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The Role of Vitamin D in the Development of Active Tuberculosis Disease in Young Children
This study was terminated September 2014.
Mycobacterium tuberculosis (MTB) results in significant morbidity and mortality worldwide, yet remains difficult to diagnose and manage, particularly in resource constrained settings. Deficiency in vitamin D, a recently recognized antimicrobial peptide, is increasingly being identified globally and has been associated with tuberculosis disease risk in adults. There is, however, a paucity of literature about the association of vitamin D and active tuberculosis in young children. Identifying vitamin D deficiency as a risk factor for active tuberculosis in young children would provide a rationale for studying its efficacy in future pediatric intervention studies to reduce tuberculosis burden.
Immune control of MTB is predominantly at the level of Th1 type response with release of interferon gamma. This leads to granuloma formation in the lung and draining lymph nodes, and containment of the disease. Several vitamins and trace elements have been implicated in the generation of Th1 type responses, notably Vitamin D, which may be associated with the control of MTB. This has been largely found in adults, with only one cross-sectional study in children. In this small study of 64 immigrant children, an association between tuberculosis disease and Vitamin D levels was found. It will be important to further establish this association in young children since children have decreased Th1 type responses through the first five years of life and the prevalence of vitamin D deficiency may also be higher in children (as high as 50% in India). Furthermore, children account for around10% of new tuberculosis disease, with higher risk of complications. We therefore propose a study to determine the association of vitamin D deficiency and tuberculosis disease and determine a potential mechanism for this by assessing the role of vitamin D in macrophage activity.
- To evaluate the association between Vitamin D deficiency and active tuberculosis disease in children under twelve years of age in a TB endemic region.
- To assess the relationship between vitamin D deficiency in sera and bactericidal activity of infected macrophages.