Vitamin D deficiency and recurrent lower respiratory tract infections: a case based discussion

Cenk Aypak, Özlem Türedi, Sümeyye Ayöz, Mehtap Acar


Lower respiratory tract infections (LRTI) are among the most prevalent infectious diseases.Vitamin D deficiency has been found to be a risk factor for LRTI. We here report a case with the diagnosis of recurrent LRTI treated safely by empirical antibiotherapy and vitamin D supplementation in order to underline the importance of assessment and treatment of vitamin D deficiency in pediatric patients with the diagnosis of LRTI.


Lower respiratory tract infections, children, Rickets, vitamin D

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UNICEF/WHO. Pneumonia: The Forgotten Killer of Children. Geneva: WHO, 2006.

Mulholland K. Magnitude of the problem of childhood pneumoniae. Lancet 354:590-592, 1999.

Whitney CG, Harper SA. Lower respiratory tract infections: prevention using vaccines. Infect Dis Clin North Am 18:899-917, 2004.

Nielsen HE, Siersma V, Andersen S, et al. Respiratory syncytial virus infection risk factors for hospital admission: a case-control study. Acta Paediatr 92:1314-21, 2003.

Welliver RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediatr 143:112-117, 2003.

Marrie TJ, Carriere KC, Jin Y, Johnson DH. Hospitalization for community-acquired pneumonia in Alberta First Nations Aboriginals compared with non-First Nations Albertans. Can Respir J 11:336-342, 2004.

Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics 117:425-432, 2006.

Hassan MK, Al-Sadoon I. Risk factors for severe pneumonia in children in Basrah. Trop Doct 31:139-141, 2001.

Muhe L, Lulseged S, Mason KE, Simoes EA. Case control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet 349:1801-1804, 1997.

Wayse V, Yousafzai A, Mogale K, Filteau S. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 years. Eur J Clin Nutr 58:563-567, 2004.

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87:1080-1086, 2008.

Holick, MF. Vitamin D deficiency. N Engl J Med 357:266-281, 2007.

Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet 1:74 -76, 1982.

Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitaminD3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373- 378, 1988.

Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet 2:1104-1105, 1982.

Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690 693, 2000.

Zhou C, Assem M, Tay JC, et al. Steroid and

xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug induced osteomalacia. J Clin Invest 116:1703-1712, 2006.

Hahn TJ. Drug-induced disorders of vitamin D and mineral metabolism. Clin Endocrinol Metab 9:107-127, 1980.

Sotaniemi EA, Hakkarainen HK, Puranen JA, Lahti

RO. Radiologic bone changes and hypocalcemia with anticonvulsant therapy in epilepsy. Ann Intern Med 77:389-394, 1972.

Fortenbery EJ, McDermott MT, Duncan WE. Effect of theophylline on calcium metabolism and circulating vitamin D metabolites. J Bone Miner Res 5:321-324, 1990.

Lehmann B, Rudolph T, Pietzsch J, Meurer M. Conversion of vitamin D3 to 1alpha,25-dihydroxyvitamin D3 in human skin equivalents. Exp Dermatol 9:97-103, 2000.

Pludowski P, Holick MF, Pilz S et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev 12:976-989, 2013.

Renton P. Radiology of rickets, osteomalacia and hyperparathyroidism. Hosp Med 59:399-403, 1998.

Battault S, Whiting SJ, Peltier SL, Sadrin S, Gerber G, Maixent JM. Vitamin D metabolism, functions and needs: From science to health claims. Eur J Nutr 52: 429-441, 2013.

Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 19:73-78, 2009.

Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med 169:384-390, 2009.

Garland CF, Comstock GW, Garland FC, Helsing KJ, Shaw EK, Gorham ED. Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet 2:1176-1178, 1989.

Gorham ED, Garland CF, Garland FC, et al. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol 97:179 -994, 2005.

Hanchette CL, Schwartz GG. Geographic patterns of prostate cancer mortality. Cancer 70:2861-2869, 1992.

Grant WB. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer 94:1867-1875, 2002.

Grant WG, Garland CF. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Res 26:2687-2700, 2006.

Giovannucci E, Liu Y, Rimm EB, et al. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst 98:451-459, 2006.

Stene LC, Ulriksen J, Magnus P, Joner G. Use of

cod liver oil during pregnancy associated with lower risk of type I diabetes on the offspring. Diabetologia 43:1093-1098, 2000.

Ponsonby A-L, McMichael A, van der Mei I. Ultraviolet radiation and autoimmune disease: insights from epidemiological research. Toxicology 181-182:71-78, 2002.

Embry AF, Snowdon LR, Vieth R. Vitamin D and

seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol 48:271-272, 2000.

McGrath J, Selten JP, Chant D. Long-term trends in sunshine duration and its association with schizophrenia birth rates and age at first registration–data from Australia and the Netherlands. Schizophr Res 54:199-212, 2002.

Gloth FM III, Alam W, Hollis B. Vitamin D vs. broad spectrum phototherapy in the treatment of seasonal effective disorder. J Nutr Health Aging 3:5-7, 1999.

Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol

Metab 92:3517-3522, 2007.

Chan TYK. Vitamin D deficiency and susceptibility to tuberculosis. Calcif Tissue Int 66:476-478, 2000.

Kaludjerovic J, Vieth R. Relationship between vitamin D during perinatal development and health. J

Midwifery Womens Health 55:550-560, 2010.

Garland CF, Garland FC, Gorham ED, et al. The

role of vitamin D in cancer prevention. Am J Public Health. 96:252-261, 2006.

Laaksi I, Ruohola JP, Tuohimaa P, et al. An association of serum vitamin D concentrations < 40 nmol/L with acute respiratory tract infection in young Finnish men. Am J Clin Nutr 86: 714-717, 2007.

Manaseki-Holland S, Qader G, Isaq Masher M, et al. Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trial. Trop Med Int Health 15:1148-1155, 2010.

Wagner CL, Greer FR. American Academy of Pediatrics, Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122:1142-1152, 2008.

Perrine CG, Sharma AJ, Jefferds ME, Serdula MK, Scanlon KS. Adherence to vitamin D recommendations among US infants. Pediatrics 125:627-632, 2010.


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