PLoS One. 2014 Dec 3;9(12):e113185. doi: 10.1371/journal.pone.0113185. eCollection 2014.
Cusick SE1, Opoka RO2, Lund TC1, John CC1, Polgreen LE3.
1Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America.
2Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America; Department of Paediatrics, College of Health Sciences, Makerere University, Kampala, Uganda.
3Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor, University of California Los Angeles, Los Angeles, California, United States of America.
Vitamin D plays an increasingly recognized role in the innate and adaptive immune response to infection. Based on demonstrated roles in up-regulating innate immunity, decreasing inflammation, and reducing the severity of disease in illnesses such as tuberculosis and influenza, we hypothesized that poor vitamin D status would be associated with severe malaria. We measured 25-hydroxyvitamin D [25(OH)D] by immunoassay in a sample of Ugandan children aged 18 months-12 years with severe malaria (cerebral malaria or severe malarial anemia, n = 40) and in healthy community children (n = 20). Ninety-five percent of children with severe malaria (n = 38) and 80% of control children (n = 16) were vitamin D-insufficient [plasma 25(OH)D <30 ng/mL]. Mean plasma 25(OH)D levels were significantly lower in children with severe malaria than in community children (21.2 vs. 25.3 ng/mL, p = 0.03). Logistic regression revealed that for every 1 ng/mL increase in plasma 25(OH)D, the odds of having severe malaria declined by 9% [OR = 0.91 (95% CI: 0.84, 1.0)]. These preliminary results suggest that vitamin D insufficiency may play a role in the development of severe malaria. Further prospective studies in larger cohorts are indicated to confirm the relationship of vitamin D levels to severity of malaria infection and to investigate causality.