BACKGROUND: Low serum concentrations of 25-hydroxyvitamin D correlate with higher susceptibility to acute respiratory tract infections (ARTIs). The case study presented here aims at sheding light on the correlation between vitamin D levels, the vitamin D supplement dose, and the incidence of ARTIs. CASE REPORT: A 23-year-old female patient with a vitamin D insufficiency was able to successfully increase her vitamin D levels from 45.60 nmol/l to 85.91 nmol/l (reference ranges 75-200 nmol/l) through the use of supplements. However, it was surprising to observe a decrease in vitamin D levels even though the patient continued taking supplements. Further examination indicated that the patient was experiencing common symptoms of an acute respiratory tract infection (ARTI). This case highlights the intricate connection between ARTIs and vitamin D intake. CONCLUSION: This case study clearly demonstrates the intricate connection between vitamin D levels, supplement treatment, and ARTIs. The observed decrease in vitamin D levels during the course of supplementation, while the patient was suffering from an ARTI, suggests that respiratory infections may affect vitamin D metabolism.

Department of Immunochemistry University Hospital and Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Immunochemistry University Hospital and Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic;

Department of Pharmacology and Toxicology Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Zobrazit více v PubMed

Tazinya AA, Halle-Ekane GE, Mbuagbaw LT, Abanda M, Atashili J, Obama MT. Risk factors for acute respiratory infections inchildren under five years attending the Bamenda Regional Hospital in Cameroon. BMC Pulm Med. 2018;18(1):7. doi: 10.1186/s12890-018-0579-7. PubMed DOI PMC

Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA. 2009;302(7):758–766. doi: 10.1001/jama.2009.1163. PubMed DOI PMC

Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006;134(6):1129–1140. doi: 10.1017/S0950268806007175. PubMed DOI PMC

Jolliffe DA, Griffiths CJ, Martineau AR. Vitamin D in the prevention of acute respiratory infection: Systematic review of clinical studies. J Steroid Biochem Mol Biol. 2013;136:321–329. doi: 10.1016/j.jsbmb.2012.11.017. PubMed DOI

Hansdottir S, Monick MM, Hinde SL, Lovan N, Look DC, Hunninghake GW. Respiratory epithelial cells convert inactive vitamin D to its active form: potential effects on host defense. J Immunol. 2008;181(10):7090–7099. doi: 10.4049/jimmunol.181.10.7090. PubMed DOI PMC

Olliver M, Spelmink L, Hiew J, Meyer-Hoffert U, Henriques-Normark B, Bergman P. Immunomodulatory effects of vitamin D on innate and adaptive immune responses to Streptococcus pneumoniae. J Infect Dis. 2013;208(9):1474–1481. doi: 10.1093/infdis/jit355. PubMed DOI

Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015;7(6):4240–4270. doi: 10.3390/nu7064240. PubMed DOI PMC

Hewison M. Antibacterial effects of vitamin D. Nat Rev Endocrinol. 2011;7(6):337–345. doi: 10.1038/nrendo.2010.226. PubMed DOI

Bergman P, Lindh AU, Björkhem-Bergman L, Lindh JD. Vitamin D and respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2013;8(6):e65835. doi: 10.1371/journal.pone.0065835. PubMed DOI PMC

Charan J, Goyal JP, Saxena D, Yadav P. Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012;3(4):300–303. doi: 10.4103/0976-500X.103685. PubMed DOI PMC

Mao S, Huang S. Vitamin D supplementation and risk of respiratory tract infections: A meta-analysis of randomized controlled trials. Scand J Infect Dis. 2013;45(9):696–702. doi: 10.3109/00365548.2013.803293. PubMed DOI

Xiao L, Xing C, Yang Z, Xu S, Wang M, Du H, Liu K, Huang Z. Vitamin D supplementation for the prevention of childhood acute respiratory infections: a systematic review of randomised controlled trials. Br J Nutr. 2015;114(7):1026–1034. doi: 10.1017/S000711451500207X. PubMed DOI

Altonen BL, Arreglado TM, Leroux O, Murray-Ramcharan M, Engdahl R. Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City. PLoS One. 2020;15(12):e0243343. doi: 10.1371/journal.pone.0243343. PubMed DOI PMC

Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC. Annual high-dose oral vitamin D and falls and fractures in older women. JAMA. 2010;303(18):1815. doi: 10.1001/jama.2010.594. PubMed DOI

Płudowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sokół D, Czech-Kowalska J, Dębski R, Decsi T, Dobrzańska A, Franek E, Głuszko P, Grant WB, Holick MF, Yankovskaya L, Konstantynowicz J, Książyk JB, Księżopolska-Orłowska K, Lewiński A, Litwin M, Lohner S, Lorenc RS, Lukaszkiewicz J, Marcinowska-Suchowierska E, Milewicz A, Misiorowski W, Nowicki M, Povoroznyuk V, Rozentryt P, Rudenka E, Shoenfeld Y, Socha P, Solnica B, Szalecki M, Tałałaj M, Varbiro S, Żmijewski MA. Practical guidelines for the supplementation of vitamin d and the treatment of deficits in central Europe - recommended vitamin d intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4):319–327. doi: 10.5603/ep.2013.0012. PubMed DOI

Charoenngam N, Holick MF. Immunologic effects of vitamin D on human health and disease. Nutrients. 2020;12(7):2097. doi: 10.3390/nu12072097. PubMed DOI PMC

Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, Martucci G, Pilz S, Malle O. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11):1498–1513. doi: 10.1038/s41430-020-0558-y. PubMed DOI PMC

Koundourakis NE, Androulakis NE, Malliaraki N, Margioris AN. Vitamin D and exercise performance in professional soccer players. PLoS One. 2014;9(7):e101659. doi: 10.1371/journal.pone.0101659. PubMed DOI PMC

Ranchordas MK, Bannock L, Robinson SL. Case study: Nutritional and lifestyle support to reduce infection incidence in an international-standard premier league soccer player. Int J Sport Nutr Exerc Metab. 2016;26(2):185–191. doi: 10.1123/ijsnem.2015-0146. PubMed DOI

Luxwolda MF, Kuipers RS, Kema IP, van der Veer E, Dijck-Brouwer DA, Muskiet FA. Vitamin D status indicators in indigenous populations in East Africa. Eur J Nutr. 2013;52(3):1115–1125. doi: 10.1007/s00394-012-0421-6. PubMed DOI

van Groningen L, Opdenoordt S, van Sorge A, Telting D, Giesen A, de Boer H. Cholecalciferol loading dose guideline for vitamin D-deficient adults. Eur J Endocrinol. 2010;162(4):805–811. doi: 10.1530/EJE-09-0932. PubMed DOI

Mann EH, Chambers ES, Pfeffer PE, Hawrylowicz CM. Immunoregulatory mechanisms of vitamin D relevant to respiratory health and asthma. Ann N Y Acad Sci. 2014;1317(1):57–69. doi: 10.1111/nyas.12410. PubMed DOI

Ao T, Kikuta J, Ishii M. The effects of vitamin D on immune system and inflammatory diseases. Biomolecules. 2021;11(11):1624. doi: 10.3390/biom11111624. PubMed DOI PMC

Henriksen VT, Rogers VE, Rasmussen GL, Trawick RH, Momberger NG, Aguirre D, Barker T. Pro-inflammatory cytokines mediate the decrease in serum 25(OH)D concentrations after total knee arthroplasty. Med Hypotheses. 2014;82(2):134–137. doi: 10.1016/j.mehy.2013.11.020. PubMed DOI

Silva MC, Furlanetto TW. Does serum 25-hydroxyvitamin D decrease during acute-phase response? A systematic review. Nutr Res. 2015;35(2):91–96. doi: 10.1016/j.nutres.2014.12.008. PubMed DOI

Sommer A, Fabri M. Vitamin D regulates cytokine patterns secreted by dendritic cells to promote differentiation of IL-22-producing T cells. PLoS One. 2015;10(6):e0130395. doi: 10.1371/journal.pone.0130395. PubMed DOI PMC

Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5(7):2502–2521. doi: 10.3390/nu5072502. PubMed DOI PMC

Karatekin G, Kaya A, Salihoğlu O, Balci H, Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009;63(4):473–477. doi: 10.1038/sj.ejcn.1602960. PubMed DOI

Feng X, Lv C, Wang F, Gan K, Zhang M, Tan W. Modulatory effect of 1,25-dihydroxyvitamin D 3 on IL1 β -induced RANKL, OPG, TNF α , and IL-6 expression in human rheumatoid synoviocyte MH7A. Clin Dev Immunol. 2013;2013:160123. doi: 10.1155/2013/160123. PubMed DOI PMC

Korf H, Wenes M, Stijlemans B, Takiishi T, Robert S, Miani M, Eizirik DL, Gysemans C, Mathieu C. 1,25-Dihydroxyvitamin D3 curtails the inflammatory and T cell stimulatory capacity of macrophages through an IL-10-dependent mechanism. Immunobiology. 2012;217(12):1292–1300. doi: 10.1016/j.imbio.2012.07.018. PubMed DOI

Guo T, Wang Y, Guo Y, Wu S, Chen W, Liu N, Wang Y, Geng D. 1, 25-D(3) protects from cerebral ischemia by maintaining BBB permeability via PPAR-γ activation. Front Cell Neurosci. 2018;12:480. doi: 10.3389/fncel.2018.00480. PubMed DOI PMC

Guillot X, Semerano L, Saidenberg-Kermanac’h N, Falgarone G, Boissier M. Vitamin D and inflammation. Joint Bone Spine. 2010;77(6):552–557. doi: 10.1016/j.jbspin.2010.09.018. PubMed DOI

Aranow C. Vitamin D and the immune system. J Invest Med. 2011;59(6):881–886. doi: 10.2310/jim.0b013e31821b8755. PubMed DOI PMC

Liu L, Xie K, Yin M, Chen X, Chen B, Ke J, Wang C. Lower serum levels of vitamin D in adults with urinary tract infection. Infection. 2022;50(3):739–746. doi: 10.1007/s15010-021-01750-2. PubMed DOI

Bradley R, Schloss J, Brown D, Celis D, Finnell J, Hedo R, Honcharov V, Pantuso T, Peña H, Lauche R, Steel A. The effects of vitamin D on acute viral respiratory infections: A rapid review. Adv Integr Med. 2020;7(4):192–202. doi: 10.1016/j.aimed.2020.07.011. PubMed DOI PMC

Saeed BQ, Jairoun AA, Ashraf Khamis A, Hatim Abdelrahim L, Abobakr Aljomhi A, Adrees AO, Saeed Fahady K, Saleh Al-Hajjaj M. Vitamin D deficiency and insufficiency among university students: prevalence, risk factors, and the association between vitamin D deficiency and episodes of respiratory tract infections. Risk Manag Healthc Policy. 2021;14:2733–2741. doi: 10.2147/RMHP.S308754. PubMed DOI PMC

Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC, Grant CC, Janssens W, Jensen ME, Kerley CP, Laaksi I, Manaseki-Holland S, Mauger D, Murdoch DR, Neale R, Rees JR, Simpson S, Stelmach I, Trilok Kumar G, Urashima M, Camargo CA, Griffiths CJ, Hooper RL. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis. Health Technol Assess. 2019;23(2):1–44. doi: 10.3310/hta23020. PubMed DOI PMC

Pham H, Rahman A, Majidi A, Waterhouse M, Neale RE. Acute respiratory tract infection and 25-hydroxyvitamin D concentration: a systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16(17):3020. doi: 10.3390/ijerph16173020. PubMed DOI PMC

Abioye AI, Bromage S, Fawzi W. Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis. BMJ Glob Health. 2021;6(1):e003176. doi: 10.1136/bmjgh-2020-003176. PubMed DOI PMC

Jolliffe DA, Camargo CA Jr, Sluyter JD, Aglipay M, Aloia JF, Ganmaa D, Bergman P, Bischoff-Ferrari HA, Borzutzky A, Damsgaard CT, Dubnov-Raz G, Esposito S, Gilham C, Ginde AA, Golan-Tripto I, Goodall EC, Grant CC, Griffiths CJ, Hibbs AM, Janssens W, Khadilkar AV, Laaksi I, Lee MT, Loeb M, Maguire JL, Majak P, Mauger DT, Manaseki-Holland S, Murdoch DR, Nakashima A, Neale RE, Pham H, Rake C, Rees JR, Rosendahl J, Scragg R, Shah D, Shimizu Y, Simpson-Yap S, Trilok-Kumar G, Urashima M, Martineau AR. Vitamin D supplementation to prevent acute respiratory infections: a systematic review and meta-analysis of aggregate data from randomised controlled trials. Lancet Diabetes Endocrinol. 2021;9(5):276–292. doi: 10.1016/S2213-8587(21)00051-6. PubMed DOI