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Zhou Y, Wu Q, Wang F, Chen S, Zhang Y, Wang W, Huang C, Liu K, Chen B. Association of variant vitamin statuses and tuberculosis development: a systematic review and meta-analysis. Ann Med 2024; 56:2396566. [PMID: 39221709 PMCID: PMC11370680 DOI: 10.1080/07853890.2024.2396566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Several studies have suggested an association between vitamin deficiency and the development of tuberculosis; however, the precise impact remains unclear. This study aimed to elucidate the relationship between distinct vitamin statuses and the occurrence of tuberculosis. MATERIALS AND METHODS Retrieval was conducted using several databases without language restrictions to capture the eligible studies on tuberculosis and vitamin status. Pooled odds ratios (ORs), relative risks (RRs), and hazard ratios (HRs) were used with 95% confidence intervals (CIs) to clarify the relationship between the different vitamin statuses (A, B, D, and E) and the occurrence of tuberculosis. Subgroup analysis, sensitivity analysis, meta-regression analysis, and Galbraith plot were performed to determine sources of heterogeneity. Potential publication biases were detected using Begg's test, Egger's test, and the trim-and-fill test. RESULTS We identified 10,266 original records from our database searches, and 69 eligible studies were considered in this study. The random-effect model showed that people with tuberculosis may exhibit vitamin A deficiency (OR = 10.66, 95%CI: 2.61-43.63, p = .001), while limited cohort studies showed that vitamin A supplementation may reduce tuberculosis occurrence. Additionally, vitamin D deficiency was identified as a risk factor for tuberculosis development (RR = 1.69, 95%CI: 1.06-2.67, p = .026), and people with tuberculosis generally had lower vitamin D levels (OR = 2.19, 95%CI: 1.76-2.73, p < .001) compared to other groups. No publication bias was detected. CONCLUSIONS This meta-analysis indicated that people with tuberculosis exhibited low levels of vitamins A and D, while vitamin D deficiency was identified as a risk factor for tuberculosis. More randomized controlled interventions at the community levels should be recommended to determine the association between specific vitamin supplementation and tuberculosis onset.
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Affiliation(s)
- Yiqing Zhou
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Qian Wu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Fei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Songhua Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yu Zhang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Chenxi Huang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- National Centre for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Zavala MJ, Becker GL, Blount RJ. Interrelationships between tuberculosis and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2023; 29:104-111. [PMID: 36647566 PMCID: PMC9877200 DOI: 10.1097/mcp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Our objective was to review the current literature regarding socioeconomic, environmental, clinical, and immunologic factors common to chronic obstructive pulmonary disease (COPD) and tuberculosis (TB). RECENT FINDINGS Recent studies suggest that TB patients might be at increased risk for developing COPD. Conversely, additional prospective cohort studies have determined that COPD patients are at increased risk for active TB: a risk that appears to be partially mediated through inhaled corticosteroid use. Tobacco smoking, poverty, air pollution, and malnutrition are associated with COPD and TB. Vitamin D has been shown to prevent COPD exacerbations, but its use for preventing TB infection remains unclear. Surfactant deficiency, elevated matrix metalloproteinases, and toll-like receptor 4 polymorphisms play key roles in the pathogenesis of both diseases. SUMMARY Recent studies have elucidated interrelationships between COPD and TB. Future research is needed to optimize clinical and public health approaches that could mitigate risk factors contributing to both diseases.
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Affiliation(s)
- Michael J Zavala
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Xu F, Ma B, Wang D, Lu J, Xiong K, Wang J. Associating the blood vitamin A, C, D and E status with tuberculosis: a systematic review and meta-analysis of observational studies. Food Funct 2022; 13:4825-4838. [PMID: 35403633 DOI: 10.1039/d1fo02827h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vitamins may play an important role in preventing tuberculosis. The purpose of this work is to associate the vitamin A, C, D and E status with tuberculosis through a systematic review and meta-analysis of observational studies. Web of Science, Pubmed and Scopus were searched from the earliest date of the database to May 2021. The standardized mean differences (SMDs) of blood vitamin concentrations and odds ratios (ORs) of vitamin deficiency between the tuberculosis patients and the control subjects were used as the main effect sizes. The effect sizes were pooled by a random-effects model using the Stata software (Version 11). The vitamin A concentration was significantly lower in the tuberculosis group than in the control group [SMD (95% CI): -0.96 (-1.31, -0.61), p < 0.01]. Only two case-control studies reported the vitamin C concentrations in the tuberculosis group versus the control group, and the difference was not significant. The blood vitamin D concentration was significantly lower in the tuberculosis group than in the control group [SMD (95% CI): -0.53 (-0.75, -0.32), p < 0.01]. Consistently, the number of people with vitamin D deficiency was significantly higher in the tuberculosis group [OR (95% CI): 2.29 (1.55, 3.37), p < 0.01]. The vitamin E concentration was significantly lower in the tuberculosis group than in the control group [SMD (95% CI): -0.34 (-0.61, -0.08), p = 0.01]. The current meta-analysis suggested a negative association between the vitamin A, D and E status and tuberculosis, and the association between the vitamin C status and tuberculosis was inconclusive due to the limited studies available.
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Affiliation(s)
- Fei Xu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
| | - Baolan Ma
- Health Management Center, The 971 Naval Hospital, Qingdao, Shandong, China
| | - Dandan Wang
- Nutritional Department, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jialin Lu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
| | - Ke Xiong
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
| | - Jinyu Wang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
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de Oliveira Rezende A, Sabóia RS, da Costa AC, da Silva Monteiro DMP, Zagmignan A, Santiago LÂM, Carvalho RC, Pereira PVS, Junqueira-Kipnis AP, de Sousa EM. Restricted Activation of the NF-κB Pathway in Individuals with Latent Tuberculosis Infection after HIF-1α Blockade. Biomedicines 2022; 10:biomedicines10040817. [PMID: 35453567 PMCID: PMC9024452 DOI: 10.3390/biomedicines10040817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Tuberculous granuloma formation is mediated by hypoxia-inducible factor 1 alpha (HIF-1α), and is essential for establishing latent tuberculosis infection (LTBI) and its progression to active tuberculosis (TB). Here, we investigated whether HIF-1α expression and adjacent mechanisms were associated with latent or active TB infection. Patients with active TB, individuals with LTBI, and healthy controls were recruited, and the expression of cytokine genes IL15, IL18, TNFA, IL6, HIF1A, and A20 in peripheral blood mononuclear cells (PBMCs) and serum vitamin D (25(OH)D3) levels were evaluated. Additionally, nuclear factor kappa B (NF-κB) and tumor necrosis factor-alpha (TNF-α) levels were analyzed in PBMC lysates and culture supernatants, respectively, after HIF-1α blockade with 2-methoxyestradiol. We observed that IL-15 expression was higher in individuals with LTBI than in patients with active TB, while IL-18 and TNF-α expression was similar between LTBI and TB groups. Additionally, serum 25(OH)D3 levels and expression of IL-6, HIF1A, and A20 were higher in patients with active TB than in individuals with LTBI. Moreover, PBMCs from individuals with LTBI showed decreased NF-κB phosphorylation and increased TNF-α production after HIF-1α blockade. Together, these results suggest that under hypoxic conditions, TNF-α production and NF-κB pathway downregulation are associated with the LTBI phenotype.
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Affiliation(s)
- Aline de Oliveira Rezende
- Graduate Program in Health Sciences, Federal University of Maranhão—UFMA, São Luís 65080-805, Brazil; (A.d.O.R.); (R.C.C.); (P.V.S.P.)
| | - Rafaella Santos Sabóia
- Graduate Program in Microbial Biology, CEUMA University—UniCEUMA, São Luís 65075-120, Brazil;
| | | | | | - Adrielle Zagmignan
- Graduate Program in Health and Services Management, CEUMA University—UniCEUMA, São Luís 65075-120, Brazil; (D.M.P.d.S.M.); (A.Z.)
| | - Luis Ângelo Macedo Santiago
- Graduate Program in Biodiversity and Biotechnology, Amazônia-BIONORTE, Federal University of Maranhão—UFMA, São Luís 65080-805, Brazil;
| | - Rafael Cardoso Carvalho
- Graduate Program in Health Sciences, Federal University of Maranhão—UFMA, São Luís 65080-805, Brazil; (A.d.O.R.); (R.C.C.); (P.V.S.P.)
| | - Paulo Vitor Soeiro Pereira
- Graduate Program in Health Sciences, Federal University of Maranhão—UFMA, São Luís 65080-805, Brazil; (A.d.O.R.); (R.C.C.); (P.V.S.P.)
| | - Ana Paula Junqueira-Kipnis
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, Brazil;
| | - Eduardo Martins de Sousa
- Graduate Program in Health Sciences, Federal University of Maranhão—UFMA, São Luís 65080-805, Brazil; (A.d.O.R.); (R.C.C.); (P.V.S.P.)
- Graduate Program in Microbial Biology, CEUMA University—UniCEUMA, São Luís 65075-120, Brazil;
- Graduate Program in Biodiversity and Biotechnology, Amazônia-BIONORTE, Federal University of Maranhão—UFMA, São Luís 65080-805, Brazil;
- Correspondence:
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Stockdale L, Sambou B, Sissoko M, Egere U, Sillah AK, Kampmann B, Basu Roy R. Vitamin D in Gambian children with discordant tuberculosis (TB) infection status despite matched TB exposure: a case control study. Eur J Pediatr 2022; 181:1263-1267. [PMID: 34643785 PMCID: PMC8897383 DOI: 10.1007/s00431-021-04272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Using a matched case control design conducted at MRC Gambia in 2015, we measured vitamin D levels in pairs of asymptomatic children with discordant tuberculin skin test status despite the same sleeping proximity to the same adult TB index case. Median ages of groups (infected; 10.0 years, uninfected 8.8 years) were not significantly different (p = 0.13). Mean vitamin D levels were 2.05 ng/mL (95% CI - 0.288 to 4.38) higher in 24 highly TB-exposed uninfected children compared with 24 matched highly TB-exposed infected children (p = 0.08). The findings warrant further investigation in larger studies to understand the implications and significance. Conclusion: Vitamin D levels were higher in TB-uninfected children compared with TB-infected despite equal high exposure to a TB case.
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Affiliation(s)
- Lisa Stockdale
- Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Basil Sambou
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Muhamed Sissoko
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Uzochukwu Egere
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, UK
| | - Abdou K. Sillah
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Robin Basu Roy
- Vaccines and Immunity Theme, MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Serum Reference Intervals of Fat-soluble Vitamins D and E in Wild Florida Manatees (Trichechus manatus latirostris) and Possible Implications for the Health of Manatees in Managed Care. J Wildl Dis 2021; 57:903-905. [PMID: 34320639 DOI: 10.7589/20-00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/09/2021] [Indexed: 11/20/2022]
Abstract
Serum levels of alpha-tocopherol (vitamin E) and 25-hydroxyvitamin D (vitamin D) were measured in 25 wild Florida manatees (Trichechus manatus latirostris) from Crystal River National Wildlife Refuge, Citrus County, Florida. The samples were collected during the 2017 and 2018 winter health assessments. Reference intervals for alpha-tocopherol were 0.15-3.2 μg/L with mean value of 0.76 μg/ml and for 25-hydroxyvitamin D were 4.3-23 nmol/L with a mean of 13.88 nmol/L. Four, long-term captive manatees and nine manatees in rehabilitation were available for comparisons. Alpha-tocopherol levels were within the established range for free-ranging manatees. Mean 25-hydroxyvitamin D levels in long-term captive and manatees in rehabilitation fell well outside the reference interval for free-ranging manatees, being 6-7-fold higher. The absence of significant differences in alpha-tocopherol between wild and captive manatees may not have any significant direct clinical implications but may warrant an investigation into other antioxidant mechanisms in manatees. The elevated 25-hydroxyvitamin D levels seen in captivity were unexpected and, in a few individuals, may pose a health challenge. Calcium is known to be elevated in captive manatees as well; a close examination of a potential hypervitaminosis D and hypercalcemia may be warranted.
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Aibana O, Huang CC, Aboud S, Arnedo-Pena A, Becerra MC, Bellido-Blasco JB, Bhosale R, Calderon R, Chiang S, Contreras C, Davaasambuu G, Fawzi WW, Franke MF, Galea JT, Garcia-Ferrer D, Gil-Fortuño M, Gomila-Sard B, Gupta A, Gupte N, Hussain R, Iborra-Millet J, Iqbal NT, Juan-Cerdán JV, Kinikar A, Lecca L, Mave V, Meseguer-Ferrer N, Montepiedra G, Mugusi FM, Owolabi OA, Parsonnet J, Roach-Poblete F, Romeu-García MA, Spector SA, Sudfeld CR, Tenforde MW, Togun TO, Yataco R, Zhang Z, Murray MB. Vitamin D status and risk of incident tuberculosis disease: A nested case-control study, systematic review, and individual-participant data meta-analysis. PLoS Med 2019; 16:e1002907. [PMID: 31509529 PMCID: PMC6738590 DOI: 10.1371/journal.pmed.1002907] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk. METHODS AND FINDINGS We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. For each case, we randomly selected four controls from among contacts who did not develop TB disease, matching on gender and year of age. We also conducted a one-stage individual-participant data (IPD) meta-analysis searching PubMed and Embase to identify prospective studies of vitamin D and TB disease until June 8, 2019. We included studies that assessed vitamin D before TB diagnosis. In the primary analysis, we defined vitamin D deficiency as 25-(OH)D < 50 nmol/L, insufficiency as 50-75 nmol/L, and sufficiency as >75nmol/L. We estimated the association between baseline vitamin D status and incident TB using conditional logistic regression in the Lima cohort and generalized linear mixed models in the meta-analysis. We further defined severe vitamin D deficiency as 25-(OH)D < 25 nmol/L and performed stratified analyses by HIV status in the IPD meta-analysis. In the Lima cohort, we analyzed 180 cases and 709 matched controls. The adjusted odds ratio (aOR) for TB risk among participants with baseline vitamin D deficiency compared to sufficient vitamin D was 1.63 (95% CI 0.75-3.52; p = 0.22). We included seven published studies in the meta-analysis and analyzed 3,544 participants. In the pooled analysis, the aOR was 1.48 (95% CI 1.04-2.10; p = 0.03). The aOR for severe vitamin D deficiency was 2.05 (95% CI 0.87-4.87; p trend for decreasing 25-(OH)D levels from sufficient vitamin D to severe deficiency = 0.02). Among 1,576 HIV-positive patients, vitamin D deficiency conferred a 2-fold (aOR 2.18, 95% CI 1.22-3.90; p = 0.01) increased risk of TB, and the aOR for severe vitamin D deficiency compared to sufficient vitamin D was 4.28 (95% CI 0.85-21.45; p = 0.08). Our Lima cohort study is limited by the short duration of follow-up, and the IPD meta-analysis is limited by the number of possible confounding covariates available across all studies. CONCLUSION Our findings suggest vitamin D predicts TB disease risk in a dose-dependent manner and that the risk of TB disease is highest among HIV-positive individuals with severe vitamin D deficiency. Randomized control trials are needed to evaluate the possible role of vitamin D supplementation on reducing TB disease risk.
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Affiliation(s)
- Omowunmi Aibana
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, United States of America
| | - Chuan-Chin Huang
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam, Tanzania
| | | | - Mercedes C. Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Ramesh Bhosale
- Department of Obstetrics & Gynecology, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Silvia Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | | | - Ganmaa Davaasambuu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jerome T. Galea
- School of Social Work, University of South Florida, Tampa, Florida, United States of America
| | | | | | | | - Amita Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University CRS, Pune, India
| | - Rabia Hussain
- Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
| | | | - Najeeha T. Iqbal
- Department of Pediatrics and Child Health and Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Aarti Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Leonid Lecca
- Partners in Health—Socios En Salud Sucursal, Lima, Peru
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University CRS, Pune, India
| | | | - Grace Montepiedra
- Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ferdinand M. Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Upanga West, Dar es Salaam, Tanzania
| | - Olumuyiwa A. Owolabi
- Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Julie Parsonnet
- Departments of Medicine and of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | | | | | - Stephen A. Spector
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, La Jolla, California, United States of America
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mark W. Tenforde
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Toyin O. Togun
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Rosa Yataco
- Partners in Health—Socios En Salud Sucursal, Lima, Peru
| | - Zibiao Zhang
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Sinha S, Gupta K, Mandal D, Das BK, Pandey RM. Serum and Bronchoalveolar Lavage Fluid 25(OH)Vitamin D3 Levels in HIV-1 and Tuberculosis: A Cross-Sectional Study from a Tertiary Care Center in North India. Curr HIV Res 2019; 16:167-173. [PMID: 29807518 DOI: 10.2174/1570162x16666180528112924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/03/2018] [Accepted: 05/24/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Vitamin D is an immunomodulator, and its deficiency is associated with Tuberculosis (TB) infection. Bronchoalveolar lavage fluid (BALF) is a rich milieu of macrophages that form the first line of defense against invading TB bacilli. As there is an increased prevalence of vitamin D deficiency in TB and human immunodeficiency virus-1 (HIV-1) subjects, we intend exploring the possibility of a localized deficiency of vitamin D metabolites in BALF of these patients. OBJECTIVE The primary objective was to assess the level of 25D3 in serum and BALF of subjects and look for a significant difference among patients and controls. The secondary objective was to find a correlation between serum and BALF 25D3 levels. METHODS We performed a cross-sectional study with subjects divided into four groups: Controls (group 1), HIV positive without active TB (group 2), active TB without HIV (group 3), and HIV-TB coinfection (group 4). BALF and serum 25D3 levels were compared between the groups. RESULTS Among the 149 (an immunomodulator) successive subjects enrolled, there were 40 subjects in group 1 (HIV-TB-), 48 in group 2 (HIV+TB-), 37 in group 3 (HIV-TB+), and 24 in group 4 (HIV+TB+). Females constituted 31.6% of the study subjects. In groups 3 and 4, there were significantly lower serum 25D3 levels compared to group 1 (p-value group 3: 0.002; group 4: 0.012). In groups 2, 3, and 4, there were significantly lower BALF 25D3 levels compared to group 1 (p-value group 2: 0.000; group 3: 0.000; group 4: 0.001). There was a significant correlation between serum and BALF 25D3 levels (Spearman's rank correlation coefficient 0.318, p-value = 0.0001). CONCLUSION Lower levels of serum and BALF 25D3 were observed in HIV, TB, and HIV-TB coinfected patients. Localized deficiency of vitamin D metabolites might be associated with increased vulnerability to TB infection.
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Affiliation(s)
- Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Dibyakanti Mandal
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - B K Das
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R M Pandey
- Department of Biostatistics, Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Vitamin D Deficiency among Patients with Tuberculosis: a Cross-Sectional Study in Iranian-Azari Population. TANAFFOS 2019; 18:11-17. [PMID: 31423135 PMCID: PMC6690331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vitamin D deficiency or insufficiency has been conducted with increased risk for tuberculosis (TB). Despite this association, discrepancies exist among different studies in different regions. The aim of this study was to evaluate the prevalence of vitamin D deficiency and its predictors in tuberculosis among the Iranian-Azari population. MATERIALS AND METHODS A total of 60 participants were enrolled in this study, 30 of which were newly diagnosed TB patients and 30 were healthy volunteers. At least two serum samples were collected, the first sample before the start of anti-TB treatment and the second sample 3 months after the effective treatment. RESULTS The prevalence of vitamin D deficiency (25 patients vs. 2 healthy individuals; P<0.001) and serum levels of the vitamin D (22.66±15.17 vs. 73.03±25.6 ng/mL; P<0.001) were significantly higher in patients with TB than healthy subjects. Likewise, the prevalence of vitamin D deficiency in the extrapulmonary TB group was higher than that of the pulmonary TB, but this difference was not statistically significant (P=0 .397). Moreover, there was no significant difference between mean levels of vitamin D in patients with tuberculosis before and after treatment (P = 0.787). Linear regression analysis showed there was no significant relationship between vitamin D levels after treatment and age, gender, body site of tuberculosis, and vitamin D levels before treatment, P≥0.68. CONCLUSION Vitamin D deficiency is higher in patients with tuberculosis than healthy individuals.
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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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Musarurwa C, Zijenah LS, Mhandire DZ, Bandason T, Mhandire K, Chipiti MM, Munjoma MW, Mujaji WB. Higher serum 25-hydroxyvitamin D concentrations are associated with active pulmonary tuberculosis in hospitalised HIV infected patients in a low income tropical setting: a cross sectional study. BMC Pulm Med 2018; 18:67. [PMID: 29739378 PMCID: PMC5941493 DOI: 10.1186/s12890-018-0640-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/02/2018] [Indexed: 11/29/2022] Open
Abstract
Background The inherent risk of developing tuberculosis (TB) in HIV- infected individuals is further enhanced by hypovitaminosis D. Interventions that offset HIV-associated immune deterioration potentially arrest disease progression and incidence of opportunistic infections including TB. Despite conflicting reports on association between vitamin D deficiency (VDD) and risk of TB, vitamin D (VD) supplementation remains a promising intervention. Methods We conducted a comparative cross-sectional study on 145 HIV+/pulmonary TB+ (PTB) and 139 HIV+/PTB− hospitalised patients to investigate association of vitamin D status and risk of PTB. Stratified random sampling was used to select archived serum specimens from participants enrolled in a randomised controlled trial (RCT) conducted to investigate the impact of using a point-of-care urine lipoarabinomannan strip test for TB diagnosis. PTB status was confirmed using sputum smear microscopy, culture or GeneXpert MTB/RIF. Serum 25-hydroxyvitamin D [25(OH) D] concentrations were assayed by competitive chemiluminescent immunoassay prior to commencement of anti-TB treatment. Effect of VD status on duration of hospital stay and patient outcomes on follow up at 8 weeks were also investigated. Median serum 25(OH) D concentrations were compared using Mann-Whitney test and covariates of serum VD status were assessed using logistic regression analysis. Results Overall VDD prevalence in the cohort was 40.9% (95% CI: 35.1–46.8). Median serum 25(OH)D concentrations were significantly higher in HIV+/PTB+ group (25.3 ng/ml, IQR:18.0–33.7) compared to the HIV+/PTB− group (20.4 ng/ml, IQR:14.6–26.9), p = 0.0003. Patients with serum 25(OH) D concentration ≥ 30 ng/ml were 1.9 times more likely to be PTB+ compared to those with serum 25(OH) D concentrations < 30 ng/ml (odds ratio (OR) 1.91; 95% CI 1.1–3.2). PTB-related death was associated with higher odds of having 25(OH) D levels≥30 ng/ml. Age, gender, CD4+ count, combination antiretroviral therapy (cART) status, efavirenz based cART regimen and length of hospital stay were not associated with vitamin D status. Conclusions The finding of an association between higher serum 25(OH) D concentrations and active PTB and TB-related mortality among hospitalised HIV-infected patients in the present study is at variance with the commonly reported association of hypovitaminosis and susceptibility to TB. Our findings though, are in concordance with a small pool of reports from other settings.
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Affiliation(s)
- Cuthbert Musarurwa
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe.
| | - Lynn Sodai Zijenah
- Department of Immunology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Doreen Zvipo Mhandire
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Kudakwashe Mhandire
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Maria Mary Chipiti
- Department of Immunology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Marshall Wesley Munjoma
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Witmore Bayayi Mujaji
- Department of Chemical Pathology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe
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Vitamin A and D Deficiencies Associated With Incident Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Multinational Case-Cohort Study. J Acquir Immune Defic Syndr 2017; 75:e71-e79. [PMID: 28169875 DOI: 10.1097/qai.0000000000001308] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Numerous micronutrients have immunomodulatory roles that may influence risk of tuberculosis (TB), but the association between baseline micronutrient deficiencies and incident TB after antiretroviral therapy (ART) initiation in HIV-infected individuals is not well characterized. METHODS We conducted a case-cohort study (n = 332) within a randomized trial comparing 3 ART regimens in 1571 HIV treatment-naive adults from 9 countries. A subcohort of 30 patients was randomly selected from each country (n = 270). Cases (n = 77; main cohort = 62, random subcohort = 15) included patients diagnosed with TB by 96 weeks post-ART initiation. We determined pretreatment concentrations of vitamin A, carotenoids, vitamin B6, vitamin B12, vitamin D, vitamin E, and selenium. We measured associations between pretreatment micronutrient deficiencies and incident TB using Breslow-weighted Cox regression models. RESULTS Median pretreatment CD4 T-cell count was 170 cells/mm; 47.3% were women; and 53.6% Black. In multivariable models after adjusting for age, sex, country, treatment arm, previous TB, baseline CD4 count, HIV viral load, body mass index, and C-reactive protein, pretreatment deficiency in vitamin A (adjusted hazard ratio, aHR 5.33, 95% confidence interval, CI: 1.54 to 18.43) and vitamin D (aHR 3.66, 95% CI: 1.16 to 11.51) were associated with TB post-ART. CONCLUSIONS In a diverse cohort of HIV-infected adults from predominantly low- and middle-income countries, deficiencies in vitamin A and vitamin D at ART initiation were independently associated with increased risk of incident TB in the ensuing 96 weeks. Vitamin A and D may be important modifiable risk factors for TB in high-risk HIV-infected patients starting ART in resource-limited highly-TB-endemic settings.
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13
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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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Ralph AP, Rashid Ali MRS, William T, Piera K, Parameswaran U, Bird E, Wilkes CS, Lee WK, Yeo TW, Anstey NM. Vitamin D and activated vitamin D in tuberculosis in equatorial Malaysia: a prospective clinical study. BMC Infect Dis 2017; 17:312. [PMID: 28449659 PMCID: PMC5408363 DOI: 10.1186/s12879-017-2314-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/08/2017] [Indexed: 12/12/2022] Open
Abstract
Background Vitamin D deficiency (low plasma 25-hydroxyvitamin D [25D] concentration) is often reported in tuberculosis. Adjunctive vitamin D has been tested for its potential to improve treatment outcomes, but has proven largely ineffective. To better understand vitamin D in tuberculosis, we investigated determinants of 25D and its immunologically active form, 1,25-dihydroxyvitamin D (1,25D), their inter-relationship in tuberculosis, longitudinal changes and association with outcome. Methods In a prospective observational study of adults with smear-positive pulmonary tuberculosis in Sabah, Malaysia, we measured serial 25D, 1,25D, vitamin D-binding protein (VDBP), albumin, calcium, parathyroid hormone, chest x-ray, week 8 sputum smear/culture and end-of-treatment outcome. Healthy control subjects were enrolled for comparison. Results 1,25D was elevated in 172 adults with tuberculosis (mean 229.0 pmol/L, 95% confidence interval: 215.4 - 242.6) compared with 95 controls (153.9, 138.4-169.4, p < 0.001), directly proportional to radiological severity (p < 0.001), and fell rapidly within one week of treatment commencement. Tuberculosis patients with higher baseline 1,25D achieved significantly higher percentage weight gain over time, including when controlling for baseline weight, however persistently elevated 1,25D was associated with worse residual x-ray changes and lower end-of-treatment BMI. 1,25D was inversely associated with PTH (p < 0.001), consistent with the extra-renal origin of the 1,25D. 25D did not differ between tuberculosis patients (mean 63.9 nmol/L, 95% CI: 60.6 - 67.3) and controls (61.3, 57.2- 65.3, p = 0.24), and was unassociated with outcomes. Among tuberculosis patients in multivariable analyses, sex, age and VDBP were associated with 25D, and age and albumin with 1,25D. 1,25-dihydroxyvitamin was not significantly asscociated with 25D. Vitamin D deficiency <25 nmol/L was uncommon, occurring in only five TB patients; 1,25D was elevated in three of them. Conclusions In an equatorial setting, high extra-renal production of 1,25D was seen in tuberculosis, including in individuals with 25D in the deficient range; however, severe 25D deficiency was uncommon. Baseline elevation of 1,25D, a marker of macrophage activation, was associated with better weight gain but persistent elevation of 1,25D was associated with worse radiological and BMI outcomes. 1,25D warrants testing in larger datasets including TB patients less responsive to treatment, such as multi-drug resistant TB, to test its utility as a marker of tuberculosis severity and treatment response.
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Affiliation(s)
- Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia. .,Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia. .,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
| | | | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Jesselton Medical Centre, Kota Kinabalu, Sabah Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.,Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Kim Piera
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Uma Parameswaran
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Elspeth Bird
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Christopher S Wilkes
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Wai Khew Lee
- Luyang Outpatient Clinic, Kota Kinabalu, Sabah, Malaysia
| | - Tsin Wen Yeo
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.,Luyang Outpatient Clinic, Kota Kinabalu, Sabah, Malaysia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.,Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
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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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