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2.
Pan Afr Med J ; 33: 195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692657

RESUMO

Pellagra is a nutritional disorder of niacin deficiency which is characterized by triad of dermatitis, diarrhea and dementia. It is often seen in a state of poor nutrition among alcoholics, homeless and patients suffering from malabsorption. Though seldom occurs in children, its re-emerging is seen as a result of worsening food security in vulnerable population during conflict or insurgency. We report the case of 12-year-old female pastoralist who presented darkening and thickening of the hands, feet, ankles, neck and her upper trunk. Conflicts and insurgency usually occur in resource constraint settings where health workers are few and overworked. Therefore, continuously educating health workers and the general public regarding nutrition and its disorders like pellagra is a priority. Public Health authorities and policy makers also ought to take pediatric nutrition serious in order to avoid its escalation in internally displaced persons or children orphaned by insurgency.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Niacina/deficiência , Pelagra/diagnóstico , Criança , Feminino , Humanos
3.
Rev Med Suisse ; 15(672): 2125-2130, 2019 Nov 20.
Artigo em Francês | MEDLINE | ID: mdl-31746568

RESUMO

In elderly or chronically ill patients, nutritional deficiencies are common and the presence of related skin lesions is not unusual. Recognition of such cutaneous involvement is important regarding the diagnosis essentially based on clinical elements. By using some clinical case reports, we will describe several pathologies related to nutritional deficiencies like scurvy, pellagra and acquired acrodermatitis enteropathica.


Assuntos
Desnutrição/complicações , Desnutrição/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , Acrodermatite/etiologia , Acrodermatite/patologia , Doença Crônica , Humanos , Pelagra/etiologia , Pelagra/patologia , Escorbuto/etiologia , Escorbuto/patologia , Dermatopatias/diagnóstico
4.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570356

RESUMO

The case involves a 62-year-old female native of the USA with a history of bipolar disorder and chronic obstructive pulmonary disease who presented with intractable diarrhoea. Prior to the index admission, she was admitted to the intensive care unit and required pericardiocentesis for an idiopathic pericardial effusion with tamponade physiology. Following discharge, she suffered intractable diarrhoea and represented for medical evaluation. She had a painful, swollen tongue as well as persistent hypoglycaemia and required glucose infusions. She had adrenal function testing which revealed adrenal insufficiency. Vitamin testing revealed normal B12 and folate levels but undetectable levels of thiamine, riboflavin and niacin. Her symptoms and signs resolved entirely with appropriate vitamin supplementation. Niacin (vitamin B3) is essential for multiple metabolic pathways, and severe deficiency may cause clinical syndrome of pellagra which is most commonly associated with diarrhoea, delirium and dermatitis. Additional physiological derangements may include adrenal insufficiency, insulin hypersensitivity and pericarditis.


Assuntos
Diarreia/etiologia , Niacina/deficiência , Pelagra/diagnóstico , Tiamina/uso terapêutico , Língua/patologia , Complexo Vitamínico B/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Pelagra/tratamento farmacológico , Pelagra/fisiopatologia , Recidiva , Resultado do Tratamento
6.
Brain Nerve ; 71(4): 360-363, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-30988221

RESUMO

Pellagra is a type of dietary deficiency disease caused by an insufficiency of niacin or tryptophan. Symptoms of pellagra include diarrhea, dermatitis, and dementia. It is usually diagnosed based on a patient's dietary history and clinical symptoms. The diagnostic triad of pellagra includes symptoms of dermatitis, dementia, and diarrhea. Dermatitis is important for the diagnosis of this condition, because dementia and diarrhea show low specificity. In the modern era, pellagra rarely occurs in developed countries. However, pellagra should be considered in the differential diagnoses of dermatitis occurring on the sun-exposed areas of skin. Additionally, a hypoalimentation state with concomitant vitamin and/or zinc deficiency is observed in patients with pellagra. After checking the patient's overall nutritional status specifically with respect to pellagra, it is important to provide adequate food, supplemented with vitamins, zinc, and nicotinic acid to treat the patient's nutritional deficiencies.


Assuntos
Pelagra/patologia , Dermatopatias/etiologia , Dermatite/etiologia , Humanos , Niacina/deficiência , Pelagra/complicações
7.
Med Sante Trop ; 29(1): 68-70, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31031251

RESUMO

OBJECTIVE: The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcome and to document the causes of pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo. METHODS: This retrospective study examined the records of patients seen for outpatient consultation and/or hospitalization in the three public dermatology departments of Lomé from January 1997 to September 2017. RESULTS: During the study period, 178 (0.4%) of 47,219 patients seen in these dermatology departments consulted for pellagra or pellagra-like erythema; 159 (89.3%) had pellagra-like erythema. The patients' mean age was 45.8±16 years, and the sex ratio (M/F) 1.8. All patients had at least one site of cutaneous involvement, nearly always erythematous or pigmented lesions in the photo-exposed areas (99.4% of cases). Gastrointestinal and neurological signs were dominated respectively by diarrhea (12.4 % of cases), peripheral neuropathies (8.4% of cases) and insomnia (8.4% of cases). The main causes identified were alcoholism (42.1% of cases) and nutritional deficiency (6.7% of cases). Five of 178 patients were infected with HIV. All patients were treated with nicotinamide and multivitamin supplementation. No deaths were recorded during follow-up. CONCLUSION: Our results document the extreme rarity of pellagra-like erythema/pellagra. Its two main causes remain alcoholism and nutritional deficiency. Moreover, its prognosis is good when treated quickly and adequately.


Assuntos
Alcoolismo/complicações , Eritema/epidemiologia , Desnutrição/complicações , Pelagra/epidemiologia , Alcoolismo/epidemiologia , Diarreia/epidemiologia , Diarreia/etiologia , Eritema/etiologia , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Niacinamida/uso terapêutico , Pelagra/terapia , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Togo/epidemiologia , Complexo Vitamínico B/uso terapêutico
8.
Alcohol Alcohol ; 54(2): 148-151, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30721993

RESUMO

AIM: To define the prevalence and clinical presentation of pellagra, a multi-systemic disease caused by the deficiency of niacin, in patients admitted to a tertiary addiction treatment centre in southern India, with alcohol dependence syndrome (ADS)-(ICD10). METHODS: Review of the health records of 2947 patients who received inpatient care for ADS between 2015 and 2017. RESULTS: Out of 2947, 31 (1%) were diagnosed with pellagra. Nearly two-thirds (64.5%) of those with pellagra were from a low-income group. Of the clinical-triad of pellagra, all patients had dermatitis, more than half (58%) had delirium, a minority (19%) had diarrhoea. Nearly two-thirds (61%) had presented in a complicated-withdrawal state. Associated conditions included peripheral neuropathy (32%); Wernicke's encephalopathy (26%); seizures (16%).Seventeen (54%) had BMI <18.5 kg/m2. Treatment was a high dose of parenteral vitamins including niacin (mean dose: 1500 mg/day) for an average of 7.5 days followed by oral multivitamin supplements. All had complete resolution of pellagrous symptoms by the end of the three weeks of inpatient care. CONCLUSIONS: Pellagra is an acute medical condition, frequently encountered in the context of alcohol dependence and poverty. It often presents with other disabling and life-threatening comorbidities like delirium tremens and Wernicke's encephalopathy. The classical triad of pellagra is only seen in a minority of cases. Thus a high index of suspicion is required lest pellagra may remain undiagnosed. Prompt identification and treatment with a high dose of niacin in combination with other vitamins result in complete recovery.


Assuntos
Delirium por Abstinência Alcoólica/epidemiologia , Alcoolismo/epidemiologia , Síndrome de Korsakoff/epidemiologia , Pelagra/epidemiologia , Adulto , Alcoolismo/complicações , Comorbidade , Humanos , Índia/epidemiologia , Síndrome de Korsakoff/complicações , Niacina/uso terapêutico , Pelagra/complicações , Pelagra/diagnóstico , Pelagra/tratamento farmacológico , Pobreza/estatística & dados numéricos , Prevalência , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Vitaminas/uso terapêutico , Adulto Jovem
11.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567139

RESUMO

A 34-year-old previously well woman presented with a 4-week history of diffuse erythema and crusting of skin affecting all four limbs. Examination revealed erythematous skin plaques associated with ulceration and fissuring affecting sun-exposed areas of all four limbs primarily on the dorsal surfaces, and a body mass index of 17 kg/m2 She was admitted under the infectious diseases unit, and an autoimmune and infective screen was performed which returned unremarkable. Dietetic consultation led to the diagnosis of severe protein-energy malnutrition, consequent to a severely restricted, primarily vegan, diet. Analysis of the patient's reported diet with nutritional software revealed grossly suboptimal caloric intake with risk of inadequacy for most micronutrients, vitamins and minerals, including niacin. Oral thiamine, multivitamin, iron supplementation and vitamin B complex were started, and a single intramuscular vitamin B12 dose was administered. Marked improvement was seen after 6 weeks, with near-complete resolution of skin changes. These findings supported a diagnosis of pellagra.


Assuntos
Micronutrientes/deficiência , Niacina/deficiência , Pelagra/diagnóstico , Pele/patologia , Dieta Vegana/efeitos adversos , Eritema/etiologia , Eritema/patologia , Feminino , Compostos Ferrosos/administração & dosagem , Compostos Ferrosos/uso terapêutico , Humanos , Hidroxocobalamina/administração & dosagem , Hidroxocobalamina/uso terapêutico , Pelagra/tratamento farmacológico , Pelagra/patologia , Tiamina/administração & dosagem , Tiamina/uso terapêutico , Resultado do Tratamento , Complexo Vitamínico B/administração & dosagem , Complexo Vitamínico B/uso terapêutico
14.
Mult Scler Relat Disord ; 25: 104-107, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30059893

RESUMO

Neuromyelitis optica (NMO), also known as Devic's disease, is a classical autoimmune disorder of the central nervous system (CNS). The relapsing-remitting disease course contributes to application of a variety of immunosuppressants to prevent further relapses after high-dose methylprednisolone pulse therapy for acute attacks. Azathioprine is one of the most widely used immunosuppressive drugs during the remission stage of NMO due to its good efficacy and favorable side-effect profile. Even if, enough attention should be paid to some rare but devastating adverse events, such as pellagra. Herein, we reported that a well-nourished patient experienced serious pellagra while receiving oral azathioprine for treating her NMO. Moreover, literature on azathioprine-induced pellagra was reviewed to raise concerns regarding patient safety.


Assuntos
Azatioprina/efeitos adversos , Imunossupressores/efeitos adversos , Neuromielite Óptica/tratamento farmacológico , Pelagra/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade , Neuromielite Óptica/patologia , Pele/patologia
15.
Clin Exp Dermatol ; 43(7): 766-769, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29855062

RESUMO

During the Second World War, thousands of captured British and Commonwealth troops were interned in prisoner-of-war (POW) camps in the Far East. Imprisonment was extremely harsh, and prisoners developed multiple pathologies induced by physical hardship, tropical infections and starvation. Immediately after the war, several POW doctors published their clinical experiences, including reports of skin disease caused by malnutrition. The most notable deficiency dermatoses seen in Far East POWs were ariboflavinosis (vitamin B2 or riboflavin deficiency) and pellagra (vitamin B3 or niacin deficiency). A lack of vitamin B2 produces a striking inflammatory disorder of scrotal skin. Reports of pellagra in POWs documented a novel widespread eruption, developing into exfoliative dermatitis, in addition to the usual photosensitive dermatosis. A review of the literature from 70 years ago provides a reminder of the skin's response to malnutrition.


Assuntos
Desnutrição/história , Pelagra/história , Prisioneiros/história , Deficiência de Riboflavina/história , Dermatopatias/história , II Guerra Mundial , Extremo Oriente , História do Século XX , Humanos , Masculino , Desnutrição/complicações , Pelagra/patologia , Deficiência de Riboflavina/patologia , Escroto/patologia , Dermatopatias/etiologia , Reino Unido
17.
Adv Food Nutr Res ; 83: 83-149, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29477227

RESUMO

Nicotinic acid and nicotinamide, collectively referred to as niacin, are nutritional precursors of the bioactive molecules nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP). NAD and NADP are important cofactors for most cellular redox reactions, and as such are essential to maintain cellular metabolism and respiration. NAD also serves as a cosubstrate for a large number of ADP-ribosylation enzymes with varied functions. Among the NAD-consuming enzymes identified to date are important genetic and epigenetic regulators, e.g., poly(ADP-ribose)polymerases and sirtuins. There is rapidly growing knowledge of the close connection between dietary niacin intake, NAD(P) availability, and the activity of NAD(P)-dependent epigenetic regulator enzymes. It points to an exciting role of dietary niacin intake as a central regulator of physiological processes, e.g., maintenance of genetic stability, and of epigenetic control mechanisms modulating metabolism and aging. Insight into the role of niacin and various NAD-related diseases ranging from cancer, aging, and metabolic diseases to cardiovascular problems has shifted our view of niacin as a vitamin to current views that explore its potential as a therapeutic.


Assuntos
Niacina/administração & dosagem , Niacina/farmacologia , Pelagra/prevenção & controle , Envelhecimento/efeitos dos fármacos , Humanos , Neoplasias , Niacina/metabolismo , Fatores de Risco , Vitaminas/administração & dosagem , Vitaminas/metabolismo , Vitaminas/farmacologia
20.
J Emerg Med ; 53(4): 554-557, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28736097

RESUMO

BACKGROUND: Pellagra, which is caused by a deficiency of niacin and tryptophan, the precursor of niacin, is a rare disease in developed countries where alcoholism is a major risk factor due to malnutrition and lack of B vitamins. Although pellagra involves treatable dementia and psychosis, it is often underdiagnosed, especially in developed countries. CASE REPORT: In Japan, a 37-year-old man presented to the emergency department with altered mental status and seizures. Wernicke encephalopathy and alcohol withdrawal were suspected. The patient was treated with multivitamins, which did not include nicotinic acid amide, and oral diazepam. Despite medical treatment, his cognitive impairment progressively worsened, and eventually, pellagra was suspected. His response to treatment with nicotinic acid amide was substantial, and he was discharged without any long-term sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite the treatable dementia and psychosis, pellagra is often underdiagnosed, especially in developed countries and alcoholic patients. Pellagra should be routinely suspected in alcoholic patients because the response to appropriate treatment is typically dramatic.


Assuntos
Alcoolismo/complicações , Disfunção Cognitiva/etiologia , Pelagra/complicações , Adulto , Serviço Hospitalar de Emergência/organização & administração , Comportamento Alimentar , Humanos , Japão , Masculino , Niacina/deficiência , Transtornos Psicóticos/etiologia , Complexo Vitamínico B/uso terapêutico , Deficiência de Vitaminas do Complexo B/complicações
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