Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy



Barr, DA ORCID: 0000-0002-2922-9381, Coussens, AK, Irvine, S, Ritchie, ND, Herbert, K, Choo-Kang, B, Raeside, D, Bell, DJ and Seaton, RA
(2017) Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy. INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 21 (6). pp. 677-683.

[img] Text
BarrDA.CoussensAK_PUR_EPTB_vitD_IJTLD.2017.pdf - Published version

Download (202kB)

Abstract

<h4>Setting</h4>Glasgow, Scotland, UK.<h4>Background</h4>Paradoxical reactions in tuberculosis (TB) are a notable example of our incomplete understanding of host-pathogen interactions during anti-tuberculosis treatment.<h4>Objectives</h4>To determine risk factors for a TB paradoxical reaction, and specifically to assess for an independent association with vitamin D use.<h4>Design</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.

Item Type: Article
Uncontrolled Keywords: host-directed therapy, innate immunity, host-pathogen interaction, inflammation
Depositing User: Symplectic Admin
Date Deposited: 05 Jun 2017 09:11
Last Modified: 19 Jan 2023 07:03
DOI: 10.5588/ijtld.16.0927
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3007810