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Vitamin D deficiency in patients with tuberculous meningitis and its relationship with treatment outcome
G V Dangeti1, S Mailankody1, C Neeradi1
1Department of Medicine.
Setting:
Data on vitamin D deficiency in tuberculous meningitis (TBM) and its relationship with treatment outcomes are limited. Some of the beneficial effects of vitamin D might be mediated through interleukin-1β (IL-1β).
Objective:
To assess the frequency of vitamin D deficiency among TBM patients, its association with treatment outcomes and correlation between vitamin D and IL-1β levels in cerebrospinal fluid (CSF).
Design:
We prospectively studied a consecutive sample of human immunodeficiency virus-negative patients with TBM treated at a hospital in southern India. We defined good outcome as survival without severe neurological disability. Serum total 25-hydroxy vitamin D (25[OH]D) and IL-1β levels in CSF were estimated on pretreatment samples.
Results:
We studied 40 patients with TBM; 22 (55%) patients had stage 3 disease. Treatment outcome was poor in 21 (53%) patients: 15 (38%) patients died and 6 (15%) had severe neurological disability. The overall mean serum 25(OH)D level was 32.30 ± 16.38 ng/ml. Ten (25%) patients had vitamin D deficiency (<20 ng/ml), and 12 (30%) patients had vitamin D insufficiency (20-30 ng/ml). However, pretreatment serum 25(OH)D levels did not differ significantly by outcome (good vs. poor outcome: 28.30 ± 14.96 vs. 35.92 ± 17.11 ng/ml, P = 0.141). Moreover, IL-1β levels in CSF did not correlate with serum 25(OH)D levels (Spearman's ρ 0.083, P = 0.609).
Conclusion:
Vitamin D deficiency/insufficiency is common among patients with TBM. However, serum 25(OH)D levels are not associated with IL-1β levels in CSF or treatment outcome.
Insights
Vitamin D deficiency is common in tuberculous meningitis (TBM) patients, but serum levels do not impact treatment outcomes or interleukin-1β levels. This study highlights the prevalence of vitamin D insufficiency in TBM.
Area of Science:
- Neurology
- Infectious Diseases
- Endocrinology
Background:
- Tuberculous meningitis (TBM) is a severe infection with limited data on vitamin D deficiency and treatment outcomes.
- Vitamin D's potential immunomodulatory effects, possibly mediated by interleukin-1β (IL-1β), suggest a role in TBM pathogenesis.
Purpose of the Study:
- To determine the frequency of vitamin D deficiency in TBM patients.
- To investigate the association between vitamin D levels and TBM treatment outcomes.
- To explore the correlation between vitamin D and IL-1β levels in cerebrospinal fluid (CSF).
Main Methods:
- Prospective study of 40 human immunodeficiency virus-negative TBM patients in southern India.
- Measurement of serum 25-hydroxy vitamin D (25[OH]D) and CSF IL-1β levels on pretreatment samples.
- Definition of good outcome as survival without severe neurological disability.
Main Results:
- Vitamin D deficiency (<20 ng/ml) was observed in 25% of patients, and insufficiency (20-30 ng/ml) in 30%.
- Pretreatment serum 25(OH)D levels did not significantly differ between patients with good and poor outcomes (P = 0.141).
- CSF IL-1β levels showed no significant correlation with serum 25(OH)D levels (Spearman's ρ = 0.083, P = 0.609).
Conclusions:
- Vitamin D deficiency and insufficiency are prevalent in TBM patients.
- Serum 25(OH)D levels are not associated with TBM treatment outcomes.
- No correlation was found between serum vitamin D and CSF IL-1β levels in TBM patients.
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