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.

Contents:

  1. Essay on the Meaning of Pellagra
  2. Essay on the Clinical Features of Pellagra
  3. Essay on the Diagnosis of Pellagra
  4. Essay on the Laboratory Findings of Pellagra
  5. Essay on the Prognosis of Pellagra
  6. Essay on the Treatment of Pellagra
  7. 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:

Skin:

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.

Digestive System:

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.

Nervous System:

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.


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