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PubMed1989

Interaction of niacin and zinc metabolism in patients with alcoholic pellagra.

The effect of zinc supplementation on the metabolism of tryptophan conversion to niacin was studied in 14 alcoholic patients with pellagra and in 7 male control subjects aged 21-45 y. The pellagrins received chemically defined diets based on crystalline amino acids through an enteral tube for 7 d. Patients were divided into two groups (A and B), both receiving a diet from which tryptophan, Zn, and niacin were excluded. Patients in group B, however, received 220 mg Zn sulfate orally. Upon admission the pellagra patients had low plasma Zn levels and low urinary excretion values of N'methylnicotinamide (N'MN) and N'methyl-2-pyridone-5-carboxamide (2-PYR) in relation to the control subjects (p less than 0.01). During the experimental period there was an increase in plasma Zn levels (p less than 0.005) and in urinary N'MN (p less than 0.05) and 2-PYR (p less than 0.05) excretion in the patients receiving Zn supplementation (group B). These results suggest that Zn interacts with niacin metabolism in alcoholic patients with pellagra through a probable mediation by vitamin B-6.

Adult↗
PubMed1977

Nutritional influences of pellagra on sebum composition.

Sebum composition has been measured in 51 patients with varying degrees of pellagra and compared with a control group of subjects in the same geographic area. In the pellagra group the wax ester percentage was 14-9 versus the normal of 21-9%. The squalene percentage was increased in the pellagra group (11-6%) versus a control value of 8-4%. A small increase in the percentage of cholesterol was also noted. These changes, which previously have been observed in starved but otherwise normal subjects, were reversible with adequate refeeding.

Adult↗
PubMed2004

Pellagra: dermatitis, dementia, and diarrhea.

Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 "D's": diarrhea, dermatitis, dementia, and death. Diagnosis of pellagra is difficult in the absence of the skin lesions, and is often facilitated by the presence of characteristic ones. The dermatitis begins as an erythema. Acute pellagra resembles sunburn in its first stages, but tanning occurs more slowly than typically in sunburn. Exacerbation follows re-exposure to sunlight. In this work we review the findings of this once mysterious disorder, one that still challenges clinicians world-wide.

Dermatitis↗
PubMed1991

Alcoholic pellagra encephalopathy combined with Wernicke disease.

Clinical and postmortem findings of a case that had combined alcoholic pellagra encephalopathy and Wernicke disease are described. This 51-year-old malnourished and chronic alcoholic man presented with progressive mental deterioration, pellagra dermatitis, hypertonus of the neck and other musculatures, myoclonic jerks with bizarre involuntary movements, in addition to total external ophthalmoplegia and gait disturbance. After administration of multivitamins, including thiamine and nicotinamide, these neurologic abnormalities were dramatically improved in a few days. However, the patient died thereafter because of sepsis associated with pneumonia. Postmortem examination revealed marked abnormalities in CNS, characterized by diffuse atrophy of gray matter and widespread neuronal degeneration and characteristic central chromatolysis in pontine nuclei, dentate nuclei, cranial nerve nuclei in the brain stem, Betz cells of the cerebral cortex, and Clarke's column and anterior horn cells of the spinal cord. There were also atrophy and gliosis of the mammillary bodies, degeneration and vascular proliferation of periaqueductal gray matter, and massive gliosis around the third ventricle. These neuropathological changes were compatible with symptoms of both alcoholic pellagra encephalopathy and Wernicke's disease, but they were also strongly suspected on clinical grounds.

Alcoholism↗
PubMedDate not supplied

[Pellagra: a disease resurging in Zaire. A study of 231 cases (author's transl)].

231 cases of pellagra among 8,000 consulting patients has been observed from May 1977 to June 1978 in the Dermatological Dispensary of the Hospital G.E.C.A.-Mines of Lumbumbashi (Zaire). This disease by nutritional deficiency can be easily recognized especially through its dermatological symptomatology. It occurs mainly in young patients fed solely on maize, but the most severe cases have been observed in prisoners. Three age groups seem particularly prone to pellagra: children after weaning, pubescent adolescents in quick growing age, grown-up women during pregnancy and lactation. Vitaminotherapy is effective in a few days; a simultaneous treatment of intestinal parasites has to be required. The incidence of this endemic pellagra worsened after the war of May 1978, reaching 7 p. 100 among the population around the main towns of the province Shaba.

Adolescent↗
PubMed1982

[Drug-induced pellagra].

In industrialized countries pellagra may nowadays be induced by inappropriate diet schedules, alcohol abuse, endogenous disorders of metabolism, and also intake or abuse of drugs. In particular, INH, hydantoine, and other anticonvulsive drugs may induce pellagra by causing disorders in vitamin B metabolism. On this pathway disorders of tryptophan metabolism may also occur. We report here on a woman who developed pellagra after long-term abuse of analgetics and psychopharmaca obviously due to disorders in gastrointestinal resorption and liver metabolism. Phenobarbital, salicylic amide, phenacetin, possible also diazepam, induced the disease most likely. The clinical diagnosis was confirmed by low blood levels of niacinamide. Discontinuation of drug medication and systemic application of vitamin preparations were followed by full remission in 6 weeks.

Diazepam↗
PubMed1982

Pellagra as the presenting manifestation of Crohn's disease.

An 18-yr-old woman hospitalized with classical signs of pellagra was found to have Crohn's disease of the small and large bowel as well as malabsorption of nicotinic acid and iron. The symptoms of pellagra disappeared after intramuscular treatment with nicotinic acid, while the malabsorption was corrected following steroid therapy for the Crohn's disease. Pellagra should thus be added to the list of complications of Crohn's disease that are secondary to malabsorption. Although this complication seems to be very rare, it may be worthwhile to check for nicotinic acid malabsorption in untreated cases of Crohn's disease in order to determine its real prevalence.

Adolescent↗
PubMed1995

Assessment of zinc nutritional status of pellagra patients.

The objective of the present study was to assess zinc nutritional status in alcoholic patients with pellagra using plasma, hair, urine and nail zinc levels, as well as the zinc tolerance test. The study was conducted on 81 patients, 73 males and eight females. Zinc parameters were compared with those of 84 individuals with no apparent disease aged 23-45 years. Plasma zinc levels were lower in patients with pellagra than in the controls (P < 0.01). The results of the zinc tolerance test showed that: (1) basal zinc levels were 69.7 +/- 16.8 micrograms/100 ml in pellagrins and 82.3 +/- 34.0 micrograms/100 ml in the controls (P < 0.01); (2) after 1 h the increase in plasma levels was similar in the pellagrin and control groups; (3) during the second hour the increase was more marked in the controls (P < 0.01), and the same was observed during the third and fourth hours (P < 0.05). Urinary zinc excretion (mg/24 h) was higher in pellagrins (P < 0.01). Zinc concentration in hair and toenails did not differ between pellagrins and controls. We conclude that pellagrins present zinc deficiency as demonstrated by plasma and urine zinc levels and by their abnormal response to the zinc tolerance test. We suggest that hair and nail zinc levels should not be used to assess zinc nutritional status in patients with pellagra.

Adult↗
PubMed1976

D-xylose absorption and jejunal morphology in African patients with pellagra (niacin tryptophan deficiency).

D-xylose absorption tests and jejunal morphology have been shown to be unaltered in 12 African patients with pellagra when compared with normal values for Zambian Africa adults; that result is contrary to two previous investigations in India and Egypt respectively. A significant inverse association has been shown, however, between D-xylose absorption and serum immunoglobulin IgG and IgA concentrations; that is consistent with previous studies and probably reflects malabsorption of xylose in the presence of systemic infections. It is concluded that pellagra per se does not alter intestinal structure or monosaccharide absorption.

Humans↗
PubMed1989

The prevention and conquest of scurvy, beri-beri, and pellagra.

I have described how many years of research were needed to overcome three nutritional diseases that occurred throughout the world. When human beings migrated from tropical and subtropical regions to the temperate zone, they lost their year-round supplies of vitamin C, and scurvy began to occur. The emergence of beri-beri had a mechanical basis; the introduction of milling, which prevented the rancidity of rice and wheat, also removed the essential vitamin B1. The circumstance leading to the third deficiency disease was reliance on maize, without supplementing it with "protective" foods, such as meat, milk, and vegetables. Under conditions of poverty, the protective foods became expensive, and pellagra appeared. Synthetic chemistry, together with improvements in the diet and in education, largely overcame scurvy, beri-beri, and pellagra, but deficiencies of vitamins A, C, and folic acid still occur widely in economically disadvantaged populations, and this is a challenge to those who wish to improve public health. The brilliant prophesies of Casimir Funk, made in 1912, were fulfilled within 25 years. Today, his word "vitamin" is universally familiar. The account of the discovery, identification and synthesis of the vitamins is the story of how human beings have overcome nutritional deficiencies that were imposed by cultural and economic disadvantages or just plain ignorance. These discoveries were a triumph of science and technology. Much of the research depended on the use of experimental animals: guinea-pigs, rats, dogs, monkeys, and chickens. Vitamins are now added to the diets of both animals and human beings.

Beriberi↗
PubMed2005

[Pellagra and panniculitis induced by chronic bacterial colonisation of the small intestine].

INTRODUCTION: Pellagra is an exceptional disorder in France. The classical description of pellagra associates a photoinduced rash with neurological impairment and intestinal dysfunction. Without adapted treatment, the progression is fatal. CASE REPORT: A 62 year-old women developed a photoinduced rash, composed of circular and erythematous elements with pustular edges. She also had panniculitis, peripheral neuropathy, depressive mood and diarrhea. Her medical past was marked by epilepsy treated with sodium valproate and hydantoin. Biological exams revealed lowered plasma levels of vitamins PP, B1, B6 and zinc, secondary to intestinal impairment induced by bacteria proliferating in the small intestine. The rash resolved with vitamin PP and zinc supplementation. The bacterial colonisation was improved by long-term, sequential antibiotics. DISCUSSION: We report a rare clinical form of pellagroid rash. The rash was induced by chronic malabsorption resulting from excessive bacterial proliferation in the diverticules of the small intestine. The antiepileptic treatment could have facilitated vitamin PP et zinc deficiency. Panniculitis was related to the bacterial proliferation. We discuss in this paper the relationship between some vitamin deficiencies, their clinical manifestations and the direct role of intestinal bacterial proliferation in the cutaneous manifestations.

Anti-Bacterial Agents↗
PubMed1975

Plasma amino acid pattern in pellagra.

Plasma free amino acid levels were determined in subjects suffering from pellagra and compared with levels observed in normal subjects of both low and high socioeconomic groups. In pellagrins, a wide variation was seen in the plasma levels of tryptophan and these levels overlapped considerably with those in the low socioeconomic group controls. Administration of 5 g L-leucine daily for 5 days to normal subjects belonging to the low socioeconomic group did not affect the plasma tryptophan levels. These data suggest that the pellagragenic action of leucine is not mediated through changes in circulating levels of tryptophan. They also indicate that a low level of plasma tryptophan per se may not be a reliable biochemical indicator in the diagnosis of pellagra.

Adult↗
PubMed1987

Tryptophan deficiency and picolinic acid: effect on zinc metabolism and clinical manifestations of pellagra.

In five experiments, rats were fed tryptophan (Tryp)-deficient diets with 6-12 micrograms/g zinc (Zn) and, in one experiment, a Zn-deficient diet to test the effect on clinical manifestations, plasma and bone Zn, and ability of picolinic acid (PA) or extra (12 micrograms/g) Zn to compensate. Tryp deficiency caused classical manifestations of pellagra although niacin intake was in excess of normal requirements. At marginal Zn intakes, oral PA caused a significant increase of plasma Zn and, compared with Tryp-adequate controls, Tryp deficiency resulted in lower plasma Zn and plasma:bone Zn ratios. Extra Zn (total 24 micrograms/g) was ineffective. Subcutaneous PA showed a tendency to lower plasma Zn. PA had no effect on clinical manifestations. We conclude that a Tryp metabolite other than nicotinic acid is necessary in the prevention of pellagra. Our hypothesis links this finding with the observed Tryp and PA effect on Zn metabolism.

Animals↗
PubMed1993

An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi.

Between February and October 1990, 18,276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285,942 Mozambican refugees in Malawi. Overall, 6.3% of the refugee population developed pellagra and the attack rate was 7.8 times higher among women than men. This outbreak followed a 5-month cessation of groundnut distribution (the major source of niacin) to refugees. A matched-pair case-control study confirmed the protective role of the daily consumption of groundnuts (Odds Ratio [OR] = 0.08), as well as the independent role of garden ownership (OR = 0.34), and home maize milling (OR = 0.3). Recommended corrective action included early case finding and treatment, distribution of niacin tablets, prompt identification of groundnut supply on the world market, fortification with niacin of the food ration and diversification of the food basket through access to local markets.

Adolescent↗
PubMed2004

Pellagra: a rare disease observed in a victim of mental and physical abuse.

Lesions of the brain stem and cerebellum due to nutritional deficiencies are mostly seen in chronic alcohol abuse and more rarely in severe malnutrition. We report the case of a 27-year-old woman, found dead in the family flat. She presented cachexia (167 cm, 25 kg) and multiple hematomas of the limbs. Postmortem examination revealed lesions due to peritonitis. Neuropathological examination showed severe atrophy of the corpus callosum and central neuronal chromatolysis, which are observed in pellagra. Inflammatory colitis or celiac disease was not found. Toxicological analysis was negative, in particular no alcohol absorption. Pellagra, which is due to nicotinamide deficiency, is a disease rarely seen in this country. In this case, nutritional deficiency was the consequence of failure to eat in a context of abuse. The woman was born of an incestuous relationship and presented intellectual retardation due to poor affective relations with her mother.

Adult↗
PubMed1991

Pellagra in a patient with an eating disorder.

A case of pellagra is described that occurred in a patient with an eating disorder and who presented with marked photosensitivity and diarrhoea. We found urinary 5-hydroxy-indole-acetic acid to be low and suggest that this may be a useful screening test. To our knowledge this is only the second reported case of pellagra associated with an eating disorder.

Adult↗
PubMed1995

Pellagra complicating Crohn's disease.

We report a 53-year-old patient with clinical features of pellagra as a complication of Crohn's disease. His symptoms improved rapidly on taking oral nicotinic acid and vitamin B complex. We suggest the paucity of reported cases of pellagra in Crohn's disease is a reflection of poor recognition of this complication.

Crohn Disease↗
PubMed1996

Stages in the recognition of epidemic pellagra in the United States: 1865-1960.

Recognition of the U.S. pellagra "epidemic" in the early part of this century occurred in stages. The recognition process distorted impressions of magnitude, rate of spread, and virulence. Unrecognized cases: Endemic pellagra developed from dietary deficiencies after the Civil War. Initially, cases were misdiagnosed as other more traditional disorders. Tradition and authority inhibited recognition. Recognition of severe cases: Beginning in 1907, outbreaks were reported in asylums. Existing severe cases came rapidly to medical attention, inflating the apparent rate of spread. Recognized cases had a fulminant course and a high case fatality. Expanded spectrum: Milder cases were increasingly recognized, leading to an exaggerated rate of increase in number of cases and a decrease in case fatality and apparent virulence. Greater sensitivity resulted largely from a shift in diagnostic thresholds, with loss of specificity and increase in false positive diagnoses. Standardization of diagnosis: Although no suitable diagnostic marker test was developed, diagnosis was ultimately standardized by development of a workable case definition and by assessment of response to an effective therapy (nicotinic acid) applied to presumptive cases.

Disease Outbreaks↗