Paradoxical upgrading reaction in extra-pulmonary tuberculosis: association with vitamin D therapy
| Autor: | D A, Barr, A K, Coussens, S, Irvine, N D, Ritchie, K, Herbert, B, Choo-Kang, D, Raeside, D J, Bell, R A, Seaton |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Age Factors Antitubercular Agents Original Articles Middle Aged Tuberculosis Lymph Node host-directed therapy Cohort Studies Logistic Models Treatment Outcome Scotland Risk Factors inflammation Host-Pathogen Interactions Multivariate Analysis Humans Tuberculosis Female Vitamin D host–pathogen interaction innate immunity Retrospective Studies |
| Zdroj: | The International Journal of Tuberculosis and Lung Disease |
| ISSN: | 1815-7920 |
| Popis: | SUMMARY SETTING: Glasgow, Scotland, UK. BACKGROUND: Paradoxical reactions in tuberculosis (TB) are a notable example of our incomplete understanding of host-pathogen interactions during anti-tuberculosis treatment. OBJECTIVES: To determine risk factors for a TB paradoxical reaction, and specifically to assess for an independent association with vitamin D use. DESIGN: 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. RESULTS: 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. CONCLUSION: 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. |
| Databáze: | OpenAIRE |
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