In this essay we will discuss about the Pellagra:- 1. Meaning of Pellagra 2. Clinical Features of Pellagra 3. Diagnosis 4. Laboratory Findings 5. Prognosis 6. Treatment 7. Prevention.
- Essay on the Meaning of Pellagra
- Essay on the Clinical Features of Pellagra
- Essay on the Diagnosis of Pellagra
- Essay on the Laboratory Findings of Pellagra
- Essay on the Prognosis of Pellagra
- Essay on the Treatment of Pellagra
- Essay on the Prevention of Pellagra
Essay # 1. Meaning of Pellagra:
Pellagra is nutritional disease endemic among poor peasants who subsist chiefly on maize. It has been called the disease of the three Ds: dermatitis, diarrhoea and dementia. But diarrhoea and mental changes are not always present in mild arid early cases and the rhental symptom is usually depression and not dementia.
The clinical features are loss of weight, increasing debility, an erythematous dermatitis characteristically affecting parts of the skin exposed to sunlight, gastro-intestinal disturbance especially diarrhoea and glossitis, and mental changes.
Essay # 2. Clinical Features of Pellagra:
a. There is an erythema resembling severe sunburn, especially the backs of the hands, the wrists, the forearms, face and neck.
b. Exposure to trauma or mechanical irritation of the skin, especially over bony prominences, may also determine the site of the lesion.
c. The skin in the affected areas is at first red and slightly swollen; it itches and burns.
d. In acute cases the skin lesions may progress to vesiculation, cracking, exudation and crusting with ulceration and sometimes secondary infection ; but in chronic cases the dermatitis occurs as a roughening and thickening of the skin with dryness, scaling and brown pigmentation.
a. There is usual digestive upset; and diarrhoea is not always present.
b. There may be nausea, a burning sensation in the epigastrium, and sometimes constipation in chronic cases.
c. The digestive symptoms may be aggravated by the presence of intestinal parasites.
d. The mouth is sore and often shows angular stomatitis and cheilosis.
e. The tongue characteristically has a ‘raw beef appearance-red, swollen and painful, though usually without loss of papillae.
f. Secondary infection of the mouth with Vincent’s organisms is common.
g. A non-infective inflammation followed by mucosal atrophy may involve the gastrointestinal tract and account for the diarrhoea which is characteristically profuse and watery, sometimes with blood and mucus in the stools.
h. The rectum and anus are frequently affected and chronic gastritis with reduction or absence of acid secretion is a common finding.
i. Vaginitis and amenorrhoea may occur.
a. In mild cases the symptoms consist of weakness, tremor, anxiety, depression and irritability; in severe acute cases delirium is common and dementia occurs in the chronic form.
b. In chronic cases there may be decreased sensation in the feet to touch and loss of vibration and position sense. The loss of position sense may give rise to ataxia.
c. Spasticity and exaggerated tendon reflexes give evidence of involvement of the pyramidal tracts. The features are those of sub acute combined degeneration of the cord and may be due to associated Vitamin Bl2 deficiency.
Essay # 3. Diagnosis of Pellagra:
a. The skin lesions are of diagnostic importance since they are only found in pellagra, whereas the gastrointestinal and mental features may be present in many other diseases. A variety of erythema’s and exfoliative skin lesions may mimic pellagra.
The two characteristic features of cutaneous pellagra are its symmetrical distribution, determined by the clothes of the patient and exposure to sunlight, and the therapeutic response to nicotinic acid.
b. A nutritional glossitis identical with the tongue changes seen in pellagra may occur without the other signs of the disease in people who have been all the times indoors, out of sunlight.
c. Pellagra is a disease affecting poor people on bad diets. Hence it is often accompanied by signs of protein energy malnutrition by anaemia and by deficiencies of thiamine and other vitamins. These together with chronic infections may complicate the clinical picture.
Essay # 4. Laboratory Findings of Pellagra:
The fasting plasma tryptophan ranges from 1 to 4.8 mg/I in pellagrins and from 6.5 to 8.8 mg/I in healthy adults. Plasma tryptophan may prove to be a convenient test for confirming a diagnosis of pellagra.
Essay # 5. Prognosis of Pellagra:
Mental symptoms, especially dementia, are the most serious features and may be permanent. Occasionally a fulminating form develops, with fever and severe prostration which can be fatal. In the past many deaths were due to secondary infections (notably tuberculosis and dysentery) or to emaciation due to general dietary failure, intensified by the diarrhoea.
Essay # 6. Treatment of Pellagra:
a. Nicotinic acid or nicotinamide are the standard treatment for quick relief of symptoms. Nicotinamide is to be preferred because it does not cause the unpleasant flushing and burning sensations that often result from taking nicotinic acid. These are transitory and harmless, but may alarm the patient.
The vitamin is rapidly absorbed from the stomach, despite severe digestive disorders. There is no need to give intravenous or intramuscular injections. The immediate response to nicotinamide is usually dramatic; within 24 hours the erythema diminishes, the tongue becomes paler and less painful and the diarrhoea ceases.
Often there is striking improvement in the patients’ behavior and mental attitude. But nicotinamide alone is usually insufficient to restore health due to other associated deficiencies, notably of protein and other components of Vitamin B complex.
Therefore, B complex should be given as a routine and if there are signs of peripheral neuropathy or sub acute combined degeneration of the cord larger doses of thiamine or Vitamin B12 are indicated.
b. To restore the patient to normal weight, the diet should provide ample energy and good quality protein, as is present in milk, eggs, meat or fish. In severely ill patients it is necessary to climb the dietetic ladder cautiously.
The food should be low in bulk to avoid further diarrhoea. The diet may be poorly tolerated because of the mental state of the patient and the sore mouth which may make eating difficult. Alcohol should be forbidden.
c. Rest in bed and sedation are necessary for severely ill pellagrins, especially those with marked mental symptoms. If the dermatitis is associated with much crusting or secondary infection, gentle washing with a bland solution is indicated.
Essay # 7. Prevention of Pellagra:
a. Enrichment of maize meal with vitamins is technically simple and inexpensive but is difficult to implement for subsistence farmers who grow their own maize. It is wise to avoid dependence on a single cereal crop, such as maize.
b. Animal husbandry should be encouraged in all areas where pellagra is endemic so that the production of milk and milk products, and meat is increased. Encouraging the planting of opaque-2 maize may help. It contains about three times as much tryptophan and twice as much lysine as conventional maize.