Abstract
BackgroundThe aim of this study is to evaluate vitamin D levels in children with latent and active TB compared to healthy controls of the same age and ethnical background.MethodsA multicenter observational study has been conducted in three tertiary care paediatric centres: Anna Meyer Children's University Hospital, Florence, Italy; Evelina London Children's Hospital, London, United Kingdom and Great Ormond Street Hospital, London, United Kingdom. Vitamin D was considered deficient if the serum level was <25 nmol/L, insufficient between 25 and 50 nmol/L and sufficient for a level >50 nmol/L.ResultsThe study population included 996 children screened for TB, which have been tested for vitamin D. Forty-four children (4.4%) had active TB, 138 (13.9%) latent TB and 814 (81.7%) were controls. Our study confirmed a high prevalence of hypovitaminosis D in the study population. A multivariate analysis confirmed an increased risk of hypovitaminosis D in children with latent and active TB compared to controls [(P = 0.018; RR = 1.61; 95% CI: 1.086-2.388), (P < 0.0001; RR = 4.587; 95% CI:1.190-9.608)].ConclusionsHypovitaminosis D was significantly associated with TB infection in our study. Further studies are needed to evaluate a possible role of vitamin D in the treatment and prevention of tuberculosis in children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0652-7) contains supplementary material, which is available to authorized users.
Highlights
The aim of this study is to evaluate vitamin D levels in children with latent and active TB compared to healthy controls of the same age and ethnical background
The statistical analysis with the Mann–Whitney U test showed that vitamin D level was significantly lower in case of latent and active TB compared to controls (p < 0.0001), with median level respectively of 45 nmol/L (IQR: 30– 62.5), 27.8 nmol/L (IQR: 19–50) and 52.5 nmol/L (IQR: 31.5-67.5)
The correlation between vitamin D deficiency and TB disease was previously demonstrated in adults [4,5,6,8,9,10,11,12,13,14], some authors do not agree with this hypothesis [34,35,36,37,38,39,40]
Summary
The aim of this study is to evaluate vitamin D levels in children with latent and active TB compared to healthy controls of the same age and ethnical background. A recent study conducted among adult TB contacts found that 94% of recruits were vitamin D insufficient and that a single, oral 2.5 mg dose of vitamin D significantly enhanced their anti-mycobacterial immunity in vitro [7]. Factors such as low socioeconomic status, poor nutrition, traditional/cultural traits, and little exposure to sunlight may contribute to vitamin D deficiency [15]. Vitamin D may enhance the production of LL-37, an antimicrobial peptide of the cathelicidin family [16,17,18,19] Antimicrobial peptides, such as defensin and cathelicidin, are involved as a first line of defences in the prevention of infections, including tuberculosis. The presence of vitamin D in neutrophils and macrophages up-regulates in a dose-dependent manner the hCAP-18 gene that codes for LL-37, which suggests that vitamin D induction of LL-37 may play a role in host defences against TB infection [3,16]
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