduced antimicrobial resistance.

Issues and controversies with vitamin A in childhood

Vitamin A deficiency is common in the developing world. Vitamin A supplementation (VAS) has been used to prevent or treat vitamin A deficiency and to decrease mortality and morbidity in children. However, there are still controversial issues in relation to the role of universal VAS in different populations. Thus, studies that look at mortality outcomes reveal that VAS decreases mortality in children >6 months of age; however, there is still controversy on the extent to which reduction in morbidity from diarrhea and respiratory infection, other than measles, decreases mortality. Studies in infants 1-5 months old show no protective effect of VAS on mortality; whether this is secondary to environmental influences (breastfeeding), or interactions with DTP vaccine, needs to be further investigated. Studies with VAS in newborns have resulted in contrasting results in countries in Africa and Asia; trials are underway to better understand this. VAS does not have a universal protective effect on lower respiratory tract infection in children; some studies reveal an increase in respiratory morbidity associated with VAS, especially in well-nourished children; in contrast, VAS may confer some protection to malnourished children. The interaction of VAS with different vaccines is under current debate; some discussions are presented.

[Therapeutic effect of double fill nine tastes soup in treating recurrent respiratory infection (RRI) and change of immune function in children]

OBJECTIVE

To investigate the therapeutic effect of double fill nine tastes soup in treating children recurrent respiratory infection (RRTI) and the change of immune function.

METHOD

77 RRTI patients were randomly selected into observation and control groups. The observation group was treated with Chinese medicine- double fill nine tastes soup,water frying points 2 times oral. The control was treated with transfer factor oral liquid,every 10 mL,2 times daily oral. Treatment periods were both two months. IgA, IgG, IgM and IL-12, TNF-alpha, INF-gamma were detected before and after treatment to assess the clinical effects and the changes of immune factors, meanwhile, a health group was established.

RESULT

Before treatment, compared with the health group, the serum IgA, IgG, IgM, IgE, IL-12, TNF-alpha, IFN-gamma in both groups were significantly different (P < 0.01). After treatment, the ratio of IgA, IgG, Ig M, IL-12, TNF-alpha, IFN-gamma in two groups were significantly different (P < 0.01). Compared with the recurrence rate and clinical effects, the observation group was better than control, and the differences were significant (P < 0.01).

CONCLUSION

Double fill nine tastes soup has significant effects in treating recurrent respiratory infection (RRI) and enhance the immune function in children.

[Hormones as biomarkers for diagnosis and prognosis]

Procalcitonin is a biomarker for estimating the likelihood of a bacterial infection. Procalcitonin-guided antibiotic therapy can reduce antibiotic overuse in respiratory tract infections. The differential diagnosis of water-electrolyte imbalances is challenging. Copeptin is co-secreted with arginine vasopressin (AVP) and is a reliable surrogate of plasma AVP. Copeptin may become a useful diagnostic tool in patients with polydipsia-polyuria syndrome and hyponatremia. Copeptin is also known to mirror different levels of stress. It appears to have an interesting potential as a new prognostic biomarker in patients with ischemic stroke. Biomarkers should not be used without the clinical context. They are meant to complement clinical judgment based upon a synthesis of available clinical and laboratory features in each patients.

Asthma, allergy and respiratory infections: the vitamin D hypothesis

The recent discovery that every tissue in the human body has vitamin D receptors and that vitamin D has pleiotropic effects has prompted an increased interest in this hormone. Vitamin D deficiency is widespread and on the increase. There is no consensus on the serum vitamin D levels to consider appropriate for global health, the cutoffs for its deficiency, or the doses to use for its supplementation. Vitamin D seems to correlate closely with host reactions against various respiratory infections. Epidemiological studies have shown that low serum 25-hydroxyvitamin D levels are associated with a higher risk of upper and lower respiratory infections in children and a shortage of vitamin D may contribute to asthmatic patients' symptoms and morbidity rates. There are studies highlighting associations between childhood asthma, fetal lung and/or immune development, and maternal vitamin D intake. An insufficiency of this vitamin also seems to be implicated in the onset of childhood atopy and food allergies. The hypothesis is that vitamin D could have a central role in these pathological situations and that it may represent a novel preventive and/or therapeutic strategy. This article reviews and discusses published data on the relationship between vitamin D and asthma and allergy, emphasizing the need for controlled, prospective studies on vitamin D supplementation to clarify whether it has a role in the prevention of and treatment for asthma and allergic conditions.

The relationship between mucosal immunoresponse and clinical outcome in patients with recurrent upper respiratory tract infections treated with a mechanical bacterial lysate

This open prospective study aims to evaluate whether a therapy with a polyvalent mechanical bacterial lysate (PMBL) could be associated to the enhancement of the locoregional immunoresponse in patients with recurrent upper respiratory tract infections. Forty patients (23 females and 17 males) were enrolled, 33 of whom concluded the study. The duration of the study was six months and each patient was visited five times. Twenty-six patients had an objective improvement in clinical and medical locoregional conditions, while in seven patients the treatment did not result in an objective amelioration. Twenty-five out of 27 patients with clinical response were characterized by an increase of specific antibodies against PMBL antigens in salivary fluids. Only two patients, with a non-significant clinical result, had a slight increase in the concentration of salivary specific IgA. The association between PMBLspecific immunoglobulin titers and clinical results was significant for IgG and IgA, but not significant for IgM. Th1 switch was detected only in patients with clinical amelioration, while the Th0 phenotype was observed in three responder and four non-responder patients. Weak Th2 polarization was also observed in one clinical responsive patient. The capacity of effectively opsonizing living bacteria was detected in samples derived from responder patients. These results suggest that PMBL treatment was able to trigger an efficient and well-targeted immune-response resulting in positive clinical outcome of the patients treated.

[Determination of capillary plasma C-reactive protein during therapy for acute infectious lung diseases]

Changes in the concentration of C-reactive protein (CRP), leukocytes, erythrocyte sedimentation rate, and differential blood count were comparatively estimated in the treatment of 66 infants (aged 1.12 +/- 0.95 years) with acute infectious lung diseases. There was a high correlation between capillary plasma and venous serum CRP concentrations. On the first day of effective antibiotic therapy, there was a significant decrease in CRP levels; the sensitivity and specificity were 96 and 94%, respectively. Thus, measurement of capillary blood CRP is an accessible and informative tool to monitor therapy for infectious lung diseases in infants.

[The analyses of Mycoplasma pneumoniae antibody test results in patients with respiratory tract infection]

OBJECTIVE

To investigate the relationship between the infection rate of Mycoplasma pneumoniae (MP) and age, sex and season.

METHODS

Passive agglutination assay was used to detect Mycoplasma pneumoniae antibodies (MP-Ab) in the serum of patients with respiratory tract infection, and MP-Ab test results in 2010 were analyzed.

RESULTS

The positive rates of 5 year test results were 30.10%; among the results, the positive rates of male and female patients were respectively 30.74% and 36.12%, the difference was statistically significant (P < 0.05); And every age group were significantly different (P < 0.001), among each group, the positive rate of 3-14 years old patients was the highest; the season was no significant difference in incidence rates; the patients of positive titer > 1:640 accounted for 10.18% of the patients.

CONCLUSION

MP infection is increasing year by year, children aged 3 to 14 has become the high-risk groups. Women are more susceptible to MP than the men and the chances of infection are throughout the year, but the most of the patients have a good prognosis.

[Stratification of risk factors of progressing of acute respiratory infection in children]

The work purpose is the complex estimation of endogenous intoxication (change of optical density of plasma and erythrocytes), depressions of tissue hypoxia and functions of protective system, clinical and laboratory stratification of the risks-factors promoting progressing of disease and complication of pneumonia. There was carried cross-section study. The study included 36 patients from 1 to 7 years with an acute respiratory infection. The control group was made up of 19 healthy children. The comparative analysis of results of the specified factors and laboratory research set as the purpose to reveal the predictable negative risk factors. Evaluation of the quantitative findings of risks-factors was carried out in 95 % taking into account the confidence interval (CI). For the acute respiratory infection complicated with pneumonia, was determined strongly marked toxemia, and also high activity of antioxidant systems (SOD and catalase) and lysosomal enzymes (catepsin, RNA) was noted. The prognosis of the authentic risks-factors of acute respiratory disease was defined with following indicators: age of the child - before three years; hereditary background with a respiratory system pathology; the tobacco use in a family; low level of knowledge of parents; incomplete treatment; change of optical density of plasma and erythrocytes; fall (reduction) of redox-potential of the system of energy maintenance. We developed predictable model on probability of expected complications of respiratory system and groups of low, average and high risk were allocated.

[Higher cortisol levels in frequently ill children as a factor increasing susceptibility to acute respiratory infections]

The authors have defined some specific features of performance of the immune and lipid-transporting systems in their association with serum cortisol levels in frequently ill children when the signs of an infectious process are absent. The possible links of a pathological process, which give rise to enhanced susceptibility to acute respiratory infections in this patient group, are described.

[Specific antibodies in children with recurrent respiratory infections immunized with pneumo 23 and Act-HIB vaccines]

AIM

Assessment of specific IgG levels in children with recurrent respiratory infections after immunization with Pneumo 23 and Act-HIB vaccines.

MATERIALS AND METHODS

Concentrations of IgG to polysaccharide capsular antigens and cell wall antigens of Streptococcus pneumoniae and Haemophilus influenzae were measured by solid-phase ELISA in sera of 256 immunized children.

RESULTS

Increase of levels of IgG to cell wall antigens and certain polysaccharide antigens was observed in patients with low or intermediate antibody levels at baseline.

CONCLUSION

Obtained results allow to conclude that vaccination of children with recurrent respiratory and middle ear infections results in induction of IgG production that proves immunological effect of performed vaccination.

Vitamin D status and acute lower respiratory infection in early childhood in Sylhet, Bangladesh

AIM

Acute lower respiratory tract infection (ALRI) is the most important global cause of childhood death. Micronutrient deficiencies may increase the risk of ALRI. A case-control study was conducted to assess the association between vitamin D status and ALRI in rural Bangladesh.

METHODS

Children aged 1-18 months hospitalized with ALRI (cases) were individually matched to controls on age, sex, and village (N = 25 pairs). The mean serum 25-hydroxyvitamin D concentration [25(OH)D] in cases and controls was compared using paired t-test. The unadjusted and adjusted odds of ALRI were assessed by multivariate conditional logistic regression.

RESULTS

Mean [25(OH)D] was significantly lower among ALRI cases than controls (29.1 nmol/L vs. 39.1 nmol/L; p = 0.015). The unadjusted odds of ALRI was halved for each 10 nmol/L increase in [25(OH)D] (OR 0.53, 95% CI 0.30-0.96). Adjustment for confounders increased the magnitude of the association.

CONCLUSION

Vitamin D status was associated with early childhood ALRI in a matched case-control study in rural Bangladesh. Randomized trials may establish whether interventions to improve vitamin D status can reduce the burden of ALRI in early childhood.