Pellagra is a disease manifested due to a lack of vitamins or improper nutrition with a lack or deficiency in the diet of proteins, nicotinic acid and tryptophan amino acids.
The disease affects equally both adults and children. Mostly the poor are sick. Pellagra can safely be called a disease of three d - dermatitis, diarrhea, dementia, in English-language reference books it is often called a disease of 4 d and add death at the end.
Nicotinic acid and pellagra
After reading this, most people can misunderstand what does nicotine have to do with it, which is quite a dangerous poison. But, in fact, nicotinic acid is one of the most important vitamins, which plays a huge role in the functioning of the human body. In the nervous system, there are special receptors, the effect of which begins only if the body has a sufficient amount of nicotinic acid, which is produced by special bacteria in the human intestines. But, despite the fact that niacin (nicotinic acid) is also found in tobacco smoke, completely different compounds pass there and therefore are quite toxic. Internal organs suffer from it, there may be various pathologies in pregnant women, the manifestation of various diseases. Pellagra disease can also occur in smokers - they practically do not have their own synthesis.
Medical history
The meaning of the word "pellagra" in translation means rough skin. The disease became especially widespread in the 19th century in almost all European countries. At the end of the same century, the disease itself disappeared in France.
In one of the case histories, pellagra is described as follows: patients have “glass” eyes with a fixed look, and a pale face. Hands as after an extensive burn or wound - all in cracks and scars. Uncertain gait with a trembling head creates the appearance of a person with alcohol intoxication. One gets the feeling that they are driven by some kind of force - they either go in one direction, then they start to flee from the last forces quite directly, or they suddenly fall with a hysterical laughter or great sobs.
The main part of the disease occurred in villages and semi-isolated groups (orphanages, prisons, mental hospitals).
The main outbreaks of the disease occurred in the spring-summer period, so experts concluded that pellagra is infectious. In another country, this disease has been registered for generations in the same family, hence the conclusion that pellagra is hereditary.
After long observations, Dr. Goldberg found that in semi-closed groups with numerous pellagra diseases there were never any registrations about the attendance of this disease by staff. Therefore, the experience conducted by myself in 1916 by Professor D. Goldberg, together with 15 colleagues, proved that pellagra is a non-communicable disease. And after a while, a substance was found that successfully cures this disease - pellagra prevention factor or PP. But in reality, this substance was found back in 1873 by the scientist Weiner, but only after many years it became clear that PP and nicotinic acid are one and the same substance.
Vitamins in the human body
Vitamin B is a serious step among all the necessary trace elements. But the most significant is the help in the formation of ATP and various reactions. This vitamin lowers the level of bad cholesterol in the blood, thereby significantly reducing the risk of cardiovascular disease.
Niacin is the only vitamin recognized by traditional medicine as an independent drug and used in the treatment of various serious diseases.
A lack of B vitamins can provoke vitamin deficiency, this contributes to:
• Low content of nicotinic acid or nicotinamide with food entering the body.
• Violation of the function of absorption of vitamin in violation of the gastrointestinal tract in retirement age.
• Lack of tryptophan amino acids with unbalanced nutrition - without it, intestinal bacteria do not synthesize nicotinic acid.
• Alcohol addiction.
• Various malignant tumors.
• Permanent overwork and stress.
The role of trace elements in the human body
A lack of vitamin D helps to reduce appetite, unstable mood, digestive upset, and so on. A small amount of ultraviolet radiation causes a lack of vitamin D in the body, which is fraught with serious consequences. Contained in fish oil, butter.
The lack of vitamin E primarily affects the general condition of the skin, hair, nails. But also synthesis of all tissues of the human body is not complete without it - it improves the transportation of oxygen in the blood, prevents the occurrence of atherosclerosis, and contributes to the normal functioning of the genitals.
Vitamin E deficiency is rare. This antioxidant is found in sufficient quantities in vegetable oils, cereals, offal and herbs. Nevertheless, if the liver does not function well, for the proper absorption of vitamins, it is necessary to stimulate the secretion of bile.
A lack of vitamin K leads to a violation of blood coagulation and often there is increased bleeding. You can replenish the balance by including liver, spinach, leaf or cabbage, tomatoes and carrots in your diet.
Vitamin A deficiency. Deficiency symptoms manifest as “night blindness," people who suffer from this disease no longer see it at dusk, but can see it perfectly during daylight hours. If the deficit occurs sharply, then dry eyes are felt. Sometimes peeling or keratinization of not only the skin, but also of the mucous membranes, failure of the endocrine glands can begin - this is also affected by a lack of vitamin A. Symptoms pass quickly enough when regulating nutrition. Contained in animal oils, liver, fish oil, yolks, red carrots, tomatoes, fresh apricots. When boiling or pickling vitamins are stored, while drying, rapid destruction occurs.
To date, several stages of vitamin A deficiency are known, the symptoms of which are described below:
1. General disorder of internal organs, both all together and some. This is due to a decrease in performance and resilience.
2. Deficiency gradually begins to manifest. In clinical studies, it is already possible to accurately determine the lack of deficiency of substances in the body.
3. Insufficient or complete lack of vitamin or violation of its digestibility.
Various types of hypovitaminosis are currently quite common, mainly in the elderly, pregnant or lactating women, athletes, children working in physically hard work.
The role of vitamins in the human body is quite obvious, and neglecting these substances is dangerous to health.
Factors provoking the disease
• Skin damage by sunburn.
• Alcoholism.
• Various diseases of the gastrointestinal tract.
• Pregnancy or breastfeeding.
• Various infectious diseases.
• Imbalance in nutrition.
Diagnosis and clinic of the disease
The lack of vitamins in the body is formed over the years, all this time masquerading as a variety of diseases - from mental to nervous. With a lack of nicotinic acid, a person has chronic fatigue syndrome, a lack of appetite, a decrease in working capacity, and a sharp decrease in body weight.
And only after the lapse of time the patient begins to complain of insomnia, irritability, migraine and forgetfulness, there is a negative reaction to loud music, bright colors and light. It rushes from one extreme to another - from a melancholy state to an aggressive one.
All these abrupt mood changes often make people think of mental illness, and they try to force the patient to visit a psychiatrist.
In this case, it will be good if the disease reaches the stage of extensive clinical manifestations, and the doctor performs a thorough examination, which reveals symmetrical red spots with a flaky surface on the body and a bright raspberry tongue with a shiny surface, with imprints of teeth along the edges, various neuritis and backache ”, loss of sensitivity of any parts of the face.
Symptoms
In principle, the patient can turn to absolutely any specialist, because pellagra manifests itself in different ways. Her symptoms are as follows:
- A dermatologist will detect a swollen and itchy epithelium of a dark red color, on which blisters periodically form, which eventually burst and get wet, in appearance a couple of days later resemble pityriasis versicolor. But over time, the skin is desquamated, and at the same time deeper layers of the epithelium become visible, or completely discolored and resembles vitiligo. In our country, pellagra is a rather rare disease.
- Upon examination by a gastroenterologist of a patient with this disease, he will find minor ulcers in the oral cavity, brightly colored tongue, weight loss. And complaints of excessive salivation, loose stools with a putrid odor, nausea, decreased or lack of appetite, discomfort in the throat or esophagus will prompt specialists to conduct additional studies - sigmoidoscopy and / or fibrogastroduodenoscopy. According to the results of the analyzes, atrophy of the mucous membrane of the gastrointestinal tract will be visible, sometimes small bleeding sores are visible on the walls.
- At the final stage of the disease, patients visit a neurologist or psychiatrist. At this point, dementia begins to progress, which is accompanied by encephalopathy or psychosis, which is manifested by various hallucinations, delusions with paranoid inclinations and psychomotor agitation. Encephalopathic syndrome is accompanied by blurred consciousness, the appearance of an uncontrolled sucking or grasping reflex, and increased muscle tone.
Symptoms of pellagra will depend on what stage the victim will contact and which specialist will find it - a matter of chance.
The clinical picture of the disease is quite diverse and can be combined with the symptoms of other hypovitaminosis.
Pellagra, a photo of the common symptoms just below, is characterized by various oral ulcers, dermatitis, stool disorder and mental disorders of a different nature. That is, the symptoms are quite diverse. In adults with pellagra disease, symptoms are caused by weakness, apathy, a decrease or complete lack of appetite and, as a result, a decrease in body weight, irritability, and fatigue.
Stool disorder, changes in the mucosa and epidermis appear by the end of winter. After some time, if untreated, after the onset of symptoms, a burning sensation in the oral cavity and profuse salivation begins. Following this, swelling of the lips, mainly the lower one, with painful cracks appears. The mucous membrane of the oral cavity is hyperemic, and the gums and tongue are covered with small ulcers. The tongue is covered with a black-brown coating, but the tip and edges are bright red. Over time, the tongue completely turns red, a lacquered gloss appears. On the edematous tongue, the papillae are hypertrophied and visible as red dots; tooth prints are visible along the edges. After this, acute signs gradually decline, the mucous membrane turns pale, the papillae atrophy, but deep grooves may appear on the surface of the tongue. Skin lesions occur mainly in open areas.
Chronic pellagra: symptoms of this disease
Blisters, a thickening of the epidermis with a scaly surface, which then begins to pigment, thin out and eventually atrophy. In some cases, the manifestation of spinal-polyradiculoneuritic, cerebrospinal or polyneuritic syndrome is possible.
With this disease, depression is often happening, gradually turning into psychosis. This condition can last for years, with annual spring exacerbations, which can occur with various complications in the form of symptoms of typhoid fever or dysentery, in rare cases, scurvy develops.
Today in highly developed countries this is a rather rare occurrence. But in some regions of Africa or Asia, pellagra is a serious problem, nevertheless, local doctors find it even in the initial stages. To do this, it will be enough to take a urine test to determine the level of methylnicotinamide, as well as the amount of nicotinic acid in the blood and the content of b-group vitamins.
Treatment
Patients need to be in a hospital, where they are prescribed a certain table of approximately the following contents:
1. Protein diet with a high content of low-fat products, meat broths, chicken or quail eggs, as well as dairy or sour-milk products.
2. Drugs containing nicotinic acid. The method and dose depend on the severity of the disease and associated pathology.
3. In severe cases, strict adherence to bed rest is required.
4. Various preparations in which vitamin B is present in the required amount.
5. In severe advanced cases, a blood transfusion is recommended.
6. For current mental disorders, according to the expert, various tranquilizers and antidepressants are mainly used.
7. The patient should avoid a long time in the open sun until recovery.
If you do not pay attention to the existing signs of the disease and do not follow the treatment, then pellagra can kill a person in about five years.
Prevention
For preventive purposes, you need a complete balanced diet with the required amount of antipellagric factor in the food consumed. The daily requirement of an adult in vitamin PP is approximately 15–25 mg.
A sufficient amount of this vitamin is found in wheat, yeast, offal. Milk contains a lot of tryptophan, which in the body is easily synthesized into nicotinic acid.
For the prevention of chronic pellagra, parenteral administration of significant doses of the required vitamins into the body is required if there is a history of diseases that interfere with the normal absorption of nutrients by the body, or in the presence of chronic or acute infections. Therefore, the role of vitamins in the human body is quite important.
It follows that such a disease is easier to prevent than to diagnose and cure in time.