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Bacterial Infections
Tuberculosis and Vitamin D – What Is the Evidence for Interaction?
a review by
Christian Wejse
Senior Registrar, Department of Infectious Diseases, Aarhus University Hospital, and Senior Research Fellow, Bandim Health Project, Guinea Bissau
The epidemic of tuberculosis (TB) has been declared a global emergency production of singlet oxygen through radiation of porphyrins has been
by the World Health Organzation (WHO).
1
New solutions are needed in suggested as a plausible explanation of why Finsen’s therapy worked.
16
The
many areas, such as adjunctive treatments and improved quality of authors also suggest that possible effects of UV radiation on the immune
care,
2
preferably with a simple approach that is feasible in low-income reactions in the skin and granuloma may lie behind the success of the
countries.
3
Vitamin D has been declared a possible adjuvant therapy;
4
treatment, i.e. a vitamin-D-mediated reaction.
this article presents a review of the available literature on vitamin D and
TB interaction. Vitamin D Used in Treatment
Cod liver oil remained an important part of TB treatment as late as 1960.
7
It
Vitamin D deficiency (VDD) has been proposed as one of the was recognised that the effect of cod liver oil on rickets was because of the
aetiological factors for TB, and the effect of vitamin D on the cell- rich vitamin D content. Using this knowledge, attempts were made to use
mediated immune response is of vital importance in conquering TB. calciferol in TB treatment. This was first described in 1943 by Charpy and
This hypothesis was proposed in modern times by Davies in 1985 based later by Dowling.
17,18
There are numerous reports of a very convincing effect
on observations of a high TB prevalence among Asian immigrants in of treatment of lupus vulgaris with calciferol or its precursor, ergosterol.
19–24
London who had low vitamin D levels.
5
However, this was not a new The largest population treated was 1,230 patients with various forms of skin
hypothesis in the medical community. TB: 748 patients had lupus vulgaris and of these 38.4% were completely
cured.
25
A Dutch group found that the well-documented effect of Finsen’s
Historical Aspects UV radiation on lupus vulgaris could be attributed to the skin formation of
vitamin D, and even noted more rapid improvements when Finsen’s lamps
Cod Liver Oil and ergosterol were used together in the treatment.
15
Vitamin D has been used in various forms both before and after the advent
of the antibiotic era. Cod liver oil, which is rich in vitamin D, was first Various forms of vitamin D were also used successfully in scrofula
20
and
recommended for TB in 1766 by Darbey,
6
and throughout the 18th abdominal TB,
26,27
and with varying results in pulmonary TB.
28–31
In the
century cod liver oil was widely used to treat consumption.
7
Bennett literature the use of vitamin D for pulmonary TB was heavily debated,
32–34
as
initiated cod liver oil treatment at his TB sanatorium in Edinburgh, with well as the appropriate dosage. Charpy initially used 1,200,000IU per week
good results: “Cod liver oil has like no other remedy rapidly restored the but later reduced the dosage to 600,000IU per 60kg bodyweight every fifth
exhaustive powers of the patient, improved the nutritive functions day for lupus vulgaris.
6,17
Most authors followed this regime, and Marcussen
generally, stopped or diminished emaciation, checked the perspiration, even noted more relapses when using less than 100,000IU per day.
35
One
quieted the cough and expectoration, and produced the most favourable group found that 30,000IU/day was sufficient for treating pulmonary TB.
36
influence on the local disease.”
8
From the Hospital for Consumption and Current recommendations are not to exceed 50,000IU/day to avoid
Diseases of the Chest in London it was reported that one to two toxicity,
37
but some data show that 100,000IU/day may also be acceptable
tablespoons of cod liver oil two to four times daily arrested disease in for a limited period of time,
38
although only trials using ≤10,000IU/day for
18%, improved disease in 63% and had no effect in 19%.
9
A 19% longer periods have not reported toxicity.
39
Interestingly, the dosage of cod
reduction in deaths due to consumption in Philadelphia between 1847 liver oil previously mentioned would be equivalent to 6,000-24,000IU/day.
37
and 1852 was attributed to the widespread use of cod liver oil
treatment.
10
However, it gradually became clear that although it was a Safety in terms of effect on calcium concentration, blood pressure and
useful adjunctive therapy at a time when few other remedies were electrocardiogram was found to be satisfactory,
32,40
but there were
available, it was not a cure-all for TB, which was also noted by those frequent cases of intoxication
27,41,42
and concerns about provoking
advocating cod liver oil.
10,11
Christian Wejse is a Senior Registrar in the Department of
Light on Mycobacteria
Infectious Diseases at Aarhus University Hospital. His research
In 1903, Niels Finsen was awarded the Nobel Prize for his discovery of the interests centre on tuberculosis and HIV in low-resource
usefulness of light therapy for lupus vulgaris.
12
The theoretical background
settings, and pneumonia. He is the author or co-author of 11
publications in international peer-reviewed journals, including
was believed to be a specific ultraviolet (UV)-induced bacteria killing.
13,14
the Journal of Infectious Diseases, the Pediatric Infectious
However, in 1958 vitamin D was also considered as the mechanism of effect
Disease Journal and Epidemiology, and a referee for Thorax
and the Journal of Infectious Disease. Dr Wejse received his
of light therapy on lupus; it was shown that the UV radiation in Finsen lamps
MD and PhD from the University of Aarhus.
could yield 100IU vitamin D per square centimetre, enough to equalise the
E:
wejse@dadlnet.dk
obtained skin concentration after an oral dose of 500,000IU.
15
Recently,
© TOUCH BRIEFINGS 2008 107
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