Assuntos
Fibrose Cística/diagnóstico , Kwashiorkor/diagnóstico , Dermatopatias/patologia , Fibrose Cística/complicações , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Exantema/patologia , Feminino , Doenças do Cabelo/patologia , Humanos , Lactente , Kwashiorkor/complicações , Desnutrição/complicações , Dermatopatias/etiologiaAssuntos
Abdome Agudo/diagnóstico , Kwashiorkor/diagnóstico , Síndrome da Realimentação/diagnóstico , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Abdome Agudo/cirurgia , Idoso de 80 Anos ou mais , Animais , Antiparasitários/uso terapêutico , Humanos , Perfuração Intestinal/etiologia , Ivermectina/administração & dosagem , Ivermectina/uso terapêutico , Doenças do Jejuno/patologia , Kwashiorkor/etiologia , Kwashiorkor/terapia , Masculino , Pneumoperitônio/diagnóstico , Complicações Pós-Operatórias , Síndrome da Realimentação/etiologia , Síndrome da Realimentação/terapia , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/microbiologia , Resultado do TratamentoRESUMO
We report a case of acquired protein energy malnutrition with associated zinc deficiency in an 18-month-old boy with type 1 glutaric acidemia. Physical examination findings included generalized nonpitting edema, widespread desquamative plaques, and sparse hair with a reddish tinge. Laboratory abnormalities included low levels of zinc, albumin, alkaline phosphatase, and iron. A review of skin manifestations of nutritional deficiencies, specifically kwashiorkor, is presented, as well as the relatively new entity called acrodermatitis dysmetabolica.
Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/diagnóstico , Encefalopatias Metabólicas/diagnóstico , Dermatite/diagnóstico , Glutaril-CoA Desidrogenase/deficiência , Desnutrição Proteico-Calórica/diagnóstico , Zinco/deficiência , Acrodermatite/diagnóstico , Erros Inatos do Metabolismo dos Aminoácidos/complicações , Biópsia , Encefalopatias Metabólicas/complicações , Dermatite/etiologia , Diagnóstico Diferencial , Humanos , Lactente , Kwashiorkor/diagnóstico , Masculino , Desnutrição Proteico-Calórica/etiologiaRESUMO
Kwashiorkor é um tipo de desnutrição proteico-energética em que há deficiência dietética de proteína, embora a ingestão de calorias se mantenha adequada. As manifestações cutâneas incluem pele xerótica, com aspecto de esmalte descascado, típica coloração avermelhada a branco-acinzentada dos cabelos, o sinal da bandeira e edema mais evidente, nos membros inferiores e na face, dando aspecto de lua cheia. O presente artigo relata o caso de um paciente adulto, do sexo masculino, previamente submetido à duodenopancreatectomia para tratamento de pancreatite crônica associada ao pseudotumor em cabeça de pâncreas que evoluiu com alterações cutâneas de kwashiorkor após tuberculose pulmonar.
Kwashiorkor is a type of protein-energy malnutrition where diet protein deficit is found, in spite of appropriate caloric intake. Cutaneous manifestations include xerosis, with abnormally dry skin that has a flaking enamel paint aspect, a typical red to gray-white hair color, the "flag sign" and more evident edema in lower limbs and face, giving it a full moon appearance. This article reports a case of a male adult patient who had undergone Whipple surgery for treatment of chronic pancreatitis associated with pseudotumor of the pancreatic head that progressed to cutaneous manifestations of kwashiorkor after pulmonary tuberculosis.
Assuntos
Adulto , Humanos , Masculino , Kwashiorkor/diagnóstico , Pancreaticoduodenectomia/efeitos adversos , Pancreatite Crônica/etiologia , Dermatopatias/etiologia , Tuberculose Pulmonar/etiologia , Doenças do Cabelo/diagnóstico , Kwashiorkor/etiologia , Pancreatite Crônica/cirurgia , Transtornos da Pigmentação/diagnósticoRESUMO
Kwashiorkor is a type of protein-energy malnutrition where diet protein deficit is found, in spite of appropriate caloric intake. Cutaneous manifestations include xerosis, with abnormally dry skin that has a flaking enamel paint aspect, a typical red to gray-white hair color, the "flag sign" and more evident edema in lower limbs and face, giving it a full moon appearance. This article reports a case of a male adult patient who had undergone Whipple surgery for treatment of chronic pancreatitis associated with pseudotumor of the pancreatic head that progressed to cutaneous manifestations of kwashiorkor after pulmonary tuberculosis.
Assuntos
Kwashiorkor/diagnóstico , Pancreaticoduodenectomia/efeitos adversos , Pancreatite Crônica/etiologia , Dermatopatias/etiologia , Tuberculose Pulmonar/etiologia , Adulto , Doenças do Cabelo/diagnóstico , Humanos , Kwashiorkor/etiologia , Masculino , Pancreatite Crônica/cirurgia , Transtornos da Pigmentação/diagnósticoRESUMO
Kwashiorkor is one of the severe forms of protein-energy malnutrition. Many characteristic dermatoses can be seen in children suffering from kwashiorkor, and some are pathognomonic. Here, we report an infant who presented with diarrhea and skin signs of kwashiorkor, and duodenal biopsy was consistent with Crohn's disease. The patient was treated with prednisolone administered orally in a tapering course plus azathioprine, in addition to nutritional supplementation. The general condition of the patient quickly improved and his skin lesions completely resolved within 2 weeks. Kwashiorkor is a serious potentially fatal disease that occurs less often in developed countries leading to low index of suspicion by physicians and pediatricians in those regions. Occasionally, dermatologists have the rare chance of alerting pediatricians to the diagnosis of kwashiorkor, thus making a difference in the care of this disease.
Assuntos
Doença de Crohn/complicações , Kwashiorkor/etiologia , Pele/patologia , Administração Oral , Azatioprina/administração & dosagem , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Lactente , Kwashiorkor/diagnóstico , Kwashiorkor/terapia , Masculino , Nutrição Parenteral/métodos , Prednisolona/administração & dosagemAssuntos
Granulomatose com Poliangiite/diagnóstico , Kwashiorkor/diagnóstico , Uretra/anormalidades , Obstrução do Colo da Bexiga Urinária/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Granulomatose com Poliangiite/terapia , Humanos , Lactente , Kwashiorkor/terapia , Masculino , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/terapia , Medição de Risco , Uretra/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgiaRESUMO
AIM: To identify risk factors for severe childhood malnutrition in a rural South African district with a high HIV/AIDS prevalence. DESIGN: Case-control study. SETTING: Bushbuckridge District, Limpopo Province, South Africa. PARTICIPANTS: 100 children with severe malnutrition (marasmus, kwashiorkor, and marasmic kwashiorkor) were compared with 200 better nourished (>-2 SD weight-for-age) controls, matched by age and village of residence. Bivariate and multivariate analyses were conducted on a variety of biological and social risk factors. RESULTS: HIV status was known only for a minority of cases (39%), of whom 87% were HIV positive, while 45% of controls were stunted. In multivariate analysis, risk factors for severe malnutrition included suspicion of HIV in the family (parents or children) (OR 217.7, 95% CI 22.7-2091.3), poor weaning practices (OR 3.0, 95% CI 2.0-4.6), parental death (OR 38.0, 95% CI 3.8-385.3), male sex (OR 2.7, 95% CI 1.2-6.0), and higher birth order (third child or higher) (OR 2.3, 95% CI 1.0-5.1). Protective factors included a diverse food intake (OR 0.53, 95% CI 0.41-0.67) and receipt of a state child support grant (OR 0.44, 95% CI 0.20-0.97). A borderline association existed for family wealth (OR 0.9 per unit, 95% CI 0.83-1.0), father smoking marijuana (OR 3.9, 95% CI 1.1-14.5), and history of a pulmonary tuberculosis contact (OR 3.2, 95% CI 0.9-11.0). CONCLUSIONS: Despite the increasing contribution of HIV to the development of severe malnutrition, traditional risk factors such as poor nutrition, parental disadvantage and illness, poverty, and social inequity remain important contributors to the prevalence of severe malnutrition. Interventions aiming to prevent and reduce severe childhood malnutrition in high HIV prevalence settings need to encompass the various dimensions of the disease: nutritional, economic, and social, and address the prevention and treatment of HIV/AIDS.
Assuntos
Infecções por HIV , Desnutrição , Aleitamento Materno , Estudos de Casos e Controles , Pré-Escolar , Características da Família , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Lactente , Kwashiorkor/diagnóstico , Kwashiorkor/epidemiologia , Kwashiorkor/etiologia , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/etiologia , Prevalência , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/epidemiologia , Desnutrição Proteico-Calórica/etiologia , Fatores de Risco , Fatores Socioeconômicos , África do Sul/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e QuestionáriosRESUMO
Aunque ancestralmente los jinetes bíblicos del hambre, la peste y la guerra han cabalgado juntos por el sendero de la historia, puede ser que las consecuencias de estas calamidades -desnutrición y muerte- hayan sido secularmente vistas de manera tan natural como la vida misma. Tal vez ésta sea la razón por la que hasta el siglo XIX -y para ser preciso, hasta 1865-, se documentó la primera descripción clínica de lo que ahora se conoce como desnutrición proteico-energética. La limitada difusión de este hallazgo dio lugar a que la enfermedad fuese redescubierta y descrita exitosamente en lengua inglesa en 1933. Un año después de creadas en 1949, la Organización Mundial de la Salud (OMS) y el Fondo para la Agricultura y la Alimentación (FOA) tomaron la decisión de unificar los criterios de diagnóstico de esta enfermedad e impulsar su investigación. En este ensayo se destacan algunos de los hitos en la historia del conocimiento científico de esta enfermedad
Assuntos
Humanos , Criança , Adolescente , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/história , Kwashiorkor/diagnóstico , Kwashiorkor/históriaAssuntos
Fenômenos Bioquímicos , Nutrição Enteral/efeitos adversos , Nutrição Parenteral/efeitos adversos , Distúrbios Nutricionais/complicações , Distúrbios Nutricionais/diagnóstico , Distúrbios Nutricionais/metabolismo , Distúrbios Nutricionais/terapia , Kwashiorkor/diagnóstico , Kwashiorkor/terapia , Apoio Nutricional , Apoio Nutricional/efeitos adversos , Apoio Nutricional/estatística & dados numéricosRESUMO
Kwashiorkor is a common affliction of children worldwide. It occurs less often in developed countries, but has been reported under a variety of circumstances, including poverty, neurologic disease, and malabsorption. Because of its rare occurrence in the United States and because the affected child has an edematous rather than wasted appearance, physicians often do not consider it as a diagnostic entity. This article describes a case of kwashiorkor in a child with food aversion that manifested as "flaky paint dermatitis." Our discussion will attempt to delineate underlying conditions that may predispose to kwashiorkor. In addition, biochemical and cellular etiologic factors that may be linked with classical and nonclassical skin findings of kwashiorkor are considered. Finally, we present a differential diagnosis for any child with a generalized eczematous or desquamative rash. Our aim is to increase the ability of health care providers to identify and treat children with kwashiorkor in a timely manner.
Assuntos
Dermatite/etiologia , Ingestão de Energia , Comportamento Alimentar/fisiologia , Ceratose/etiologia , Kwashiorkor/etiologia , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Kwashiorkor/diagnóstico , Transtornos da Pigmentação/etiologiaRESUMO
Golden and Ramdath proposed the free radical theory of kwashiorkor, suggesting that the changes seen in kwashiorkor may be the result of an imbalance between the production and safe disposal of free radicals. In malnourished children, mineral metabolism and antioxidant status need renewed attention especially in relation to cause and functional significance of the changes in concentration of these substances. In the present study, the modified Wellcome classification was used to classify the protein energy malnourished children into kwashiorkor marasmic-kwashiorkor, marasmus and underweight. Twenty-six healthy and normal children were used as controls. Standard procedures were used for the analyses of the biochemical parameters. Our results showed that plasma total cholesterol, sodium, potassium and bicarbonate, beta-carotene, retinol and uric acid were significantly lower in the malnourished group than the control group (P < 0.05), while transaminases were significantly increased in the malnourished group (P < 0.05). These findings suggest an altered electrolyte and antioxidant status in protein energy malnutrition.
Assuntos
Alanina Transaminase/sangue , Antioxidantes/metabolismo , Aspartato Aminotransferases/sangue , Transtornos da Nutrição Infantil/metabolismo , Colesterol/sangue , Eletrólitos/sangue , Kwashiorkor/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Análise de Variância , Bicarbonatos/sangue , Estudos de Casos e Controles , Transtornos da Nutrição Infantil/classificação , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Pré-Escolar , Hematócrito , Humanos , Lactente , Kwashiorkor/classificação , Kwashiorkor/complicações , Kwashiorkor/diagnóstico , Nigéria/epidemiologia , Avaliação Nutricional , Estado Nutricional , Potássio/sangue , Prevalência , Desnutrição Proteico-Calórica/classificação , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Sódio/sangue , Magreza/metabolismo , Ácido Úrico/sangue , Vitamina A/sangue , beta Caroteno/sangueRESUMO
Various alterations in hormonal levels have been suggested to contribute to the development of nutritional oedema and fatty liver in children with kwashiorkor. We present an infant who underwent near-total pancreatectomy at the age of 4 weeks and developed kwashiorkor after 11 weeks. The sequence of events following surgery can be divided into two phases. The first phase was characterized by hyperinsulinaemia and hypoglycaemia before feeds. During this phase, although the weight gain was slow (10 g/day) serum albumin (32 g/I) and prealbumin (0.23 g/I) concentrations were maintained with no oedema or hepatomegaly. In the second phase, insulin deficiency prevailed and he was receiving the same amount of milk (protein)/day (enriched with starch). During that phase he rapidly developed hypoalbuminaemia (18 g/l), hypoprealbuminaemia (0.1 g/l), oedema, hepatomegaly, and dermatosis. This case demonstrates clearly the important role of defective insulin secretion in the development of nutritional oedema and hepatomegaly.
Assuntos
Edema/etiologia , Hepatomegalia/etiologia , Insulina/sangue , Kwashiorkor/terapia , Edema/fisiopatologia , Hepatomegalia/fisiopatologia , Humanos , Lactente , Kwashiorkor/diagnóstico , Masculino , PancreatectomiaRESUMO
OBJECTIVES: To determine the presence of radical promoting iron (non-protein-bound or loosely bound or free iron) in the plasma of children with kwashiorkor. DESIGN: The bleomycin assay was employed for the quantitation of free or loosely bound iron. SETTING: The Red Cross War Memorial Children's Hospital, Cape Town, Tertiary Care. SUBJECTS: Fifty children on admission with kwashiorkor: six with marasmus and twelve healthy well-nourished controls. RESULTS: Non-protein-bound iron was detected in the plasma of 58% of children with kwashiorkor but was absent in marasmic and healthy well-nourished children. CONCLUSIONS: The presence of radical promoting iron supports the hypothesis that a free radical injury probably plays a role in the pathogenesis of kwashiorkor and its removal may improve mortality.
Assuntos
Ferro/sangue , Desnutrição Proteico-Calórica/sangue , Bleomicina , Estudos de Casos e Controles , Pré-Escolar , Humanos , Lactente , Kwashiorkor/sangue , Kwashiorkor/diagnóstico , Ligação Proteica , Desnutrição Proteico-Calórica/diagnósticoRESUMO
This prospective study aimed to determine differences in nutritional status, incidence of pressure sores, and incidence of mortality between two groups, one composed of 33 elderly, institutionalized patients with cancer and the other a matched group of 33 patients without cancer. Subjects with cancer were paired with subjects without cancer based on age (mean = 78), sex, and pressure sore risk. Skin breakdown, dietary intake, and blood and serum indices of nutritional status were studied for 12 weeks. Of the subjects with cancer, 85% developed pressure sores, compared to 70% of the subjects without cancer. Hemoglobin (Hgb) (female), serum total protein, total lymphocyte count, serum albumin, serum total iron binding capacity, and serum transferrin were significantly lower in subjects with cancer with pressure sores than in subjects without cancer with pressure sores. Total lymphocyte count and serum total protein were significantly lower in subjects with cancer with pressure sores than in subjects with cancer without pressure sores. Kwashiorkor was found in 70% of the subjects with cancer, compared to 21% of the subjects without cancer. During the study, 39% of the subjects with cancer and 15% of the subjects without cancer died. All 13 of the subjects with cancer who died had kwashiorkor and pressure sores and had died an average of three weeks after developing pressure sores. These results implicate that elderly patients with cancer who have protein deficiencies should be considered to be at risk of pressure sore development. Frequent repositioning and mattress overlays that reduce pressure and increase comfort may delay development of pressure sores.(ABSTRACT TRUNCATED AT 250 WORDS)