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Title: Vitamin D deficiency and TB disease phenotype
Authors: Pareek, Manish
Innes, J.
Sridhar, S.
Grass, L.
Connell, D.
Woltmann, G.
Wiselka, M.
Martineau, A. R.
Min Kon, O.
Dedicoat, M.
Lalvani, A.
First Published: 23-Sep-2015
Publisher: BMJ Publishing Group
Citation: Thorax, 2015 (In press) doi:10.1136/thoraxjnl-2014-206617
Abstract: Background: Extrapulmonary TB is increasingly common, yet the determinants of the wide clinical spectrum of TB are poorly understood. Methods: We examined surveillance data (Birmingham, UK: 1980–2009 and USA Centers for Disease Control: 1993–2008) to identify demographic factors associated with extrapulmonary TB. We then directly tested association of these factors and serum 25-hydroxycholecalciferol (25(OH)D) concentration with extrapulmonary TB by multivariable analysis in a separate UK cohort. Results: Data were available for 10 152 and 277 013 TB cases for Birmingham and US, respectively. Local-born individuals of white ethnicity had a lower proportion of extrapulmonary disease when compared with local-born non-whites (p<0.0001); both groups had a lower proportion of extrapulmonary disease when compared with foreign-born non-whites (p<0.0001). In a separate UK cohort (n=462), individuals with extrapulmonary TB had lower mean serum 25(OH)D concentration than those with pulmonary TB (11.4 vs 15.2 nmol/L, respectively, p=0.0001). On multivariable analysis, vitamin D deficiency was strongly associated with extrapulmonary TB independently of ethnicity, gender and other factors. Doubling in serum 25(OH)D concentration conferred substantially reduced risk of extrapulmonary disease (OR 0.55, 95% CI 0.41 to 0.73). Conclusions: We identify vitamin D deficiency as a probable risk factor for extrapulmonary dissemination in TB, which may account for the associations of dark-skinned ethnicity and female gender with extrapulmonary disease. Our findings implicate vitamin D status in Mycobacterium tuberculosis containment in vivo and, given the high prevalence of deficiency, may inform development of novel TB prevention strategies.
DOI Link: 10.1136/thoraxjnl-2014-206617
ISSN: 0040-6376
eISSN: 1468-3296
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © The Authors, 2015. Produced by BMJ Publishing group under license. Deposited with reference to the publisher’s archiving policy available on the SHERPA/RoMEO website.
Appears in Collections:Published Articles, Dept. of Infection, Immunity and Inflammation

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