Relationship Between Serum Vitamin D Levels and Bacterial Load Sputum in Tuberculosis Patients in Simalungun, North Sumatra, Indonesia

Abstract

Abstract: Vitamin D is involved in innate and adaptive immune function and its deficiency is a risk factor for tuberculosis (TB) infection. The aim of this study was to describe the prevalence of vitamin D deficiency in newly diagnosed tuberculosis patients and to examine the relationship between vitamin D levels and sputum swab positivity, which reflects bacterial load. This is a cross-sectional study conducted from June 2022 to August 2022 at multiple primary health care facilities at Buntu Turunan Public Health Center and Perdagangan Regional General Hospital, Simalungun Regency. Up to 101 adult tuberculosis patients who were sputum smear-positive, untreated, on treatment, or had a treatment duration of 1 week or less to her were recruited. Sputum examination was scored using the International Union for Tuberculosis and Lung Disease (IUATLD) rating scale. Serum 25(OH) vitamin D level was estimated using enzyme-linked immunosorbent assay (ELISA) and interpreted as deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), or optimum (30-100 ng/mL). The association between vitamin D levels and positive levels of AFB sputum was analyzed using Spearman's correlation test. The prevalence of vitamin D deficiency in new pulmonary tuberculosis patients with positive sputum smear was 20.79%. There was a weak relationship between vitamin D levels and AFB sputum positive levels (p=0.017), with a correlation coefficient of (-0.278). Despite Indonesia being an equatorial region and having plenty of sunshine throughout the year, many of the newly diagnosed tuberculosis patients were vitamin D deficient. This study shows that vitamin D does influence bacterial load and that low levels of 25(OH)-vitamin D are associated with higher bacterial load.