ABSTRACT
El escorbuto es una enfermedad producida por déficit de vitamina C. Aunque es poco frecuente, en los últimos años observamos un incremento de casos en niños con trastornos de la conducta alimentaria. Sus manifestaciones son variadas, ya que esta vitamina actúa como cofactor en numerosos procesos, como la síntesis de colágeno. Las manifestaciones cutáneas características son las petequias, equimosis e hiperqueratosis. El compromiso mucoso se manifiesta como gingivitis con hipertrofia, hemorragias y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática. El objetivo de este trabajo es describir una cohorte de pacientes diagnosticados en los últimos años, manifestaciones clínicas y hallazgos en relación con su conducta alimentaria y trastornos del neurodesarrollo.
Scurvy is a disease caused by vitamin C deficiency. Although rare, in recent years, the number of scurvy cases in children with eating disorders has increased. Its manifestations are varied because vitamin C is a cofactor in numerous processes, such as collagen synthesis. The typical skin manifestations include petechiae, bruising, and hyperkeratosis. Mucosal involvement manifests as gingivitis with hypertrophy, bleeding, and loss of teeth. The diagnosis is based on clinical findings and may be confirmed by measuring plasma vitamin C levels. The objective of this study was to describe a cohort of patients diagnosed with scurvy in recent years, its clinical manifestations, and findings in relation to their eating behavior and neurodevelopmental disorders.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Scurvy/complications , Scurvy/etiology , Feeding and Eating Disorders/complications , Feeding and Eating Disorders/etiology , Food PreferencesABSTRACT
Scurvy is a disease caused by vitamin C deficiency. Although rare, in recent years, the number of scurvy cases in children with eating disorders has increased. Its manifestations are varied because vitamin C is a cofactor in numerous processes, such as collagen synthesis. The typical skin manifestations include petechiae, bruising, and hyperkeratosis. Mucosal involvement manifests as gingivitis with hypertrophy, bleeding, and loss of teeth. The diagnosis is based on clinical findings and may be confirmed by measuring plasma vitamin C levels. The objective of this study was to describe a cohort of patients diagnosed with scurvy in recent years, its clinical manifestations, and findings in relation to their eating behavior and neurodevelopmental disorders.
El escorbuto es una enfermedad producida por déficit de vitamina C. Aunque es poco frecuente, en los últimos años observamos un incremento de casos en niños con trastornos de la conducta alimentaria. Sus manifestaciones son variadas, ya que esta vitamina actúa como cofactor en numerosos procesos, como la síntesis de colágeno. Las manifestaciones cutáneas características son las petequias, equimosis e hiperqueratosis. El compromiso mucoso se manifiesta como gingivitis con hipertrofia, hemorragias y pérdida de piezas dentarias. El diagnóstico es clínico y puede confirmarse mediante la determinación de la vitamina C plasmática. El objetivo de este trabajo es describir una cohorte de pacientes diagnosticados en los últimos años, manifestaciones clínicas y hallazgos en relación con su conducta alimentaria y trastornos del neurodesarrollo.
Subject(s)
Scurvy , Humans , Scurvy/diagnosis , Scurvy/complications , Male , Female , Child , Child, Preschool , Adolescent , Feeding and Eating Disorders/complications , Feeding and Eating Disorders/etiology , Food Preferences , InfantABSTRACT
MAIN RESULTS: An outbreak of illness compatible with scurvy occurred among male prison inmates; most frequent signs/symptoms were edema and pain in lower limbs, difficulty in walking and hematoma/ecchymosis; the associated factor was age > 40 years. IMPLICATIONS FOR SERVICES: The results can contribute to the identification and description of scurvy outbreaks in other contexts and territories. Epidemiological studies of events like this enhance the practice of field epidemiology in health services. PERSPECTIVES: It is expected that the prevention of hypovitaminosis, such as scurvy, will be based on public policies aimed at the population deprived of liberty; and that the capabilities of health services to detect and respond to cases of the disease will be improved. OBJECTIVE: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. METHODS: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. RESULTS: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. CONCLUSION: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.
Subject(s)
Scurvy , Humans , Male , Adult , Case-Control Studies , Scurvy/epidemiology , Brazil/epidemiology , Prisons , Ecchymosis , Disease Outbreaks , Hematoma , PainABSTRACT
Despite its rarity, symptomatic micronutrient deficiency remains a public health problem. Scurvy is the differential diagnosis for bleeding disorders and hematological and rheumatological diseases, especially in patients with eating disorders. However, it is unrelated to autism spectrum disorders or other neurodevelopmental disorders. A previously healthy 10-year-old boy living in São Paulo, Brazil, had a history of significant food selectivity unrelated to autism spectrum disorder, resulting in symptomatic ascorbic acid deficiency (scurvy). This resulted in pain and purpuric lesions on the lower limbs, gingival edema, bleeding during tooth brushing, asthenia, weakness, malaise, and sadness. Therefore, dietary anamnesis is important for routine monitoring of child growth and development. This process helps prevent nutritional deficiencies, facilitates early diagnosis of eating disorders, and enables multidisciplinary follow-up for these patients.
Subject(s)
Autism Spectrum Disorder , Malnutrition , Scurvy , Male , Child , Humans , Scurvy/complications , Scurvy/diagnosis , Brazil , Diagnosis, DifferentialSubject(s)
Scurvy , Humans , Scurvy/complications , Scurvy/diagnosis , Scurvy/drug therapy , Ascorbic Acid/therapeutic use , VitaminsABSTRACT
Introduction: Scurvy is a disease resulting from a severe vitamin C deficiency, and its diagnosis is often challenging owing to nonspecific symptoms. Objective: encouraging dentists to reflect on systemic causes that may influence the oral manifestations of diseases. Emphasize that despite a disease from the last century, today you can still find vitamin deficiencies, and report of a case of Scurvy with gingival alterations. Case Report: A 30-year-old female patient sought dental care because she experienced sensitivity in her gums and bleeding. Intraoral examination revealed a slightly swollen gingiva which was erythematous, with friable consistency, and bled upon probing. Diseases such as anemia, hypovitaminosis, and AIDS, were considered within the diagnostic hypothesis of gingivitis. After hematological investigation, a very low level of vitamin C was detected, and scurvy was diagnosed. Vitamin C supplementation was then initiated in addition to the control of oral hygiene. After four months, clinical improvement was observed. Conclusion: Althou-gh there are few cases in the literature, oral surgeons must be aware of oral alterations associated with scurvy. The search for local and systemic etiological factors is important because changes in general health have a direct impact on oral tissues. (AU)
Subject(s)
Humans , Female , Adult , Scurvy , Gingivitis , Oral Manifestations , Ascorbic Acid Deficiency , AvitaminosisABSTRACT
La vitamina C o ácido ascórbico es imprescindible para el correcto funcionamiento del organismo. Los seres humanos no pueden sintetizarla; en consecuencia, dependen estrictamente de su aporte exógeno. Su déficit causa escorbuto, un cuadro que se manifiesta con fatiga, mialgias y poliartralgias, hemorragias en la piel y sangrado de las encías. Es una enfermedad infrecuente. La mayoría de los casos publicados corresponden a niños con restricciones alimentarias por trastornos del neurodesarrollo. La respuesta satisfactoria al aporte de ácido ascórbico confirma el diagnóstico. La sospecha de esta enfermedad evitaría exámenes complementarios innecesarios y el tratamiento temprano ayudaría a revertir los síntomas y prevenir complicaciones. Se presenta el caso de un varón de 13 años que consulta por dolor en ambas caderas con progresión hacia las rodillas, sumado a pérdida de la fuerza y hematomas en los miembros inferiores. El objetivo de esta presentación es resaltar la importancia de la anamnesis alimentaria completa y evitar un abordaje tardío con múltiples intervenciones. Nivel de Evidencia: IV
Vitamin C or ascorbic acid is essential for the correct functioning of the organism. As it cannot be synthesized by humans, it is obtained from external food sources. Deficiency of ascorbic acid produces scurvy, which includes symptoms as fatigue, myalgia and polyarthralgia, associated with skin hemorrhage and bleeding gums. Scurvy is a rare entity. Most of the reported cases involve children with food restrictions due to neurodevelopmental disorders. The early detection of the clinical signs of this condition would avoid unnecessary complementary tests, and early treatment would help reverse symptoms and prevent complications. Case Report: a 13-year-old male patient presented with pain in both hips radiating to the knees associated with loss of strength and hematomas in the lower limbs. Objective: to highlight the importance of a complete nutritional assessment to avoid a late approach with multiple interventions. Level of Evidence: IV
Subject(s)
Child , Scurvy , Arthralgia , Gait AnalysisABSTRACT
Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.
Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.
Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor< 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.
Subject(s)
Humans , Male , Adult , Middle Aged , Ascorbic Acid Deficiency/diagnosis , Scurvy/epidemiology , Disease Outbreaks , Prisoners , Avitaminosis/diagnosis , Brazil , Field EpidemiologyABSTRACT
El escorbuto es una enfermedad producida por déficit de vitamina C. Si bien en la actualidad es poco frecuente, la bibliografía describe grupos de riesgo en la población pediátrica, dentro de los que se encuentran los pacientes con alteraciones alimentarias. Se reporta el caso de un adolescente varón, de 11 años de edad, que desarrolló la enfermedad por un hábito alimentario selectivo, sin ingesta de frutas ni verduras. El objetivo del reporte es resaltar la importancia de la anamnesis alimentaria completa en la consulta con el equipo de salud, que permita sospechar y detectar de manera temprana y oportuna trastornos por déficit de micronutrientes como el escorbuto.
Scurvy is a disease caused by vitamin C deficiency. Although it is currently rare, risk groups in the pediatric population are described in the bibliography, including patients with eating disorders. We report the case of an 11-year-old male adolescent who developed the disease due to a selective eating habit, without fruits or vegetables. The objective of this report is to highlight the importance of complete food anamnesis in consultation with the health team, which allows to suspect and detect early and timely micronutrient deficiency disorders such as scurvy.
Subject(s)
Humans , Male , Child , Adolescent , Scurvy/diagnosis , Scurvy/etiology , Feeding and Eating Disorders , Risk Factors , Micronutrients , Feeding BehaviorABSTRACT
Scurvy is a disease caused by vitamin C deficiency. Although it is currently rare, risk groups in the pediatric population are described in the bibliography, including patients with eating disorders. We report the case of an 11-year-old male adolescent who developed the disease due to a selective eating habit, without fruits or vegetables. The objective of this report is to highlight the importance of complete food anamnesis in consultation with the health team, which allows to suspect and detect early and timely micronutrient deficiency disorders such as scurvy.
El escorbuto es una enfermedad producida por déficit de vitamina C. Si bien en la actualidad es poco frecuente, la bibliografía describe grupos de riesgo en la población pediátrica, dentro de los que se encuentran los pacientes con alteraciones alimentarias. Se reporta el caso de un adolescente varón, de 11 años de edad, que desarrolló la enfermedad por un hábito alimentario selectivo, sin ingesta de frutas ni verduras. El objetivo del reporte es resaltar la importancia de la anamnesis alimentaria completa en la consulta con el equipo de salud, que permita sospechar y detectar de manera temprana y oportuna trastornos por déficit de micronutrientes como el escorbuto. Palabras clave: escorbuto, vitamina C, deficiencia de ácido ascórbico, micronutrientes.
Subject(s)
Feeding and Eating Disorders , Scurvy , Adolescent , Child , Feeding Behavior , Humans , Male , Micronutrients , Risk Factors , Scurvy/diagnosis , Scurvy/etiologySubject(s)
Scurvy , Ascorbic Acid/therapeutic use , Child , Diet , Humans , Scurvy/diagnosis , Scurvy/etiologyABSTRACT
El término escorbuto procede de una palabra del antiguo escandinavo, scorbruck, que significa "hinchazones ulceradas". Es una entidad infrecuente en pediatría, causada por deficiencia nutricional exógena de ácido ascórbico. Los seres humanos, a diferencia de otros seres vivos, no pueden sintetizar la vitamina C y, en consecuencia, dependen estrictamente de su aporte exógeno. El escorbuto puede simular varios desórdenes reumatológicos. Aunque es poco común, puede presentarse como pseudovasculitis o artritis crónica. Para el diagnóstico en pacientes que presentan síntomas músculo esqueléticos se requiere un alto índice de sospecha. Se reporta el caso de un paciente masculino de 9 años que desarrolló la enfermedad por un hábito alimentario selectivo de larga evolución, sin ingesta de frutas ni verduras. El objetivo del presente reporte es alertar al pediatra acerca del desarrollo de escorbuto como potencial consecuencia de las dietas restrictivas, y la importancia de realizar una anamnesis alimentaria completa ante la sospecha diagnóstica
The term scurvy comes from a word from the old Scandinavian, scorbruck, which means ulcerated swellings. Scurvy is an infrequent entity in pediatrics caused by exogenous nutritional deficiency of ascorbic acid. Human beings, unlike other living beings, can not synthesize vitamin C and, consequently, they depend strictly on their exogenous contribution. Scurvy can simulate several rheumatological disorders. Although it is uncommon, it can present as pseudovasculitis or chronic arthritis. A high index of suspicion is required to diagnose patients with musculoskeletal symptoms. We report a case of a 9-year-old male patient who developed the disease due to a long-term selective eating habit, without fruits or vegetables intake. The objective of this report is to alert the pediatrician about the development of scurvy as a potential consequence of restrictive diets, and the importance of performing a complete dietary history to suspect diagnosis
Subject(s)
Humans , Child , Ascorbic Acid , Scurvy , Diet TherapyABSTRACT
Contexto: Escorbuto tem sido identificado, modernamente, com certa frequência devido ao aumento de fatores de riscos como neoplasias, bypass gástrico, quadros infecciosos, uso crônico de diuréticos, doenças neuropsiquiátricas, alcoolismo, dieta inadequada e progressivo envelhecimento populacional, com mais idosos morando sozinhos. Relato de caso: Apresentamos o caso de paciente pós-bariátrica, sexo feminino, 43 anos, cardiopata grave sob longa internação em uso de altas doses de diuréticos e drogas vasoativas, que desenvolveu púrpuras e equimoses espontâneas nos membros inferiores e no abdome. O tratamento com vitamina C endovenosa levou à melhora clínica das lesões e da condição hemodinâmica em três semanas. Discussão: O escorbuto se manifesta de forma insidiosa e pouco específica em pacientes com comorbidades crônicas. Alterações hemorrágicas (petéquias, equimoses, sangramento gengival), edema articular, fadiga, anorexia, anemia, xerose, e susceptibilidade a infecções, devem levar à suspeita clínica em pacientes de risco. Conclusão: Os clínicos devem estar atentos ao diagnóstico do escorbuto moderno, especialmente, em pacientes bariátricos.
Subject(s)
Humans , Female , Adult , Scurvy , Dermoscopy , Diagnosis , Bariatric Surgery , Heart DiseasesABSTRACT
El escorbuto es una enfermedad ocasionada por el déficit de vitamina C. La vitamina C, también llamada ácido ascórbico, actúa como cofactor de la propil-lisil hidroxilasa, enzima que interviene en la biosíntesis de colágeno; por ello es de vital importancia en la integridad estructural de piel, mucosas, anexos, vasos sanguíneos, huesos y dientes. Las manifestaciones clínicas incluyen síntomas constitucionales severos como debilidad y fatiga. Los hallazgos cutáneos iniciales son pápulas hiperqueratósicas foliculares y púrpura palpable perifolicular. Con el tiempo aparecen áreas extensas de equimosis, edema en miembros inferiores, hemorragias en astillas en uñas y alopecia difusa. Por lo general se describe esta enfermedad como asociada a tiempos pasados y extremadamente infrecuente en países desarrollados. Sin embargo, actualmente se ha detectado un aumento en el número de casos, asociados con malnutrición severa. Desórdenes psiquiátricos como la anorexia nerviosa, alcoholismo y deficiencias nutricionales por dietas excesivas y mal balanceadas o escasez de recursos económicos constituyen los principales factores de riesgo hoy en día. El tratamiento consiste en la corrección del déficit mediante la mediante suplementación con vitamina C vía oral. Presentamos una mujer de 24 años con escorbuto asociado a anorexia nerviosa y a dieta pobre en vegetales y fruta.
Scurvy is a disease caused by a deficit of vitamin C. Vitamin C, also called ascorbic acid, acts as a cofactor for propyl-lysyl hydroxylase, an enzyme that is involved in collagen biosynthesis, vitally important in the structural integrity of skin, mucous membranes, annexes, blood vessels, bones and teeth. Clinical manifestations include severe constitutional symptoms such as weakness and fatigue. The initial cutaneous findings are follicular hyperkeratotic papules and perifollicular palpable purpura. Over time, large areas of ecchymosis, edema of the lower limbs, splinter hemorrhages in nails and diffuse alopecia appear. Usually this disease is described as associated with past times and extremely uncommon in developed countries. However, the number of cases have been increasing, especially those associated with severe malnutrition. Psychiatric disorders such as anorexia nervosa, alcoholism and nutritional deficiencies due to excessive and poorly balanced diets or shortage of economic resources are the main risk factors nowadays. Correcting the deficit with oral vitamin C supplementation is the treatment of the disease. We present a 24-year-old woman with scurvy associated with anorexia nervosa and a diet low in vegetables and fruit.