Indian Journal of Medical Research

CORRESPONDENCE
Year
: 2015  |  Volume : 141  |  Issue : 6  |  Page : 839--840

Association between vitamin D deficiency & paediatric tuberculosis


Eda Demir Onal, Dilek Berker, Serdar Guler 
 Ankara Numune Research & Training Hospital, Department of Endocrinology & Metabolism, Ankara, Turkey

Correspondence Address:
Eda Demir Onal
Cukurambar Mah 1465, Sok 10/14, TR-06510, Balgat, Çankaya, Ankara
Turkey




How to cite this article:
Onal ED, Berker D, Guler S. Association between vitamin D deficiency & paediatric tuberculosis.Indian J Med Res 2015;141:839-840


How to cite this URL:
Onal ED, Berker D, Guler S. Association between vitamin D deficiency & paediatric tuberculosis. Indian J Med Res [serial online] 2015 [cited 2020 Aug 7 ];141:839-840
Available from: http://www.ijmr.org.in/text.asp?2015/141/6/839/160725


Full Text

Sir,

I read with great interest the article by Khandelwal et al[1] . They undertook a study to determine the baseline 25-hydroxy vitamin D levels in children suffering from intrathoracic tuberculosis and its association with type and outcome of tuberculosis. Majority of Indian children with newly diagnosed intrathoracic tuberculosis were found to be deficient in vitamin D and children who did not demonstrate sputum conversion after intensive phase of antituberculosis therapy had lower baseline 25-hydroxy vitamin D levels as compared to those who did [1] . The article has important messages. But there are some issues which need to be clarified.

First issue is the absence of a control group. We think that a control group is a " sine quanone" for that kind of a study and all the subjects in the control group should have tuberculin skin test and chest radiography to screen for latent tuberculosis.

Another issue is that the authors should have better statistically analyzed the impact of the presence of cavitary disease on smear conversion because the presence of cavitary disease has been previously reported to be associated with a longer time to sputum smear conversion in patients with active pulmonary tuberculosis [2] . This parameter may interfere with the proposed effect of vitamin D deficiency on smear conversion.

As a last point, was there any patient who had paradoxical response to antituberculosis therapy in this series? Paradoxical deterioration during antituberculosis therapy is defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves [3 ] and it has been observed in upto 16 per cent of patients in another study [4] . Following the antituberculosis therapy, improved immune function leading to a greater inflammatory reaction is thought to be responsible for paradoxical deterioration.We think that the answer to our question is important because the absence of any paradoxical response in the vitamin D insufficient and deficient groups may provide indirect evidence for impaired immune reconstitution in these groups of patients.

References

1Khandelwal D, Gupta N, Mukherjee A, Lodha R, Singh V, Grewal HM, et al & Delhi Paedictric TB Study Group. Vitamin D levels in Indian children with intrathoracic tuberculosis. Indian J Med Res 2014; 140 : 531-7.
2Domínguez-Castellano A, Muniain MA, Rodriguez-Baño J, Garcia M, Rios MJ, Galvez J, et al. Factors associated with time to sputum smear conversion in active pulmonary tuberculosis. Int J Tuberc Lung Dis 2003; 7 : 432-8.
3Onal IK, Bayraktar Y, Unal S. Paradoxical deterioration during the course of antituberculous treatment. J Natl Med Assoc 2006; 98 : 954-5.
4Jeon K, Choi WI, An JS, Lim SY, Kim WJ, Park GM, et al. Paradoxical response in HIV-negative patients with pleural tuberculosis: a retrospective multicentre study. Int J Tuberc Lung Dis 2012; 16 : 846-51.