In this section
@article{Lalvani:2015:10.1136/thoraxjnl-2014-206617,
author = {Lalvani, A and Pareek, M and Sridhar, S and Grass, L and Connell, D and Kon, OM},
doi = {10.1136/thoraxjnl-2014-206617},
journal = {Thorax},
pages = {1171--1180},
title = {Vitamin d deficiency and tuberculosis disease phenotype},
url = {http://dx.doi.org/10.1136/thoraxjnl-2014-206617},
volume = {70},
year = {2015}
}
TY - JOUR
AB - Background Extrapulmonary TB is increasinglycommon, yet the determinants of the wide clinicalspectrum 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 factorsassociated with extrapulmonary TB. We then directlytested association of these factors and serum 25-hydroxycholecalciferol (25(OH)D) concentration withextrapulmonary TB by multivariable analysis in aseparate UK cohort.Results Data were available for 10 152 and 277 013TB cases for Birmingham and US, respectively.Local-born individuals of white ethnicity had a lowerproportion of extrapulmonary disease when comparedwith local-born non-whites (p<0.0001); both groupshad a lower proportion of extrapulmonary disease whencompared with foreign-born non-whites (p<0.0001). Ina separate UK cohort (n=462), individuals withextrapulmonary TB had lower mean serum 25(OH)Dconcentration than those with pulmonary TB (11.4 vs15.2 nmol/L, respectively, p=0.0001). On multivariableanalysis, vitamin D deficiency was strongly associated withextrapulmonary TB independently of ethnicity, gender andother factors. Doubling in serum 25(OH)D concentrationconferred substantially reduced risk of extrapulmonarydisease (OR 0.55, 95% CI 0.41 to 0.73).Conclusions We identify vitamin D deficiency as aprobable risk factor for extrapulmonary dissemination inTB, which may account for the associations of darkskinnedethnicity and female gender with extrapulmonarydisease. Our findings implicate vitamin D status inMycobacterium tuberculosis containment in vivo and, given the high prevalence of deficiency, may informdevelopment of novel TB prevention strategies.
AU - Lalvani,A
AU - Pareek,M
AU - Sridhar,S
AU - Grass,L
AU - Connell,D
AU - Kon,OM
DO - 10.1136/thoraxjnl-2014-206617
EP - 1180
PY - 2015///
SN - 1468-3296
SP - 1171
TI - Vitamin d deficiency and tuberculosis disease phenotype
T2 - Thorax
UR - http://dx.doi.org/10.1136/thoraxjnl-2014-206617
VL - 70
ER -
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