Vitamin D Deficiency (VDD) and Susceptibility towards Severe Dengue Fever—A Prospective Cross-Sectional Study of Hospitalized Dengue Fever Patients from Lahore, Pakistan

Abstract

Dengue is a mosquito-borne flaviviral serious febrile illness, most common in the tropical and subtropical regions including Pakistan. Vitamin D is a strong immunomodulator affecting both the innate and adaptive immune responses and plays a pivotal role in pathogen-defense mechanisms. There has been considerable interest in the possible role of vitamin D in dengue viral (DENV) infection. In the present prospective cross-sectional study, we assessed a possible association between serum vitamin D deficiency (VDD) and susceptibility towards severe dengue fever (DF) illness. Serum vitamin D levels were measured at the time of hospitalization in 97 patients diagnosed with dengue fever (DF), dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) at Mayo Hospital, King Edward Medical University, Lahore, PK, from 16 November 2021 to 15 January 2022. In terms of disease severity, 37 (38.1%) patients were DF, 52 (53.6%) were DHF grade 1 and 2, and 8 (8.2%) were DSS. The results revealed that most patients (75 (77.3%)) were vitamin-D-deficient (i.e., serum level < 20 ng/mL), including 27 (73.0%) in DF, 41 (78.8%) in DHF grade 1 and 2, and 7 (87.5%) in DSS. The degree of VDD was somewhat higher in DSS patients as compared to DF and DHF grade 1 and 2 patients. Overall, serum vitamin D levels ranged from 4.2 to 109.7 ng/mL, and the median (IQR) was in the VDD range, i.e., 12.2 (9.1, 17.8) ng/mL. Our results suggest that there may be a possible association between VDD and susceptibility towards severe dengue illness. Hence, maintaining sufficient vitamin D levels in the body either through diet or supplementation may help provide adequate immune protection against severe dengue fever illness. Further research is warranted.

Analysis of essential hematological parameters and nutrient levels of dengue patients aiming for quick recovery and sustainable immunity

“…11 A study suggests that maintaining adequate vitamin D levels through diet or supplementation may provide adequate immune protection against severe dengue illness. 12,13 A study determined that 40% of subjects had a B12 level below 200 pg/L, potentially leading to severe thrombocytopenia, slower platelet count recovery, and prolonged hospitalization in dengue fever patients. 14 A study in India analyzed the serum proteome of dengue patients, revealing significant changes in several proteins with biological functions.…”

A comparative absorption study of sucrosomial® orodispersible vitamin D3 supplementation vs. a reference chewable tablet and soft gel capsule vitamin D3 in improving circulatory 25(OH)D levels in healthy adults with vitamin D deficiency—Results from a prospective randomized clinical trial

“…In recent years, the role of Vit D in immune and inflammatory responses has been extensively studied. Reported evidence suggests Vit D as an endogenous regulator of both innate and adaptive immunity (3)(4)(5)(7)(8)(9)(10)(11). Circulatory Vit D levels affect the proliferation and differentiation of immune cells, and its deficiency results in impaired immune response and increases the risk of developing immune-related diseases.…”

Role of Serum Vitamin D Level in the Progression of Dengue Viral Illness: A Potential Immunomodulator?: A Literature Review

“…Summary of a prospective cross-sectional study in Lahore, Pakistan assessing the vitamin D level in hospitalized patients with dengue illness According to the above table, we can conclude that the serum vitamin D level was somewhat lower in DSS patients in comparison to DF and DHF patients. There is a possible association between low serum vitamin D levels and as increased risk of severe dengue illness(Iqtadar et al, 2023) …”