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At least 19 recordsLinked to original sources
PubMed1999

[Prevalence of HIV infection in patients with pellagra and pellagra-like erythemas].

Pellagra is a systemic disorder caused by severe niacin deficiency. While uncommon in Europe and North America, pellagra and pellagra-like erythema are frequently encountered in undernourished adults in poor African countries. The purpose of this three-year prospective study was to determine the prevalence of HIV infection in patients with pellagra. Between 1996 and 1998, all documented cases of pellagra and pellagra-like erythema diagnosed in the Dermatology Department and Internal Medicine Department of the Teaching Hospital in Lome, Togo were included. Patients underwent screening tests for HIV infection. During the study period, pellagra or pellagra-like erythema was diagnosed in a total of 108 patients (59 women and 49 men) with a mean age of 41 +/- 3.5 years (range, 18 to 68 years). Serology tests for HIV were positive in 6 of these patients (5.5 p. 100; mean age 35 years). In four asymptomatic patients with no opportunistic infection, detection of HIV was an incidental discovery. The other two patients had AIDS symptoms. The principal causes of pellagra were malnutrition (n = 30), alcoholism (n = 15), and combined malnutrition and alcoholism (n = 60). The findings of this study suggest that the incidence of HIV infection in patients with pellagra and pellagra-like erythema is low, i.e., not higher than in the general population. This study also confirms previous etiologic and epidemiological data concerning pellagra in poor countries, i.e., the preponderant role of nutritional deficiency.

Adolescent↗
PubMedDate not supplied

Politics and pellagra: the epidemic of pellagra in the U.S. in the early twentieth century.

The epidemic of pellagra in the first half of this century at its peak produced at least 250,000 cases and caused 7,000 deaths a year for several decades in 15 southern states. It also filled hospital wards in other states, which had a similar incidence but refused to report their cases. Political influences interfered, not only with surveillance of the disease, but also in its study, recognition of its cause, and the institution of preventive measures when they became known. Politicians and the general public felt that it was more acceptable for pellagra to be infectious than for it to be a form of malnutrition, a result of poverty and thus an embarrassing social problem. Retrospectively, a change in the method of milling cornmeal, degermination, which began shortly after 1900, probably accounted for the appearance of the epidemic; such a process was suggested at the time, but the suggestion was ignored.

Disease Outbreaks↗
PubMed1982

Tryptophan metabolism in alcoholic pellagra patients: measurements of urinary metabolites and histochemical studies of related muscle enzymes.

Biochemical and enzymatic aspects of tryptophan-niacin metabolism were studied in 15 adult alcoholic pellagra patients and in 14 controls. In addition to the clinical signs of niacin deficiency, most of the pellagra patients had other signs of malnutrition. Plasma tryptophan in pellagra patients was 2.07 +/- 1.27 mumol/dl, and in the controls 4.84 +/- 2.21 mumol/dl (p less than 0.001). The erythrocyte glutamic oxaloacetic transaminase index was 1.94 +/- 0.77 in the pellagra patients and 1.58 +/- 0.73 in the controls. The urinary levels of 3-hydroxyanthranilic acid were 34.49 +/- 21.47 mumol/g of creatinine in the pellagra patients and 14.51 +/- 8.02 mumol/g creatinine in the controls (p less than 0.02). The urinary levels of N'methylinicotinamide were 2.13 +/- 1.18 mg/g creatinine in the pellagra patients and 4.76 +/- 1.94 mg/g creatinine in the controls (p less than 0.01). The excretion of N'-methyl-2-pyridone-5-carboxamide (2-pyridone) was 2.94 +/- 2.37 mg/g creatinine in the pellagra patients and 10.19 +/- 7.49 mg/g creatinine in the controls (p less than 0.01). The histoenzymological activity of 3-hydroxyanthranilate oxidase in the deltoid muscle was higher in the pellagra patients than in the controls, whereas alpha-glycerophosphate dehydrogenase activity was higher in the controls. These results suggest that for alcoholic pellagra patients the tryptophan-niacin pathway is inhibited after the 3-hydroxyanthranilate oxidase step.

3-Hydroxyanthranilic Acid↗
PubMed2003

Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature.

Pellagra is a nutritional wasting disease attributable to a combined deficiency of tryptophan and niacin (nicotinic acid). It is characterized clinically by four classic symptoms often referred to as the four Ds: diarrhea, dermatitis, dementia, and death. Prior to the development of these symptoms, other nonspecific symptoms insidiously manifest and mostly affect the dermatological, neuropsychiatric, and gastrointestinal systems. A review of the literature reveals several case reports describing pellagra in patients with anorexia nervosa. The most common features of pellagra in patients with anorexia nervosa are cutaneous manifestations such as erythema on sun-exposed areas, glossitis, and stomatitis. Health care providers might consider a trial of 150-500 mg niacin if anorexic patients exhibit these cutaneous findings. Pellagra can be diagnosed if cutaneous symptoms resolve within 24-48 hours after oral niacin administration. To further corroborate a diagnosis of pellagra in anorexic patients, specific 24-hour urine tests for niacin metabolites and 5-hydroxy-indole-acetic acid could be run prior to treatment with niacin being instituted. Other factors, such as mycotoxins, excessive dietary leucine intake (although not in anorexia), estrogens and progestogens, carcinoid syndrome, and various medications, might also lead to the development of pellagra. Although pellagra appears to be a rare, yet possible secondary complication of anorexia nervosa, it should be considered in the work-up of patients who exhibit cutaneous manifestations subsequent to sunlight exposure.

Anorexia Nervosa↗
PubMed2000

Serum electrolytes in hospitalized pellagra alcoholics.

BACKGROUND: Owing to high diarrhoea and protein malnutrition frequencies in pellagra, we hypothesised that pellagra patients would have higher electrolyte disturbances than non-pellagra alcoholics. OBJECTIVE: To compare serum electrolytes of hospitalised alcoholics with or without pellagra. DESIGN: Retrospective and descriptive case-control study. SETTING: Internal Medicine wards at a University Hospital, Medical School of Uberaba, Brazil. SUBJECTS: Medical records were reviewed to obtain relevant clinical details, main diagnosis and laboratory data, including serum electrolytes on hospital admission of pellagra patients (n=33) and a randomly chosen control group of alcoholics (n=37), matched in age, gender and socio-economic status. Anaemia was ascertained by haemoglobin <12.5 g/dl (men) and 1.5 g/dl (women), and hypoalbuminemia by serum albumin <3.3 g/dl. RESULTS: Pellagra and controls showed similar age (39.4+/-13.1 vs 45.0+/-11.4 years) and a male predominance of gender (69.7 vs 78.4%), and similar associated diagnoses, including high blood pressure (21.2 vs 16.2%), peripheral neuropathy (12.1 vs 13. 5%), and pneumonia (9.1 vs 13.5%). Despite displaying similar serum sodium (136.6+/-6.1 vs 137.8+/-5.7 mEq/I), magnesium (1.72+/-0.74 vs 1.62+/-0.34 mg/dl), phosphorus (3.79+/-0.87 vs 3.87+/-0.78 mEq/1) than controls,in addition to higher hypoalbuminemia (76.2 vs 33%) and anaemia (60.6 vs 35.1%) frequencies. CONCLUSIONS: Higher anaemia and hypoalbuminemia frequencies associated with lower serum potassium levels suggest increased protein malnutrition prevalence among pellagrins.

Adult↗
PubMed1985

Pellagra encephalopathy among tuberculous patients: its relation to isoniazid therapy.

Eight cases of pellagra, diagnosed on the grounds of neuropathological findings and retrospective study of clinical data, were found among 106 necropsy cases of tuberculosis. Although these eight patients had shown various mental, neurological and gastrointestinal symptoms, as well as skin lesions, the diagnosis of pellagra had not been made clinically. In all the patients, pellagra symptoms appeared during isoniazid therapy. Death occurred 4 to 16 weeks later. Isoniazid inhibits the conversion of tryptophan to niacin and may induce pellagra, particularly in poorly nourished patients. Pellagra should be suspected whenever tuberculous patients under treatment with isoniazid develop mental, neurological or gastrointestinal symptoms, even in the absence of typical pellagra dermatitis.

Adult↗
PubMed2001

Pellagra in 2 homeless men.

Pellagra is a nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. Untreated, pellagra is fatal. Two cases of pellagra in contemporary homeless people are described. Complete evaluation supported a clinical diagnosis of pellagra after exclusion of other possibilities. Signs and symptoms resolved after institution of niacin therapy and change in diet. Appropriate suspicion for a diagnosis of pellagra requires attention to a combination of socioeconomic and behavioral risk factors for nutritional deficiency. The combination of homelessness, alcohol abuse, and failure to eat regularly--particularly, failure to make use of shelter-based meal programs--may identify people at special risk in contemporary settings.

Diagnosis, Differential↗
PubMed1983

The relationship of pellagra to corn and the low availability of niacin in cereals.

The poorest inhabitants of an area generally eat the narrowest range of foods, and one staple (which serves as a cheap source of calories) dominates. In turn, the specific type of malnutrition seen in that area depends upon that predominant staple and how it is processed before consumption. Corn, used here in the sense of "Indian corn" or maize, was brought to Europe from America, and over the period 1750-1850 became the typical peasant's staple in many of the areas bordering the Mediterranean. By the end of that period, it had also come to be recognized that pellagra had become a serious, chronic disease in these same countries, flaring up each spring amongst the poorest people living on diets containing much corn and very little animal food (i.e., meat, eggs or dairy products) or wine and being generally in a state of wretchedness. Nothing of the sort was seen in areas where wheat and rice were the staple foods, even when they were highly milled. Most scientists agreed on this association with corn, though not on what was the true cause-and-effect relationship. Research in the present century has shown that pellagra is primarily due to a dietary deficiency of niacin. However, the niacin content of different foods did not tie in well with their pellagra-preventive value. But then it was discovered that a second nutrient, tryptophan, could act as precursor of the vitamin with approximately one sixtieth of the activity of the actual vitamin. The "niacin equivalent" values of foods (calculated from their content of both nutrients) show a much better correlation with their pellagra-preventive value. Thus, mature corn is lower in niacin content than are wheat and rice; also the mixed proteins of corn are lower in their tryptophan content. What is not explained by the calculation of "niacin equivalent" is the general freedom from pellagra of the peasants in Mexico and Central America, where corn has been the staple for millenia and where poverty, the consequent lack of animal foods in the diet, and general misery, have been fully equal to the conditions in Europe. It has been known for 40 years that analytical values for the niacin content of foods depended greatly on the method of extraction used, with the highest values being obtained after treatment with alkali. We have confirmed with rat growth assays that the niacin in corn, wheat and rice is only about one-third available to this species, even after ordinary cooking at neutral pH.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2003

Epidemiologists explain pellagra: gender, race, and political economy in the work of Edgar Sydenstricker.

Between 1900 and 1940, at least 100,000 individuals in the southern United States died of pellagra, a dietary deficiency disease. Although half of these pellagra victims were African-American and more than two-thirds were women, contemporary observers paid little attention to these gender and racial differences in their analyses of disease. This article reviews the classic epidemiological studies of Joseph Goldberger and Edgar Sydenstricker, who argued that pellagra was deeply rooted in the political economy of cotton monoculture in the South. The methods that Sydenstricker brought to epidemiology from early work on political economy obscured the role of gender inequalities in pellagra, and his focus on economic underdevelopment led him to ignore the prominent role of African-Americans as pellagra's principal victims. Research methods and traditions, no less than more overt ideologies, played a role in maintaining the subordinate social position of women and African-Americans in the southern United States.

Black People↗
PubMed1997

Crohn's disease associated with pellagra and increased excretion of 5-hydroxyindolacetic acid.

A 47-year-old woman with seronegative polyarthritis, diarrhea, and photosensitivity dermatitis was found to have Crohn's disease and pellagra. The presence of high values of 5-hydroxyindolacetic acid in the urine began the exhaustive investigations and finally enterotomy. No mass lesion was found. Argyrophilic cells were not increased in areas of inflamed intestinal mucosa or the normal mucosa. The disagreement between biochemical and histologic findings was attributed to sampling error. Antiinflammatory treatment for Crohn's disease was given and the gastrointestinal and articular symptoms improved, excretion of 5-hydroxyindolacetic acid returned to normal and there was no relapse of pellagra. Pellagra as a complication of Crohn's disease has been described in 4 cases; malnutrition and intestinal malabsorption were the proposed mechanisms for the niacin deficiency and pellagra of those patients. In the current case, the pathogenesis of pellagra may be accounted to wastage of tryptophan by an increased pool of intestinal argyrophilic cells, suggested by increased urinary excretion of 5-hydroxyindolacetic acid.

Anti-Inflammatory Agents↗
PubMed2000

Effectiveness of food fortification in the United States: the case of pellagra.

OBJECTIVES: We evaluated the possible role of niacin fortification of the US food supply and other concurrent influences in eliminating the nutritional deficiency disease pellagra. METHODS: We traced chronological changes in pellagra mortality and morbidity and compared them with the development of federal regulations, state laws, and other national activities pertaining to the fortification of cereal-grain products with niacin and other B vitamins. We also compared these changes with other concurrent changes that would have affected pellagra mortality or morbidity. RESULTS: The results show the difficulty of evaluating the effectiveness of a single public health initiative such as food fortification without controlled experimental trials. Nonetheless, the results provide support for the belief that food fortification played a significant role in the elimination of pellagra in the United States. CONCLUSIONS: Food fortification that is designed to restore amounts of nutrients lost through grain milling was an effective tool in preventing pellagra, a classical nutritional deficiency disease, during the 1930s and 1940s, when food availability and variety were considerably less than are currently found in the United States.

Adolescent↗
PubMed2000

Pellagra in the United States: a historical perspective.

Pellagra was in existence for nearly two centuries in Europe before being recognized in the United States, where it was first reported in 1902. Over the next two decades, pellagra occurred in epidemic proportions in the American South. Poverty and consumption of corn were the most frequently observed risk factors. Since the exact cause and cure of pellagra was not known, a culture of "pellagraphobia" formed among the public. Patients were shunned and ostracized. The medical community implicated spoiled corn as the cause of pellagra, which had economic repercussions for agriculturists. Joseph Goldberger, MD, of the United States Public Health Service eventually solved the secret of the malady: faulty diet. Goldberger was able to prevent and induce pellagra by dietary modification, a landmark event in the annals of medicine, nutrition, and epidemiology. His work and the social history of that period are reviewed.

Disease Outbreaks↗
PubMed1982

Pellagra: "A reappraisal".

A brief review of the epidemiological history of pellagra is attempted. In Europe and North America Pellagra is practically eradicated at the present time. However, in mediterranean countries, with much sunlight, cases of the disease are sporadically seen. Nevertheless, in countries with a low nutritional level Pellagra still exists as endemic form. In Athens, Greece, the last decade 1971-1981, 56 new cases of Pellagra were studied. A short analysis of the above cases concerning mainly the real cause of the disease is presented. Moreover, the more recent aspects concerning the aetiological factors responsible for the appearance of Pellagra, with special emphasis to vitamins, is reported.

Alcoholism↗
PubMed1993

Pellagra--increased viscosity of extracellular matrix.

Pellagra is the result of increased viscosity of extracellular matrix (ECM). The skin changes in pellagra localize at sites of sun exposure or trauma because the mediators which are released cannot diffuse from the area. Edema is reported as the first clinical and microscopic change. Changes in the ECM are not directly visible. Increased viscosity of ECM in the gastrointestinal tract would decrease absorption of fluid and nutrients from the bowel resulting in diarrhea. In the tongue the excess ECM viscosity holds water producing swelling. The effect of climate and seasons relates to the increased demand for ECM repair on sunlight exposed areas. Infections increase the severity of pellagra by requiring increased tissue repair. Local infections are often unusually severe. Infections have a greater inflammatory component at sites of high ECM viscosity. Nicotinic acid reverses the neurologic and gastrointestinal changes of pellagra in 24 h. This suggests a simple rapid mode of action. Nicotinic acid plays a major role in tissue respiration which is essential for tissue repair and degradation of glycosaminoglycans. Altering ECM viscosity is a method of modulating inflammation, immunity, and normal tissue physiology.

Central Nervous System↗