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Pellagra ppt show 20200428 db

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Balakrishnan D. Dr.
Balakrishnan D. Dr.

Pellagra is a systemic disease caused by niacin (vitamin B3) deficiency. It is characterized by 4 D's: dermatitis, diarrhea, dementia, and death if left untreated. It results from a diet lacking in niacin and tryptophan, which is converted to niacin in the body. Historically, it was common where maize and rice were staples since processing removes the niacin precursor tryptophan. Symptoms include scaly skin rashes, especially on sun-exposed areas, inflammation of the mouth and tongue, diarrhea, and progressive dementia. Treatment involves niacin supplementation either orally or via IV.

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Balakrishnan D BAS17201 Neurology Balakrishnan D 20200427 Pellagra Pellagra A systemic disease, due to Vitamin deficiency (Deficiency of Vitamin B 3, Niacin, Nicotinamide) BSc MBBS MS DLO PhD
BAS17201 Neurology Balakrishnan D 20200427 Dermatitis Diarrhoea Dementia 3 D Pellagra
BAS17201 Neurology Balakrishnan D 20200427 Dermatitis Diarrhoea Dementia 3 D Pellagra If not treated promptly, a fourth D occurs: DEATH
BAS17201 Neurology Balakrishnan D 20200427 Pellagra A systemic disease, due to Vitamin deficiency Vitamin B3, Niacin, Nicotinamide Pellagra is a consequence of a diet, low in both Niacin B3, and the amino acid Tryptophan. Tryptophan is a precursor for the vitamin B3. Pellagra reverts to normal, within days of oral supplementation. Pellagra
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Pellagra used to be common in Africa and India, where the staple diet is Rice / Corn / Maize. In US, Pellagra was prevalent in the south, in early 1900s, when corn was consumed largely. The earliest description of pellagra was by a Spanish physician Don Gaspar Casal, in 1763. He described all the clinical features. He correctly ascribed the disease to unbalanced diets (based on maize), of the poor peasants in the Asturia region of Spain. Presently, this condition has been almost wiped out by better nutrition, consumption of milk products, fortification of bread etc. But, it still lingers in Refugee / Returnee populations. Pellagra
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dementia, Delusions or mental confusion. Diarrhoea, Pain in abdomen, loss of appetite, weakness. Dermatitis forms around the neck (Casal necklace) Scaly skin sores, especially in sun-exposed areas of the skin. Mucositis (inflamed oral cavity, bright red tongue, angular cheilitis Present in many alcoholics. Clinical features
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dermatitis Red, flaky skin, with distinct margins Areas of discoloration, ranging from red to brown thick, crusty, scaly, or cracked skin itchy, burning patches of skin, Sun exposed parts e.g. Neck: Casal necklace. Inflamed mucous membrane, bright red tongue.
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dermatitis Casal Necklace Dry Holly leaf-like dermatitis Dry scaly lesions
BAS17201 Neurology Balakrishnan D 20200427 Pellagra In this disease, the skin peels away, resembling the Holly leaves. Please note the distinct margins of the lesions Pellagra pel: leaf, agra: coarse, rough
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dermatitis Please note the distinct margins of the lesions
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dementia Progressive dementia Apprehension (fear) and confusion in the early stages. Progressing to severe derangement with maniacal outbursts. Confusion, Disorientation Ataxia also is seen in some persons Spastic para paresis, Peripheral neuropathy In the late stages, the worst occurs,
BAS17201 Neurology Balakrishnan D 20200427 In preparing Maize, Corn and Rice, after you remove the husk, there is one more layer called Aleurone layer. This contains certain amino acids particularly Tryptophan. This is a precursor to Niacin. Originally, the The American natives used to soak maize in lime water. Some in India used to parboil the paddy, before milling. Both practices are not practised now. Polishing the rice, removes the aleurone layer.
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Tryptophan Tryptophan is a precursor to neuro transmitter, Serotonin hormone Melatonin and vitamin B3 (Niacin). Tryptophan is an essential amino acid i.e. humans cannot synthesize it. It must be obtained from the diet. It is plentiful in Chocolate, dried dates, Oats, Peanuts, Chickpeas, Almonds Milk, Yoghurt, curds, cheese, Meat, fish, eggs, Poultry, Sesame, Sunflower seeds, Pumpkin Buckwheat, Spirulina
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Tryptophan Tryptophan is a precursor to neuro transmitter, Serotonin hormone Melatonin and vitamin B3 (Niacin). Tryptophan is an essential amino acid i.e. humans cannot synthesize it. It must be obtained from the diet. It is plentiful in Chocolate, dried dates, Oats, Peanuts, Chickpeas, Almonds Milk, Yoghurt, curds, cheese, Meat, fish, eggs, Poultry, Sesame, Sunflower seeds, Pumpkin Buckwheat, Spirulina Germination potentiates the presence of Niacin & Tryptophan.
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Depletion of niacin from food stuff by bad practices Reduced intake due to various causes, including alcohol Not taking enough food, containing the precursor, Tryptophan Non availability of glucose to the body (Brain) Brain tissue damage infarction - Neuropathy Pathogenesis
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Secondary pellagra are caused by the following: (a) malabsorption: usually associated with jejuno-ileitis, gastroenterostomy and Crohn's disease. (b) chronic alcoholism: pellagra in chronic alcoholics is usually due to a combination of their diets being very limited in niacin and tryptophan, and due to an incomplete absorption of the already poor diet. (c) abnormalities of tryptophan metabolism: in Hartnup's disease there is a block in the tryptophannicotinic acid pathway which can lead to pellagra due to nicotinic acid deficiency (d) chemotherapeutic agents: the following are known to provoke pellagra: Isoniazid, 6-Mercaptopurine, 5-Fluorouracil and Chloramphenicol.
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Differential Diagnosis & investigations All the diseases which can cause diarrhoea, dermatitis and dementia, just like the Beriberi, Wernickes, Korsakoff, are the differential diagnosis, for this condition. Almost, similarly, alcoholism history will be present in both the conditions. The laboratory investigations will have to focus on ruling out these conditions. Urinary excretion of Niacin HPLC methods for estimating the Plasma levels of Nicotinamide
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Treatment Supplementation Fortification of bread with niacin IV Vitamins
BAS17201 Neurology Balakrishnan D 20200427 Pellagra Thank you Balakrishnan D

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Pellagra ppt show 20200428 db

  • 1. Balakrishnan D BAS17201 Neurology Balakrishnan D 20200427 Pellagra Pellagra A systemic disease, due to Vitamin deficiency (Deficiency of Vitamin B 3, Niacin, Nicotinamide) BSc MBBS MS DLO PhD
  • 2. BAS17201 Neurology Balakrishnan D 20200427 Dermatitis Diarrhoea Dementia 3 D Pellagra
  • 3. BAS17201 Neurology Balakrishnan D 20200427 Dermatitis Diarrhoea Dementia 3 D Pellagra If not treated promptly, a fourth D occurs: DEATH
  • 4. BAS17201 Neurology Balakrishnan D 20200427 Pellagra A systemic disease, due to Vitamin deficiency Vitamin B3, Niacin, Nicotinamide Pellagra is a consequence of a diet, low in both Niacin B3, and the amino acid Tryptophan. Tryptophan is a precursor for the vitamin B3. Pellagra reverts to normal, within days of oral supplementation. Pellagra
  • 5. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Pellagra used to be common in Africa and India, where the staple diet is Rice / Corn / Maize. In US, Pellagra was prevalent in the south, in early 1900s, when corn was consumed largely. The earliest description of pellagra was by a Spanish physician Don Gaspar Casal, in 1763. He described all the clinical features. He correctly ascribed the disease to unbalanced diets (based on maize), of the poor peasants in the Asturia region of Spain. Presently, this condition has been almost wiped out by better nutrition, consumption of milk products, fortification of bread etc. But, it still lingers in Refugee / Returnee populations. Pellagra
  • 6. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dementia, Delusions or mental confusion. Diarrhoea, Pain in abdomen, loss of appetite, weakness. Dermatitis forms around the neck (Casal necklace) Scaly skin sores, especially in sun-exposed areas of the skin. Mucositis (inflamed oral cavity, bright red tongue, angular cheilitis Present in many alcoholics. Clinical features
  • 7. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dermatitis Red, flaky skin, with distinct margins Areas of discoloration, ranging from red to brown thick, crusty, scaly, or cracked skin itchy, burning patches of skin, Sun exposed parts e.g. Neck: Casal necklace. Inflamed mucous membrane, bright red tongue.
  • 8. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dermatitis Casal Necklace Dry Holly leaf-like dermatitis Dry scaly lesions
  • 9. BAS17201 Neurology Balakrishnan D 20200427 Pellagra In this disease, the skin peels away, resembling the Holly leaves. Please note the distinct margins of the lesions Pellagra pel: leaf, agra: coarse, rough
  • 10. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dermatitis Please note the distinct margins of the lesions
  • 11. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Dementia Progressive dementia Apprehension (fear) and confusion in the early stages. Progressing to severe derangement with maniacal outbursts. Confusion, Disorientation Ataxia also is seen in some persons Spastic para paresis, Peripheral neuropathy In the late stages, the worst occurs,
  • 12. BAS17201 Neurology Balakrishnan D 20200427 In preparing Maize, Corn and Rice, after you remove the husk, there is one more layer called Aleurone layer. This contains certain amino acids particularly Tryptophan. This is a precursor to Niacin. Originally, the The American natives used to soak maize in lime water. Some in India used to parboil the paddy, before milling. Both practices are not practised now. Polishing the rice, removes the aleurone layer.
  • 13. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Tryptophan Tryptophan is a precursor to neuro transmitter, Serotonin hormone Melatonin and vitamin B3 (Niacin). Tryptophan is an essential amino acid i.e. humans cannot synthesize it. It must be obtained from the diet. It is plentiful in Chocolate, dried dates, Oats, Peanuts, Chickpeas, Almonds Milk, Yoghurt, curds, cheese, Meat, fish, eggs, Poultry, Sesame, Sunflower seeds, Pumpkin Buckwheat, Spirulina
  • 14. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Tryptophan Tryptophan is a precursor to neuro transmitter, Serotonin hormone Melatonin and vitamin B3 (Niacin). Tryptophan is an essential amino acid i.e. humans cannot synthesize it. It must be obtained from the diet. It is plentiful in Chocolate, dried dates, Oats, Peanuts, Chickpeas, Almonds Milk, Yoghurt, curds, cheese, Meat, fish, eggs, Poultry, Sesame, Sunflower seeds, Pumpkin Buckwheat, Spirulina Germination potentiates the presence of Niacin & Tryptophan.
  • 15. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Depletion of niacin from food stuff by bad practices Reduced intake due to various causes, including alcohol Not taking enough food, containing the precursor, Tryptophan Non availability of glucose to the body (Brain) Brain tissue damage infarction - Neuropathy Pathogenesis
  • 16. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Secondary pellagra are caused by the following: (a) malabsorption: usually associated with jejuno-ileitis, gastroenterostomy and Crohn's disease. (b) chronic alcoholism: pellagra in chronic alcoholics is usually due to a combination of their diets being very limited in niacin and tryptophan, and due to an incomplete absorption of the already poor diet. (c) abnormalities of tryptophan metabolism: in Hartnup's disease there is a block in the tryptophannicotinic acid pathway which can lead to pellagra due to nicotinic acid deficiency (d) chemotherapeutic agents: the following are known to provoke pellagra: Isoniazid, 6-Mercaptopurine, 5-Fluorouracil and Chloramphenicol.
  • 17. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Differential Diagnosis & investigations All the diseases which can cause diarrhoea, dermatitis and dementia, just like the Beriberi, Wernickes, Korsakoff, are the differential diagnosis, for this condition. Almost, similarly, alcoholism history will be present in both the conditions. The laboratory investigations will have to focus on ruling out these conditions. Urinary excretion of Niacin HPLC methods for estimating the Plasma levels of Nicotinamide
  • 18. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Treatment Supplementation Fortification of bread with niacin IV Vitamins
  • 19. BAS17201 Neurology Balakrishnan D 20200427 Pellagra Thank you Balakrishnan D