Vitamin D Deficiency Prevalence And Its Association with Bacterial Load Sputum in Newly Diagnosed TB Patients

Melviana Lubis, Bintang Yinke Magdalena Sinaga, Nita Andriani Lubis

Abstract


Vitamin D plays a role in innate and adaptive immune functions, and its deficiency has become a risk factor for TB infection. This study aimed to describe the prevalence of vitamin D deficiency in newly diagnosed TB patients and to examine the relationship between vitamin D levels and sputum smear positivity that reflects bacterial load. This is a cross-sectional study conducted at several primary health care facilities in Medan and Deli Serdang from November 2015 to June 2016. As many as 86 subjects adult TB patients with positive smear sputum who had not received therapy or had at most 1 week on therapy were recruited. Sputum examination were interpreted using IUATLD (International Union Against Tuberculosis and Lung Disease) grading 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 level and positivity level of AFB sputum was analyzed using Spearman correlation test. The prevalence of VDD in new pulmonary TB patients with positive smear sputum was 17.4%.  There was a weak relationship between vitamin D level and positivity level of  AFB sputum (p = 0.014), with a correlation coefficient of (-0.264). Many of newly diagnosed TB patients had vitamin D deficiency despite the fact that Indonesia is an equatorial area with sufficient sunshine throughout the year. This study shows vitamin D indeed affect bacterial load and a low 25 (OH) vitamin D level is associated with higher bacterial load.

 

Prevalensi Defisiensi Vitamin D pada Pasien TB Paru Baru dan Hubungan dengan Derajat Kepositifan Sputum Basil Tahan Asam

Vitamin D berperan dalam imunitas bawaan dan adaptif. Kekurangan vitamin D merupakan faktor risiko terinfeksi TB. Penelitian ini bertujuan menggambarkan prevalensi defisiensi vitamin D pada pasien TB baru dan mengetahui hubungan kadar vitamin D dengan derajat kepositifan sputum yang mencerminkan kepadatan bakteri. Penelitian potong lintang ini dilakukan di beberapa Puskesmas di wilayah Medan dan Deli Serdang pada November 2015 hingga Juni 2016. Subjek penelitian sebanyak 86 pasien TB dewasa dengan sputum basil tahan asam (BTA) positif, yang belum atau maksimal 1 minggu mengkonsumsi obat. Pemeriksaan sputum dinilai menggunakan skala IUATLD. Kadar vitamin D serum 25 (OH) dinilai dengan metode ELISA dan diklasifikasikan menjadi defisiensi (<20 ng/mL), insuffisiensi (20–29 ng/mL), optimum (30–100 ng/mL). Hubungan kadar vitamin D dengan tingkat kepositifan sputum BTA dilakukan dengan uji korelasi Spearman. Prevalensi VDD pada pasien TB paru baru dengan sputum positif adalah 17,4%. Terdapat  hubungan antara kadar vitamin D dan tingkat kepositifan sputum BTA (p=0,014), dengan koefisien korelasi (-0,264). Banyak pasien TB paru baru yang mengalami kekurangan vitamin D, meskipun Indonesia berada di khatulistiwa dengan kecukupan sinar matahari sepanjang tahun. Penelitian ini menunjukkan bahwa vitamin D berhubungan dengan kepositifan sputum dan kadar vitamin D yang rendah berhubungan dengan kepadatan bakteri yang lebih tinggi.


Keywords


bacterial load, pulmonary tuberculosis, vitamin D deficiency

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References


World Health Organization. Global tuberculosis report 2018 [Internet]. Geneva: World Health Organization; 2018. [ cited 2018 March 15]. Available from: https://www.who.int/tb/publications/global_report/en/

Zhai W, Wu F, Zhang Y, Fu Y, Liu Z. The immune escape mechanisms of Mycobacterium Tuberculosis. Int J Mol Sci. 2019;20(2).

Kamen DL, Vin T. Vitamin D and molecular actions on the immune system modulation of innate and autoimmunity. J Mol Med. 2010;88(5):441–50.

Gombart AF. The vitamin D-antimicrobial peptide pathway and its role in protection against infection. Future Microbiol. 2009;4:1151–65.

Yamshchikov A, Kurbatova E. Vitamin D status and antimicrobial peptide cathelicidin (LL-37) concentrations in patients with active pulmonary tuberculosis. Am J Clin Nutr, 2010;92(3):603–11.

Holick MF, 2009. Vitamin D status: measurement, interpretation and clinical application. Ann Epidemiol. 2009;19(2):73-8.

Green TJ, Skeaffl CM, Rockell JEP, Venn BJ, Lambert A, Todd J, et al. Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr. 2008;62(3):373-8.

Heaney RP, Weaver CM. Overview of vitamin D. In: Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary reference intakes calcium and vitamin D. 1st ed. Washington DC: The National Academies Press; 2003. p. 75–134.

Karampini E, Rao D, Abiona S, Asuquo B, Stokes T. The incidence of vitamin D deficiency in patients newly diagnosed with tuberculosis in a South London hospital. Chest. 2011;140(4):785A.

Karoli R, Fatima J, Gupta SS, Shukla V, Moidurrehman, Manhar M. Vitamin D Deficiency in Medical Patients at a Teaching Hospital in North India. J Assoc Physicians India. 2015;63:35-9.

Tessema B, Moges F, Habte D, Hiruy N, Yismaw S, Melkieneh K, et al. Vitamin D deficiency among smear positive pulmonary tuberculosis patients and their tuberculosis negative household contacts in Northwest Ethiopia: a case–control study. Ann Clin Microbiol Antimicrob. 2017;16(1):1-8.

Nimitphong H, Holick MF. Vitamin D status and sun exposure in Southeast Asia. Dermatoendocrinol. 2013;5(1):34-7

Saragih JP, Sinaga B, Amir Z. Hubungan Kadar Vitamin D dalam Darah dengan Kejadian Tuberkulosis Paru. J Respir Indo. 2015;35(1):51-6

Yuvaraj B, Sridhar MG, Kumar SV, Kadhiravan T. Association of Serum Vitamin D Levels with Bacterial Load in Pulmonary Tuberculosis Patients. Tuberc Respir Dis. 2016;79(3):153-7.

Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol 2007;179:2060-3

Chun RF, Adams JS, Hewison M. Immunomodulation by vitamin D: Implications for TB. Expert Rev Clin Pharmacol 2011;4(5):583–91.

Panda, S., Tiwari, A., Luthra, K. et al. Association of Fok1 VDR polymorphism with Vitamin D and its associated molecules in pulmonary tuberculosis patients and their householdcontacts. Sci Rep. 2019;9(1):1–10. Available from: http://dx.doi.org/10.1038/s41598-019-51803-8




DOI: https://doi.org/10.15395/mkb.v52n1.1937

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