Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy.
Int J Tuberc Lung Dis. 2017 Jun 1;21(6):677-683. doi: 10.5588/ijtld.16.0927.
Barr DA david.barr at liverpool.ac.uk, Coussens AK, Irvine S3, Ritchie ND, Herbert K, Choo-Kang B, Raeside D, Bell DJ, Seaton RA
- Million TB deaths annually, yet proven treatments of Vitamin D, sunshine, etc are not used – July 2017
- Tuberculosis -100 percent cure rate with 10,000 IU of vitamin D daily – RCT 2006
Clinic C was such an outlier that it was not included in their analysis
Possible reasons by VitaminDWiki as to why Clinic C had ZERO PUR
- Clinic C patients also get some Vitamin D co-factors, such as Magnesium in their water
- Clinic C is outdoors (Note that TB used to be cured by sunlight)
- Older patients
- Different ethnicity
- Different daily dose size
- Included a bolus dose
- Dose was different – D3 vs D2
- Dose taken at different time of day
- A different TB treatment given at Clinic C
- Vitamin Dwas given significantly before or after conventional TB treatment
Download the PDF from VitaminDWiki
SETTING: Glasgow, Scotland, UK.
BACKGROUND: Paradoxical reactions in tuberculosis (TB) are a notable example of our incomplete understanding of host-pathogen interactions during anti-tuberculosis treatment.
OBJECTIVES: To determine risk factors for a TB paradoxical reaction, and specifically to assess for an independent association with vitamin D use.
DESIGN:
Consecutive human immunodeficiency virus (HIV) negative adult patients treated for extra-pulmonary TB were identified from an Extended Surveillance of Mycobacterial Infections database. In our setting, vitamin D was variably prescribed for newly diagnosed TB patients. A previously published definition of paradoxical TB reaction was retrospectively applied to, and data on all previously described risk factors were extracted from, centralised electronic patient records. The association with vitamin D use was assessed using multivariate logistic regression.
RESULTS:
Of the 249 patients included, most had TB adenopathy; 222/249 had microbiologically and/or histologically confirmed TB. Vitamin D was prescribed for 57/249 (23%) patients; 37/249 (15%) were classified as having paradoxical reactions. Younger age, acid-fast bacilli-positive invasive samples, multiple disease sites, lower lymphocyte count and vitamin D use were found to be independent risk factors.
CONCLUSION: We speculate that vitamin D-mediated signalling of pro-inflammatory innate immune cells, along with high antigenic load, may mediate paradoxical reactions in anti-tuberculosis treatment.
PMID: 28482963 PMCID: PMC5424669 DOI: 10.5588/ijtld.16.0927
Clipped from PDF
- “A published definition of a PUR1 (‘worsening of pre-existing tuberculous lesions on the basis of clinical or radiological findings or development of new TB lesions in patients who had received antituberculosis treatment for at least 10 days and whose conditions were reported to be improving’ “
- “Clinic C was found to be an outlier with much lower rates of vitamin D prescribing and PUR than the other sites.
Only 11/53 (21%) of patients at clinic C were prescribed vitamin D, and none had an observed PUR (Figure B )"