Abstract
Abstract:Vitamin D regulates calcium homeostasis in the body and may play a major role in regulating immune responses to tuberculosis (TB). Pilot studies suggest that vitamin D supplementation may improve outcomes in pulmonary TB (PTB), but clinical evidence using vitamin D in TB treatment is limited. We present a case of vitamin D deficiency in a woman with refractory drug-susceptible PTB. Antituberculous therapy and the correction of vitamin D deficiency resulted in clinical and microbiologic improvement at month 13 of her treatment. The basis for vitamin D/TB interactions and a brief literature review are discussed. Data from controlled trials are needed to evaluate the efficacy of vitamin D as adjunctive TB therapy.
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References
References1. Global Tuberculosis Control: surveillance, planning, financing. WHO Report 2008, World Health Organization, Geneva, Available at: http://www.who.int/tb/publications/global_report/2008/summary/en/index.html. Accessed November 19, 2008.2. Tangpricha V. Vitamin D deficiency in the Southern United States. South Med J 2007;100:384–385.TangprichaVVitamin D deficiency in the Southern United States.South Med J2007100384-3853. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266–281.HolickMFVitamin D deficiency.N Engl J Med2007357266-2814. Clemens TL, Adams JS, Henderson SL, et al. Increased skin pigment reduces the capacity of skin to synthesize vitamin D3. Lancet 1982;1:74–76.ClemensTL]]AdamsJS]]HendersonSL&etal;Increased skin pigment reduces the capacity of skin to synthesize vitamin D3.Lancet1982174-765. Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006;311:1770–1773.LiuPT]]StengerS]]LiH&etal;Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response.Science20063111770-17736. Sita-Lumsden A, Lapthorn G, Swaminathan R, et al. Reactivation of tuberculosis and vitamin D deficiency: the contribution of diet and exposure to sunlight. Thorax 2007;62:1003–1007.Sita-LumsdenA]]LapthornG]]SwaminathanR&etal;Reactivation of tuberculosis and vitamin D deficiency: the contribution of diet and exposure to sunlight.Thorax2007621003-10077. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 2008;37:113–119.NnoahamKE]]ClarkeALow serum vitamin D levels and tuberculosis: a systematic review and meta-analysis.Int J Epidemiol200837113-1198. Grange JM, Davies PD, Brown RC, et al. A study of vitamin D levels in Indonesian patients with untreated pulmonary tuberculosis. Tubercle 1985;66:187–191.GrangeJM]]DaviesPD]]BrownRC&etal;A study of vitamin D levels in Indonesian patients with untreated pulmonary tuberculosis.Tubercle198566187-1919. Stead WW, Senner JW, Reddick WT, et al. Racial differences in susceptibility to infection by Mycobacterium tuberculosis. N Engl J Med 1990;322:422–427.SteadWW]]SennerJW]]ReddickWT&etal;Racial differences in susceptibility to infection by Mycobacterium tuberculosis.N Engl J Med1990322422-42710. Martineau AR, Wilkinson RJ, Wilkinson KA, et al. A single dose of vitamin D enhances immunity to mycobacteria. Am J Respir Crit Care Med 2007;176:208–213.MartineauAR]]WilkinsonRJ]]WilkinsonKA&etal;A single dose of vitamin D enhances immunity to mycobacteria.Am J Respir Crit Care Med2007176208-21311. Nursyam EW, Amin Z, Rumende CM. The effect of vitamin D as supplementary treatment in patients with moderately advanced pulmonary tuberculous lesion. Acta Med Indones 2006;38:3–5.NursyamEW]]AminZ]]RumendeCMThe effect of vitamin D as supplementary treatment in patients with moderately advanced pulmonary tuberculous lesion.Acta Med Indones2006383-512. Johnson MA, Kimlin MG. Vitamin D, aging, and the 2005 Dietary Guidelines for Americans. Nutr Rev 2006;64:410–421.JohnsonMA]]KimlinMGVitamin D, aging, and the 2005 Dietary Guidelines for Americans.Nutr Rev200664410-42113. Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008;93:677–681.HolickMF]]BiancuzzoRM]]ChenTC&etal;Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D.J Clin Endocrinol Metab200893677-68114. Adams JS, Kantorovich V, Wu C, et al. Resolution of vitamin D insufficiency in osteopenic patients results in rapid recovery of bone mineral density. J Clin Endocrinol Metab 1999;84:2729–2730.AdamsJS]]KantorovichV]]WuC&etal;Resolution of vitamin D insufficiency in osteopenic patients results in rapid recovery of bone mineral density.J Clin Endocrinol Metab1999842729-273015. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet 1998;351:805–806.MalabananA]]VeronikisIE]]HolickMFRedefining vitamin D insufficiency.Lancet1998351805-80616. Przybelski R, Agrawal S, Krueger D, et al. Rapid correction of low vitamin D status in nursing home residents. Osteoporos Int 2008;19:1621–1628.PrzybelskiR]]AgrawalS]]KruegerD&etal;Rapid correction of low vitamin D status in nursing home residents.Osteoporos Int2008191621-1628
