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Tuberculosis

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Summary

Tuberculosis is a respiratory illness that usually affects the lungs, but can also infect the kidney, spine, or brain. Tuberculosis can be either dormant or active. Dormant tuberculosis is when you become infected with the tuberculosis bacteria, but you don’t get sick and you’re not contagious. Tuberculosis becomes activated in people with weak immune systems.

Vitamin D is an important part of your immune system. Vitamin D can help to increase the amount of good immune proteins that fight and destroy bacteria. People with low levels of vitamin D are more likely to develop dormant tuberculosis, and are also more likely to progress to active tuberculosis. Having high levels of vitamin D may be a way to help prevent tuberculosis infection, but more experiments need to be done to say for sure.

Some experiments have shown that people with tuberculosis who take vitamin D supplements have a faster recovery and fewer symptoms. More experiments are needed to determine whether or not vitamin D can help to treat tuberculosis.

If you want to take vitamin D to prevent or treat tuberculosis, it is unlikely to cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to prevent or treat tuberculosis.

If you have tuberculosis, you shouldn’t take vitamin D in place of any treatment medications. Talk to your physician for more advice about taking supplements.

What is tuberculosis?

Tuberculosis, or TB, is a respiratory illness that usually affects the lungs, but can also infect the kidney, spine, or brain. TB can be either dormant or active.

Dormant TB, also called latent TB, is when someone gets infected with the TB bacteria, but might not ever become sick. This means that the TB bacteria is living in your body, but not causing you to become sick. Usually, people with strong immune systems can live with dormant TB without ever having symptoms. People who have dormant TB are not contagious. They can’t spread the TB bacteria to other people. However, dormant TB can turn into active TB when your immune system is not strong.

TB becomes active when your immune system can’t stop the bacteria from growing. A weak immune system means that it will be easier for the TB bacteria to multiply in your body, causing you to become sick. People with active TB are contagious and can spread it to other people1.

What are the symptoms of tuberculosis?

Symptoms of active TB include1:

  • A bad cough for more than 3 weeks
  • Chest pain
  • Coughing up blood or mucus
  • Feeling weak or tired
  • Weight loss
  • No appetite
  • Fever, chills, or night sweats

Someone with dormant TB won’t have any symptoms, and usually they don’t even know that they have it. The treatment for TB involves at least 6 months of antibiotics.

How common is tuberculosis?

sick girl

Worldwide, 1 out of every 3 people is infected with TB, but most of them have dormant TB. Only 1 out of 10 people with dormant TB will progress to active TB.

Worldwide, 1 out of every 3 people is infected with TB, but most of them have dormant TB.  Only 1 out of 10 people with dormant TB will progress to active TB2.

There are some things that can increase your chances of progressing to active TB, including1:

  • Having HIV/AIDS
  • Being recently infected with TB
  • Having other health conditions, like diabetes or cancer
  • Abusing alcohol or drugs

All of these things cause a weak immune system, which makes it harder for your body to fight the TB bacteria. Someone who works or spends a lot of time in hospitals, nursing homes, or homeless shelters may also have a higher chance of developing TB.

The best way to prevent getting infected with TB in the first place is to practice good hygiene, like washing your hands often and not touching your eyes, mouth, or nose.

How does tuberculosis spread?

TB is contagious and spreads through the air. The bacteria that cause TB can spread when someone who is infected coughs, sneezes, or even talks. Droplets containing the bacteria travel through the air and can be directly inhaled by another person through the mouth or nose. The droplets may also land on a surface and you could pick them up by touching the surface and then become infected after touching your eyes, nose, or mouth1,3.

What is the link between tuberculosis and vitamin D?

Before antibiotics for TB were discovered, people with TB were treated with sun therapy. Doctors thought that something in the sun was helping to cure people with TB, which may mean that vitamin D plays some role. Vitamin D is made in the skin from sunlight4.

Vitamin D is an important part of the immune system. Vitamin D receptors are found on the surface of a cell where they receive chemical signals. By attaching themselves to a receptor, these chemical signals direct a cell to do something, for example, to act in a certain way, or to divide or die.

There are vitamin D receptors found on cells in the immune system and the respiratory tract, and vitamin D can bind to these receptors. Vitamin D works in the immune system by lowering levels of bad inflammatory proteins, while at the same time increasing amounts of good antimicrobial proteins that can destroy invading bacteria, like TB. Having enough vitamin D can help your immune system to kill the TB bacteria or keep it from becoming active5.

There are good cells in the immune system called macrophages. Macrophages can engulf and “eat” invading bacteria and viruses, which protects your body from getting infections and illnesses. The TB bacteria try to infect your body by attacking your macrophages. Vitamin D helps your immune system by making macrophages stronger and more able to fight the TB bacteria5,6,7.

It is thought that someone’s vitamin D level may be a factor in whether or not they become infected with TB or progress to active TB. Studies have found that people with low levels of vitamin D are more likely to get TB than people with higher levels of vitamin D4. More experiments need to be done to determine if taking vitamin D supplements can help to prevent or treat TB.

What does the research say in general about vitamin D and tuberculosis?

Preventing tuberculosis

Most studies that have been done about preventing TB are about stopping the dormant TB disease from becoming active. Researchers think that people with low levels of vitamin D have an increased risk of getting infected with TB after being exposed to it, as well as an increased risk of progressing from dormant to active TB5.

Researchers think that people with low levels of vitamin D have an increased risk of getting infected with TB after being exposed to it.

Researchers think that people with low levels of vitamin D have an increased risk of getting infected with TB after being exposed to it.

A study looked at people who were in close contact with others who had active TB and found that people who had low levels of vitamin D were more likely to become infected with TB. The people with the highest vitamin D levels had the lowest chances of developing a dormant TB infection8. People who live in the same house as someone with TB have a doubled risk of developing TB themselves9.

Some studies have been done about sunlight exposure and TB. A researcher in the U.K. found that seasons with low amounts of sunshine, like the winter, are linked to greater numbers of people developing active TB six months later, which is about how long it takes for TB to develop and activate in the body. Vitamin D levels also tend to be lower in the winter. Researchers think that low levels of vitamin D may be a factor that influences someone’s chances of developing TB10.

It has been shown in many studies that people with TB tend to have lower levels of vitamin D. However, more experiments are needed to determine whether or not taking a vitamin D supplement can help to prevent TB.

Treating and recovering from tuberculosis

Some studies have looked at giving vitamin D supplements to people with TB, along with the normal antibiotics used to treat TB. These studies have shown that people with TB who are given vitamin D may recover more quickly from the illness11.

A study in Japan found that people with TB who had low levels of vitamin D were sick for a longer period of time. Researchers think that low vitamin D levels may cause a longer illness or worse symptoms from TB12.

Overall, more experiments need to be done to determine whether or not vitamin D can help to treat TB.

What does recent research say about vitamin D and tuberculosis?

Preventing tuberculosis

An experiment done in 2012 in Mongolia looked at preventing TB infection in schoolchildren. The children were given either 800 IU of vitamin D every day for 6 months or a dummy pill. The researchers tested the children’s skin before and after to see if they developed dormant TB. They found that13:

  • Children who were in the vitamin D group and had the highest vitamin D levels were least likely to develop dormant TB during the study.

The researchers conclude that children taking a vitamin D supplement may be less likely to develop TB, which could prevent active TB infections from spreading through schools.

A study done in Pakistan in 2010 looked at people who lived in the same house as someone else with TB. They wanted to see if high vitamin D levels could prevent TB in someone who was at a high risk of catching it. They found that14:

  • People with low levels of vitamin D were 5 times more likely to develop TB than those with higher vitamin D levels.
  • None of the people with the highest vitamin D levels got active TB.
  • Females were more likely to have low levels of vitamin D and progress to active TB.

Treating and recovering from tuberculosis

An experiment was done in 2011 that looked at the time it took for people with TB to recover. People were given 100,000 IU of vitamin D twice a month for 2 months or a dummy pill in addition to their normal antibiotics.  The researchers found that15,16:

  • People in the vitamin D group had a faster recovery from TB.
  • The vitamin D group had greater amounts of good antimicrobial proteins and fewer bad inflammatory proteins.

Vitamin D may help the TB medicine to work faster and cause a quicker recovery.

An experiment published in 2013 gave people with active TB 2 doses of 600,000 IU of vitamin D one month apart or a dummy pill, along with the normal antibiotics. The researchers looked at people’s TB symptoms and how fast they recovered. They found that11:

  • People in the vitamin D group cleared the TB infection faster than the dummy pill group.
  • The vitamin D group showed a better immune response to the TB infection.

The researchers think that two high doses of vitamin D may lead to a faster recovery and stronger immune systems in people with TB.

Key points from the research

  • People with low levels of vitamin D are more likely to get TB.
  • Vitamin D can help reduce inflammation caused by the TB infection and increase the number of proteins that fight against germs.
  • Some studies have shown that people who take a vitamin D supplement recover from TB faster.
  • More experiments are needed to determine whether or not taking a vitamin D supplement can help to prevent or treat TB.

What does this mean for me?

Research has shown that there is a link between vitamin D and TB. People who have low vitamin D levels are more likely to get infected with dormant TB, and are more likely to progress to active TB. Vitamin D plays an important role in helping your immune system to fight infections.

woman enjoying sun

Vitamin D plays an important role in helping your immune system to fight infections.

Most observational studies show that there is a link between low vitamin D levels and TB. Some experiments show that taking a vitamin D supplement can help you to recover faster from TB. More research is needed to see if taking a vitamin D supplement can help to prevent and treat TB.

If you want to take vitamin D to prevent or help treat TB, it is unlikely to cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to prevent or treat TB.

If you have TB, you shouldn’t take vitamin D in place of any treatment medications. Talk to your physician for more advice about taking supplements.

References

  1. Centers for Disease Control and Prevention. Tuberculosis (TB). 2012. Web. <www.cdc.gov/tb/topic/basics/default.htm>
  2. Jaganath D & Mupere E. Childhood tuberculosis and malnutrition. JID 2012;206:1809-15.
  3. Mayo Clinic. Tuberculosis. 2013. Web. < http://www.mayoclinic.org/diseases-conditions/tuberculosis/basics/prevention/con-20021761>
  4. Martineau A. Old wine in new bottles: vitamin D in the treatment and prevention of tuberculosis. Proceedings of the Nutrition Society 2012;71:84-89.
  5. Ralph AP, Lucas RM & Norval M. Vitamin D and solar ultraviolet radiation in the treatment of tuberculosis. Lancet 2013;13:77-88.
  6. Nature Reviews. Monocytes and macrophages. Web. 2011. < http://www.nature.com/nri/focus/macrophages/index.html>
  7. Nnoaham KE & Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. International Journal of Epidemiology 2008;37:113-119.
  8. Arnedo-Pena A, Juan-Cerdan JV, Romeu-Garica A, et al. Latent tuberculosis infection, tuberculin skin test and vitamin D status in contacts of tuberculosis patients: a cross-sectional and case-control study. BMC Infectious Diseases 2011;11(349):1-8.
  9. Joshi L, Ponnana M, Penmetsa SR, et al. Serum vitamin D levels and VDR polymorphisms (Bsml and Fokl) in patients and their household contacts susceptible to tuberculosis. Human Immunology 2014;79:113-119.
  10. Koh GCKW, Hawthorne G, Turner AM, et al. Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study. PLOS One 2013;8(3):1-5.
  11. Salahuddin N, Ali F, Hasan Z, et al. Vitamin D accelerates clinical recovery from tuberculosis: results of the SUCCINT study [supplementary cholecalciferol in recovery from tuberculosis]. A randomized, placebo-controlled, clinical trial of vitamin D supplementation in patients with pulmonary tuberculosis. BMC Infectious Diseases 2013;13(22):1-11.
  12. Sato S. Relationship between 25-hydroxyvitamin D levels and treatment course of pulmonary tuberculosis. Respiratory Investigation 2012;50(2):40-45.
  13. Ganmaa D, Giovannucci E, Bloom BR, et al. Vitamin D, tuberculin skin test conversion, and latent tuberculosis inMongolian school-age children: a randomized, double-blind,placebo-controlled feasibility trial. Am J Clin Nutr 2012;96:391-6.
  14. Talat N, Perry S, Parsonnet J, et al. Vitamin D deficiency and tuberculosis progression. Emerging Infectious Diseases 2010;16(5):1-3.
  15. Martineau A, Timms PM, Bothamley GH, et al. High dose vitamin D3 during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomized controlled trial. Lancet 2011;377:242-250.
  16. Coussens AK, Wilkinson RJ, Hanifa Y, et al. Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment. PNAS 2012;109(38):15449-15454.

This page was last updated May 2014.

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