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. 2025 Apr 29:12:1554723.
doi: 10.3389/fmed.2025.1554723. eCollection 2025.

Impact of vitamin C deficiency on imaging patterns and ventilatory function in pulmonary tuberculosis

Ramona Cioboata #  1   2 , Mara Amalia Balteanu #  3 , Ovidiu Mircea Zlatian  4 , Silviu Gabriel Vlasceanu  5 , Mircea Vasile Popescu Driga  4 , Denisa Maria Mitroi  6 , Oana Maria Catana  6 , Cezar Ionut Buciu  6 , Georgiana Camen  7 , Adina Andreea Mirea  8
Affiliations

Impact of vitamin C deficiency on imaging patterns and ventilatory function in pulmonary tuberculosis

Ramona Cioboata et al. Front Med (Lausanne). .

Abstract

Background: Studies have shown that vitamin C is essential for the immune response to tuberculosis (TB), and that its deficiency may elevate the risk of TB and related complications. This prospective study investigated the association between disease severity, imaging findings and vitamin C levels.

Methods: This study enrolled 109 patients with confirmed pulmonary tuberculosis based on Mycobacterium tuberculosis culture. Patients were divided into two groups based on serum vitamin C levels: 59 patients (54.13%) with normal levels and 50 (45.87%) with low levels.

Results: At baseline, patients in the low vitamin C group showed significantly higher bacillar loads, with 86.00% presenting loads of 2+ or higher compared with 59.32% in the normal group (p < 0.001). After 2 months of treatment, 83.05% of the normal vitamin C group achieved culture conversion, while only 28.00% of the low vitamin C group reached the same milestone (p < 0.001). CT imaging at baseline revealed that the low vitamin C group had a significantly higher mean frequency of the tree-in-bud pattern (2.66 vs. 2.05; p < 0.001). Cavitary lesions were more prevalent in the low vitamin C group, in the superior right lobe (0.34 vs. 0.13; p = 0.011) and superior left lobe (0.34 vs. 0.14; p = 0.012). After 6 months of treatment, the low vitamin C group exhibited a higher prevalence of bronchiectasis (mean involvement in both lungs: 0.58 vs. 0.16; p < 0.001), cavitary lesions (0.32 vs. 0.00; p = 0.002), and fibrosis (0.90 vs. 0.36; p < 0.001). Pulmonary function tests showed greater impairment in the low vitamin C group. The forced expiratory volume decreased by 5.77% compared to 3.59% in the normal group (p < 0.001), the forced vital capacity (FVC) decreased by 12.00% vs. 6.67% (p < 0.001), and the Tiffeneau index by 3.34 vs. 2.13 (p = 0.002). Receiver operating characteristic (ROC) analysis indicated that FVC (AUC = 0.826) and forced expiratory flow (AUC = 0.745) were stronger predictors of treatment success in patients with normal vitamin C levels.

Conclusion: Vitamin C deficiency is correlated with increased disease severity, delayed bacterial clearance, and persistent pulmonary damage in patients with tuberculosis. Vitamin C supplementation can enhance treatment outcomes in tuberculosis therapy.

Keywords: CT scan; chest imaging; pulmonary tuberculosis; spirometry; vitamin C.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Criteria used to determine the final cohort of study participants.
FIGURE 2
FIGURE 2
Timely evolution of the microscopy acid-fast bacilli (AFB) load in sputum of the patients with low and normal levels of vitamin C. AFB smear microscopy stands for microscopical Mtb load with semiquantitative assessment from 0 to 3+.
FIGURE 3
FIGURE 3
Timely evolution of the culture acid-fast bacilli (AFB) load in sputum of the patients with low and normal levels of vitamin C. AFB smear microscopy stands for microscopical Mtb load with semiquantitative assessment from 0 to 3+.
FIGURE 4
FIGURE 4
Pulmonary computed tomography (CT) lesions at baseline.
FIGURE 5
FIGURE 5
Pulmonary computed tomography (CT) lesions after 6 months of anti-tuberculosis (TB) treatment.
FIGURE 6
FIGURE 6
Comparison of pulmonary computed tomography (CT) lesions at baseline and after 6 months of treatment.
FIGURE 7
FIGURE 7
Receiver operating characteristic (ROC) analysis of pulmonary function parameters.
See this image and copyright information in PMC

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