Author/Authors :
Arnedo-Pena، Alberto نويسنده Section of Epidemiology, Centre of Public Health, Regional Ministry of Health, Castell?n, Spain Arnedo-Pena, Alberto , Vicente Juan-Cerdan، Jose نويسنده Biochemical Laboratory, Hospital General, Castellon,
Spain , , Angeles Romeu-Garcia، Maria نويسنده Epidemiology Division, Public Health Centre Castellon,
Spain , , Garcia-Ferrer، Daniel نويسنده Biochemical Laboratory, Hospital General, Castellon,
Spain , , Iborra-Millet، Jesus نويسنده Biochemical Laboratory, Hospital General, Castellon,
Spain , , Antonio Ferrero-Vega، Jose نويسنده Biochemical Laboratory, Hospital General, Castellon,
Spain , , Bautista Bellido-Blasco، Juan نويسنده Epidemiology Division, Public Health Centre Castellon,
Spain , , Meseguer-Ferrer، Noemi نويسنده Epidemiology Division, Public Health Centre Castellon,
Spain , , Pardo-Serrano، Francisco نويسنده Microbiology Laboratory, Hospital General, Castellon,
Spain ,
Abstract :
Serum vitamin D (VitD) status is associated with active
tuberculosis (TB) and TB infection conversion (TBIC). The objective of
the present study was to quantify the risks of TB (latent, conversion,
disease) in accordance with VitD status and other variables among the
contacts of pulmonary TB patients. From 2009 to 2012, a cohort of the
contacts of pulmonary TB patients was studied to rule out and prevent TB
in Castellon (Spain). The exams performed included a tuberculin skin
test (TST), a QuantiFERON Gold in-tube test® (QFTGIT), blood and
radiographic tests, and an initial measurement of serum VitD status.
Contacts who were initially without active TB were followed up through
2015. Multinomial logistic regression (MLR) analyses were carried out.
From a total of 572 contacts of pulmonary TB patients with VitD status
measurement, 523 completed the follow-up (participation rate 91.4%).
Among them, five groups could be established: 3 new cases of pulmonary
TB (0.6%), 27 cases of TBIC (5.2%), 116 cases of latent TB infection
(LTBI) (22.2%), 125 uninfected TB contacts with only one TST or QFTGIT
measurement (23.9%), and 252 uninfected TB contacts with two TST or
QFTGIT measurements (48.2%). The comparison of these five groups
revealed several significant differences, including age, whether they
were foreign-born, place of residence, social class, high exposure to an
index case with sputum acid-fast bacilli (AFB), and VitD status. The MLR
analysis for all groups, with the group of uninfected TB contacts with
two TST or QFTGIT measurements as a reference, estimated that only two
of these factors were significantly associated with TB in three or more
groups; these factors were VitD status and high exposure and a sputum
AFB-positive index case. VitD status was a protector against pulmonary
TB with a relative risk (RR) of 0.86 (95% confidence interval [CI] 0.74
- 0.99) and against TBIC (R = 0.95; 95% CI 0.91 - 0.99), while it was
not associated with LTBI (RR = 0.99; 95% CI 0.97-1.01). Only 34.0% of
the contacts had sufficient VitD levels (≥ 30 ng/mL). Our results
suggest that a sufficient VitD level could be a protective factor
against TBIC and active TB.
