Vitamin D deficiency and delayed sputum smear conversion in pulmonary TB in Pakistan

2013 
Background: Tuberculosis constitutes a major health problem in developing country like Pakistan. There are many factors that contribute in development of drug resistant TB and late sputum smear conversion and most important is the immunity. It has been proven in many studies proved, Vitamin D has a strong immunomodulator effect and vitamin D receptor (VDR) increases the expression of certain antimycobacterial compound in macrophages called cathecidilin. The aim of this study was to compare the degree of vitamin D insufficiency (VDI) and vitamin D deficiency (VDD) in TB patients and delay in sputum conversion for AFB. Method: Serum 25 hydroxy vitamin D3 level has been measured by EIA in 100 blood samples obtained from active PTB patients with no co-morbidity and meanwhile sputum smear conversion for Mycobacterium tuberculosis has been examined after every two weeks till sputum converted negative for AFB. Results: Out of 100 TB patients, 67 were female and 33 male, patients were categorized in three groups 62 were new, 29 retreatment and 9 MDR TB cases. Results showed vitamin D deficiency in 51%, vitamin D insufficiency in 46% and sufficient level of vitamin D in 3%. 57 cases showed delayed sputum conversion and 43 showed early. Significant p-value (0.00) indicated an important association between level of vitamin D and sputum smear conversion time. Conclusion: Most of the TB patients in Pakistan have hypovitaminosis D and that found to be a strong factor in delayed sputum conversion. Genetics of VDR polymorphism of these patients is under study.
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