Vitamin C Deficiency Linked to Poor Lung Recovery and Delayed Tuberculosis Clearance, Study Finds

Patients with low vitamin C levels had slower recovery, with only 68% achieving bacterial clearance at six months versus 89.8% in those with normal levels. They also showed more lung damage—bronchiectasis, fibrosis, and cavitary lesions—and greater declines in lung function, including a 12% drop in forced vital capacity and a larger decrease in the Tiffeneau index (3.34 vs. 2.13).

Vitamin C is essential for a robust immune response to tuberculosis, and its deficiency can elevate the risk of TB and related complications. Despite its importance, the connection between vitamin C levels and the severity of TB has not been thoroughly explored.

Ramona Cioboata, Department of Pneumology, University of Medicine and Pharmacy of Craiova, Craiova, Romania, and colleagues sought to bridge this gap by investigating the relationship between vitamin C deficiency, disease severity, and imaging findings in TB patients. The study highlighted that low vitamin C levels were linked to worse disease outcomes, underscoring the critical role of this nutrient in both the immune response and overall TB management.

For this purpose, the researchers enrolled 109 patients with confirmed pulmonary tuberculosis, diagnosed through Mycobacterium tuberculosis culture. The participants were divided into two groups based on their serum vitamin C levels: 59 patients (54.13%) with normal levels and 50 patients (45.87%) with low levels.

The study revealed the following findings:

• At baseline, patients with low vitamin C levels had higher bacillary loads, with 86% showing loads of 2+ or higher, compared to 59.32% in the normal group.
• After two months, 83.05% of the normal vitamin C group achieved culture conversion, while only 28% of the low vitamin C group reached this milestone.
• CT scans at baseline showed that the low vitamin C group had a higher frequency of the tree-in-bud pattern (2.66 vs. 2.05).
• The low vitamin C group also had more cavitary lesions, especially in the superior right and left lobes.
• After six months, the low vitamin C group had a higher prevalence of bronchiectasis (0.58 vs. 0.16), cavitary lesions (0.32 vs. 0.00), and fibrosis (0.90 vs. 0.36).
• Pulmonary function tests revealed greater impairment in the low vitamin C group, with a 5.77% decrease in forced expiratory volume, a 12% reduction in forced vital capacity (FVC), and a 3.34-point drop in the Tiffeneau index.
• Receiver operating characteristic (ROC) analysis showed that FVC and forced expiratory flow were stronger predictors of treatment success in patients with normal vitamin C levels.

The authors concluded that vitamin C deficiency in tuberculosis patients is associated with greater disease severity, delayed bacterial clearance, and persistent lung damage. They suggested vitamin C supplementation could support standard TB therapy and improve outcomes.

However, they acknowledged limitations such as the study’s observational design, small sample size, and potential confounding factors like diet, smoking, and comorbidities. They called for larger, randomized trials to confirm these findings and establish causality.

Reference:

Cioboata, R., Balteanu, M. A., Zlatian, O. M., Vlasceanu, S. G., Driga, M. V., Mitroi, D. M., Catana, O. M., Buciu, C. I., Camen, G., & Mirea, A. A. (2025). Impact of vitamin C deficiency on imaging patterns and ventilatory function in pulmonary tuberculosis. Frontiers in Medicine, 12, 1554723. https://doi.org/10.3389/fmed.2025.1554723