PURPOSE: Vitamin D is known to have an important role in macrophage activation and the subsequent restriction in Mycobacterium tuberculosis (MTB) growth, and it has been implicated as a risk factor for tuberculosis (TB). Our aim was to establish the prevalence of vitamin D deficiency in patients newly diagnosed with TB in our hospital. We also aimed to determine potential associations between vitamin D deficiency and age, gender, ethnicity, length of stay in the United Kingdom (UK), HIV status and site of disease.
METHODS: A prospective study of all patients who were diagnosed with TB (October 2010 to May 2011) in Queen Elizabeth Hospital, Woolwich. Calcium, alkaline phosphatase (ALP), vitamin D and parathyroid hormone (PTH) levels were checked prior to commencing antituberculous treatment (ATT).
RESULTS: 65 TB notifications were made within the specified time period (male: 52%, female: 48%, median age: 29 years). 62 patients (95.4%) were vitamin D deficient at the time of diagnosis, with a vitamin D level less than 10µg/L. 46 patients (71%) were severely deficient in vitamin D (level < 4µg/L). 38 patients (58.5%) were born in the Indian subcontinent (including India, Pakistan, Bangladesh, Nepal and Sri-Lanka), 18 (27.6%) were black-African, 4 (6.2%) were Vietnamese, 4 (6.2%) were white, born in the UK and 1 (1.5%) was white, born outside the UK. The median duration of stay in the UK (for non-UK born patients) was 3 years (range: 1 to 49 years). All patients were HIV negative at the time of TB diagnosis. Levels of vitamin D were similar between men and women and there was no significant difference in vitamin D levels between patients with pulmonary and those with extra-pulmonary TB.
CONCLUSIONS: The huge majority of our patients with a new diagnosis of TB were found to be deficient in vitamin D. Further studies are needed in order to elucidate the complicated relationship of vitamin D deficiency and TB, as well as to assess the effect of vitamin D replacement in TB outcomes.
CLINICAL IMPLICATIONS: Vitamin D deficiency needs to be addressed on patients newly diagnosed with TB.
DISCLOSURE: The following authors have nothing to disclose: Elena Karampini, Deepak Rao, Stella Abiona, Bassey Asuquo, Thomas Stokes
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