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Rickets, Vitamin D Deficiency and Tuberculosis in Children of St. Petersburg and its Region
Yulia Yarovaya1, Marina Lozovskaya1, Elenа Vasil'eva1
1Department of Phthisiology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
Insights
Children with vitamin D deficiency and rickets are significantly more likely to be diagnosed with active tuberculosis (TB). Early pediatric intervention for rickets is crucial to prevent immunodeficiency and TB progression in high-risk children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Endocrinology
Background:
- Vitamin D insufficiency is prevalent in children, leading to rickets and compromised immunity.
- Tuberculosis (TB) diagnosis in children is a significant public health concern.
- Rickets can impair immune status, potentially influencing TB progression.
Purpose of the Study:
- To assess the likelihood of active TB diagnosis in children with TB infection and vitamin D deficiency.
- To evaluate the association between rickets, vitamin D deficiency, and TB diagnosis in children.
- To highlight the importance of early rickets diagnosis and treatment in preventing TB progression.
Main Methods:
- A study of 98 children aged 1-14 years with positive TB immunological tests (ATP and/or IGRA).
- Diagnostic evaluation included TB assessment and serum 25(OH)D measurement for vitamin D status.
- Children with immunodeficiency or hereditary diseases were excluded.
Main Results:
- Rickets-related changes were observed in 70.4% of children.
- Vitamin D deficiency (insufficiency, moderate, or severe) was detected in 91.8% of cases.
- Children with rickets had 4 times higher odds of active TB (OR=4.009), while vitamin D deficiency increased odds by 10 times (OR=10.411).
- The presence of either rickets or vitamin D deficiency significantly elevated the odds of active TB diagnosis (OR=41.167).
Conclusions:
- Low vitamin D levels and rickets are strongly associated with an increased likelihood of active TB in children.
- Pediatricians must be vigilant in diagnosing and treating rickets to prevent immune compromise and TB progression.
- Heightened TB monitoring is recommended for high-risk children with vitamin D deficiency and rickets, emphasizing early pediatric intervention.
Introduction:
Given the widespread prevalence of vitamin D insufficiency and its clinical manifestations (such as rickets and compromised immune status) in children, this study aimed to assess the likelihood of tuberculosis (TB) diagnosis in children with TB infection and positive ESAT-6/CFP-10 test results, alongside signs of vitamin D deficiency (clinical rickets and/or low serum vitamin D levels).
Method:
A total of 98 children aged 1-14 years were examined at the TB department of St. Petersburg Children's Infectious Diseases Hospital No. 3 (2022-2024). Inclusion criteria were a positive ATP test and/or IGRA result. Exclusion criteria included immunodeficiency disorders and hereditary diseases. Diagnostic evaluation for TB and vitamin D status (via serum calcidiol (25(OH)D) measurement was performed.
Result:
Rickets-related changes were observed in 70.4±4.6% of cases. Vitamin D insufficiency was detected in 21.4±4.4%, moderate deficiency in 36.7±5.1%, and severe deficiency in 33.7±5.0%. A significantly higher probability of active TB diagnosis was found in children with: • Rickets signs: OR=4.009 (95% CI 1.609-9.987), RR=1.872 (1.148-3.054), φ=0.310. • Vitamin D deficiency: OR=10.411 (3.762-28.809), RR=3.182 (1.648-6.145), φ=0.493. • Either factor: OR=41.167 (10.699-158.404), RR=27.986 (2.720-23.443), φ=0.677 (strong association).
Discussion:
The low vitamin D levels in children require not only special attention from TB specialists to patients with tuberculosis infection who test positive in immunological tests for ESAT-6 and CFP-10 antigens and show signs of rickets and/or vitamin D deficiency, but also increased vigilance from pediatricians in the timely diagnosis and treatment of rickets. Rickets often manifests early, has a prolonged course, and can lead to impaired immune status, which is significant for the progression from latent tuberculosis infection to active disease.
Conclusion:
Vitamin D deficiency and rickets should prompt heightened TB monitoring in high-risk children, emphasizing early pediatric intervention to prevent immunodeficiency and TB progression.
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