Rationale for and clinical and laboratory evaluation of the efficiency of using vitamin D in the combination therapy of acute intestinal infections in children


Rudyk A.V., Gorelov A.V.

1Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; 2I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
Objective. To evaluate the clinical and laboratory efficiency of using vitamin D in the combination therapy of acute intestinal infections (AIIs) of various etiologies in 1- to 6-year-old children with varying vitamin D status.
Subjects and methods. A total of 215 hospitalized children were examined. Of them, 106 patients received standard therapy and 109 had vitamin D supplementation calculated with reference to the vitamin D [serum 25(OH)D] status for one month (the status was examined at 1, 8, and 30 days of therapy). General clinical indicators, gastrointestinal digestive function, severity of inflammation in the intestinal wall (fecal calprotectin (FCP) values), and serum 25(OH)D levels were assessed.
Results. Patients even with deficiency in vitamin D after its supplementation were noted to have a shorter relief of the main clinical manifestations of the disease (p < 0.01), normalization of stool on discharge in all the patients (p < 0.01). In the early convalescence period after bacterial AIIs and intestinal infections of unknown etiology, the coli distal syndrome was completely relieved; elevated FCP levels were recorded only in 17.9% of cases; the 25(OH)D levels did not decrease, but remained unchanged, and reached the optimum level of vitamin D at 30 days of its therapy.
Conclusion. There is evidence that the use of vitamin D at the therapeutic doses is effective not only in treating AIIs of various etiologies, but also in normalizing the vitamin D status.
Keywords: fecal calprotectin, serum 25(OH)D, vitamin D status, acute intestinal infections, children
Read entire article

Literature

  1. Gorelov A.V., Grigorovich M. S. [Acute enteric infections in children: long-term outcomes, the factors determining them. The optimization of rehabilitation]. Kirov: Vesi, 2012; 29–106. (In Russ.) .
  2. Yarcev M.N., Plahtienko M.V. [Frequently ill children and immune deficiency]. Rossijskij allergologicheskij zhurnal 2010; (5): 58–66. (In Russ.).
  3. Rook G.A. The rol of vitamin D in tuberculosis. Am. Rev. Respir. Dis. 1988; 138(4): 768–70.
  4. Davies P.D. A possible link between vitamin D deficiency and impaired host defence to Mycobacterium tuberculosis. Tubercle 1985; 66(4): 301–6.
  5. Martineau A.R. Old wine in new bottles: vitamin D in the treatment and prevention of tuberculosis. Proc. Nutr. Soc. 2012; 71(1): 84–9.
  6. Selvaraj P. Vitamin D, vitamin D receptor, and cathelicidini in the treatment of tuberculosis. Vitam Horm. 2011; 86: 307–25.
  7. Urashima M., Segawa T., Okazaki M., Kurihara M., Wada Y., Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am. J. Clin. Nutr. 2010; 91(5): 1255–60. DOI: 10.3945/ajcn.2009.29094.
  8. Bischoff-Ferrari H.A., Burckhardt P., Quack-Loetscher K., Gerber B., I’Allemand D., Laimbacher J., Bachmann M., Rizzoli R. Vitamin D deficiency: Evidence, safety, and recommendations for the Swiss population. Report written by a group of experts on behalf of the Federal Commission for Nutrition (FCN) 2012. http://www.iccidd.org/p142000804.html.
  9. Liu P.T. Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependen on the induction of cathelicidin. J. Immunol. 2007; 179(4): 2060–63.
  10. Liu P.T., Stenger S., Li H., Wenzel L., Tan B.H., Krutzik S.R., Ochoa M.T., Schauber J., Wu K., Meinken C., Kamen D.L., Wagner M., Bals R., Steinmeyer A., Zügel U., Gallo R.L., Eisenberg D., Hewison M., Hollis B.W., Adams J.S., Bloom B.R., Modlin R.L. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311(5768): 1770–3.
  11. [The role of vitamin D in the formation of the child’s health. A national programme of vitamin D. Review of the Symposium]. Experts: Gromova O.A., Maltsev S.V., Zakharova I.N., Namazova-Baranova L. Consilium Medicum. Pediatrics (Suppl.). 2015; (1): 5–13. http://con-med.ru/ upload/iblock/f70/1.pdf (In Russ.)
  12. Chen C.C., Huang J. L., Chang C.J. Chang, Kong M.S. Faecal calprotectin as a correlative marker in clinical severity of infectious diarrhea and usefulness in evaluating bacterial or viral pathogens in children. J. Pediatr. Gastroenterol. Nutr. 2012; 55(5): 541–7.
  13. Kessaevа I. K. [Clinical and epidemiological characteristics and improvement of diagnostics of acute intestinal infections in children]. Cand. Med. Diss. Stavropole, 2015; 5–6. http://stgmu.ru/userfiles/depts/scientist/ Avtoreferat_KESSAEVA__na_sajt.pdf (In Russ.).
  14. Denisov M.Yu. [Practical gastroenterology for the pediatrician]. Мoscow: Izdatelstvo Makeeva, 1999. 295 p. (In Russ.).


About the Autors

For correspondence:
Anna V. Rudyk, Postgraduate, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
Address: 3a, Novogireevskaya St., Moscow 111123, Russia
E-mail: belka-177@yandex.ru
Information about the authors:
Prof. Alexandr V. Gorelov, MD, Corresponding Member of the Russian Academy of Sciences; Head, Clinical Department of Infectious Diseases, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; е-mail: crie@pcr.ru


Similar Articles

Back to Content

Бионика Медиа