Vitamin D levels and monospot tests in military personnel with acute pharyngitis: a retrospective chart review

Sean R Maloney, David Almarines, Paula Goolkasian, Sean R Maloney, David Almarines, Paula Goolkasian

Abstract

Some recent studies have proposed an important role for vitamin D in reducing the risk of infection by assisting in the suppression of viruses and by controlling the inflammatory response. A low vitamin D state may have a detrimental effect on the immune system's ability to produce activated CD8+ T cells, and it may increase the inflammatory reaction to Epstein Barr virus. The aim of this chart review was to see if serum 25 OH vitamin D3 levels in service members with acute pharyngitis were lower in those who had positive rather than negative monospot tests. A retrospective chart review was conducted on the medical records of service members who presented to sick call at Camp Lejeune, NC with acute pharyngitis from October 8, 2010 until June 30, 2011. Serum 25 OH vitamin D3 levels were compared between those with positive and negative monospot test results. Of the 25 records that were reviewed, there were 9 (36%) service members with positive results, and they were found to have lower vitamin D levels (Median = 20.80 ng/ml, Interquartile range = 10.15) than those with negative test results (Median = 30.35 ng/ml, Interquartile range = 17.05), Mann-Whitney U = 41, p = .039. Only 1 of the 9 with positive test results had a normal serum 25 OH vitamin D3 level (30 ng/ml or greater) compared with 9 of the 16 with negative test results. Optimal vitamin D stores may play a significant role in reducing the risk of developing acute mononucleosis but larger, prospective studies will be needed to verify these findings.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Boxplots comparing Serum 25 OH…
Figure 1. Boxplots comparing Serum 25 OH vitamin D3 levels (upper panel) and age (lower panel) between those with acute pharyngitis who test positive and negative on the monospot test.

References

    1. Van Cauwenberge PB, Vander Mijnsbrugge A, Ebell MH (2004) Epstein-Barr virus infectious mononucleosis. American Family Physician 70: 1279–1287.
    1. Van Cauwenberge PB, Vander Mijnsbrugge A (1991) Pharyngitis: a survey of the microbiologic etiology. Pediatr Infect Dis J 10: S39–42.
    1. Candy B, Chalder T, Cleare AJ, Wessley S, White PD, et al. (2002) Recovery from infectious mononucleosis: a case for more than symptomatic therapy? A systematic review. Br J Gen Pract 52: 844–51.
    1. Amon W, Farrell PJ (2005) Reactivation of Epstein-Barr virus from latency. Rev Med Virol 15: 149–56.
    1. Cunha BA, Bronze MS, Levy CS, Talavera F, King JW (2013) Infectious mononucleosis workup. Available: . Accessed 2014 March 13.
    1. D’Alessandro DM, Alessandro MP. What causes a false Positive Monospot Test. Available: 2014 April 2.
    1. Adams JS, Hewison M (2008) Unexpected actions of vitamin D - new perspective on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab. 4: 1–17.
    1. Hewsin M (2010) Vitamin D and the intracrinology of innate immunity. Mol Cell Endocrinol. 321: 103–111.
    1. Bikle DD (2010) Vitamin D: newly discovered actions require reconsideration of physiologic requirements. Trends in Endocrinology and Metabolism. 21: 375–384.
    1. Moran-Auth Y, Penna-Martinez M, Shoghi F, Ramos-Lopez E, Badenhoop K (2013) Vitamin D status and gene transcription in immune cells. J Steroid Biochem Mol Biol. 136: 83–5.
    1. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357: 266–281.
    1. Gordon Y, Romanowski EG, Yates KA, Mcdermott AM (2004) Human cathelicidin(LL-37/hCAP-18) demonstrates direct antiviral activity against adenovirus and herpes simplex in vitro. Invest Ophthalmol Vis Sci 45: E-abstract 2256.
    1. Beard JA, Bearden A, Striker R (2011) Vitamin D and the anti-viral state. J Clin Virol 50: 194–200.
    1. Maloney CSR, Jensen S, Gil-Rivas V, Goolkasian P (2013) Latent viral immune inflammatory response model for chronic multisymptom illness. Med Hypotheses 80: 220–229.
    1. Pender MP (2012) CD8+ T-Cell Deficiency, Epstein-Barr virus infection, vitamin D deficiency, and steps to autoimmunity: A unifying hypothesis. Autoimmune Dis DOI:10.1155/2012/189096.
    1. Saizer J, Nystrom M, Hallmans G, Stenlund H, Wadell G, Sundstrom P (2013) Epstein-Barr virus antibodies and vitamin D in prospective multiple sclerosis biobank samples. Mult Scler. 19: 1587–91.
    1. Zwart SR, Mehta SK, Ploutz-Snyder R, Bourbeau Y, Locke JP, et al. (2011) Response to vitamin D supplementation during Antarctic winter is related to BMI, and supplementation can mitigate Epstein-Barr Virus Reactivation. J Nutr. 141: 692–697.
    1. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, et al. (2011) Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 96: 1911–1930.
    1. Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, et al. (2007) The effects of seasonal variation of 25-hydroxyvitamin D and fat mass on a diagnosis of vitamin D sufficiency. Am J Clin Nutr 86: 959–964.
    1. Shoben AB, Kestenbaum B, Levin G, Hoofnagle AN, Psaty BM, et al. (2011) Seasonal variation in 25-hydroxyvitamin D concentrations in the cardiovaxcular health study. Am J Epidemiol. 174: 1363–1372.
    1. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A (2006) Serum 25-Hydroxyvitamin D Levels and Risk of Multiple Sclerosis. JAMA. 296: 2832–2838.

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