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Pellagra

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Pellagra

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Pellagra is a disease caused by low levels of niacin, also known as vitamin B-3. It's marked by dementia, diarrhea, and dermatitis, also known as “the three Ds”. If left untreated, pellagra can be fatal.
There are two types of pellagra, known as primary pellagra and secondary pellagra.
Primary pellagra is caused by diets low in niacin or tryptophan
Secondary pellagra occurs when your body can’t absorb niacin

Pellagra is a disease caused by low levels of niacin, also known as vitamin B-3. It's marked by dementia, diarrhea, and dermatitis, also known as “the three Ds”. If left untreated, pellagra can be fatal.
There are two types of pellagra, known as primary pellagra and secondary pellagra.
Primary pellagra is caused by diets low in niacin or tryptophan
Secondary pellagra occurs when your body can’t absorb niacin

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Pellagra

  1. 1. PELLAGRA Vyan Barzan Lava Ali Gashbin Farhad Hawnaz Osman
  2. 2. OUTLINES VITAMIN B3 ( NIACIN ) PELLAGRA Definition Types History Symptoms Diagnosis Treatment Prevention Incidence Of Pellagra Reference NAMES OF VITAMIN B3 History Sources Of Vitamin B3  Properties Structure Biosynthesis Function Recommended Daily Allowance
  3. 3. VITAMIN B3 ( NIACIN )
  4. 4. NAMES OF VITAMIN B3 Niacin Nicotinamide Vitamin P or (pellagra preventive) Anti black tongue factor Nicotinic acid
  5. 5. PROPERTIES Niacin is odorless, white crystalline substance Soluble in water and ethyl alcohol Less soluble in ether and benzene Resistance to heat , air , oxidation and alkalis Nicotinamide , when pure occurs as white needle like crystals
  6. 6.  White crystalline niacin
  7. 7. STRUCTURE: Organic compound with formula C6H5NO2 Niacin has carboxyl group (COOH) at 3-position , whereas , in nicotinamide the carboxyl group is replaced by carboxamide group (CONH2)
  8. 8. Plant form Animal form
  9. 9. HISTORY First isolated in 1911 by Funk Called it as anti black tongue factor
  10. 10.  Discovered By Joseph Goldberger in 1928  An Austrian-Amirican physician of the U.S. Public Health Service
  11. 11. Isolates by Conrad Arnold Elvehjem In 1938
  12. 12. SOURCES OF VITAMIN B3
  13. 13. BIOSYNTHESIS The liver can synthesize niacin from essential amino acid tryptophan requiring 60mg of tryptophan to make one mg of niacin. Dietary nicotinamide , niacin and tryptophan contribute to the synthesis of the coenzymes NAD+ and NADP+. 60mg tryptophan : 1 mg niacin
  14. 14. Tryptophan (in presence of Fe) Kynurenine (NADPH → NADP) Quinolinic acid Nicotinic acid Mononcleotid e (NMN) Nicotinic acid dinucleotide ( NAD) Niacin
  15. 15. FUNCTION Helps body to break down carbohydrates , fats, and proteins into energy Has a role in producing certain hormones in the adrenal glands Helps remove harmful chemicals from the liver Normally in body:
  16. 16. For healthy function of nervous system Helps to maintain a healthy skin Helps to increase the flow of blood to the peripheral capillary system
  17. 17. THERAPUTIC USES: For lipid disorder and cardiovascular disease Vascular anti-inflammatory effect A specific niacin receptor in adipocyte and immune cells Niacin non competitively inhibits hepatocyte DGAT2,a key enzyme for TG synthesis
  18. 18. RECOMMENDED DAILY ALLOWANCE Adult (men) 15-20 mg/day  Adult (women) 13-15mg/day Children 8-15mg/day Infant 650mcg Lactating women 20 mg Upper level is 35 mg
  19. 19. PELLAGRA
  20. 20. DEFINITION Systemic disease Nutritional disease , Result from niacin deficiency Affect digestive system, skin and nerves Characterized by diarrhea , dermatitis and dementia
  21. 21. TYPES Primary Results from inadequate amount of niacin and / or tryptophan in the diet Secondary Occurs when there is enough niacin in the diet but something prevents its absorption. This type occur in :
  22. 22. Chronic alcoholism Prolonged diarrhea
  23. 23. Gastrointestinal disease Liver cirrhosis
  24. 24. Carcinoid tumor  Hartnup disease(tryptophan metabolism disorder)  Drugs(isoniazid , phenytoin , azathioprine , antidepressant …)
  25. 25. HISTORY Pelle → skin , Agra → Sour First discovered by Spanish Don Gasper Casal in 1735 as a disease of 3D In 1937 discovered that pellagra caused by nicotinamide deficiency
  26. 26. SYMPTOMS • The most common symptoms: 3Ds Dermatitis Dementia Diarrhea
  27. 27. 1.DERMATITIS Also known as eczema Is a group of diseases that results in inflammation of the skin Characterized by itching , red skin ,rash and lesion In cases of short duration , there maybe small blisters and swelling But in long duration , the skin may become thickened
  28. 28. Red skin with blister
  29. 29. On the neck ,the dermatitis lesions appear in the form of a necklace called Casals necklace.
  30. 30. Rash of Pellagra Bilateral and symmetrical Usually start in sun expose area Then classically dorsa of hands , face , neck and chest. Can have intense pruritus Start as well demarcated erythematous patches Second stage – dry , scaley , hyperkeratotic
  31. 31. 2.DEMENTIA  Is a brain disease  Cause long term decrease in the ability to think and remember  And also cause emotional problems  Difficulties with language and decrease in motivation  It does not affect level of persons consciousness
  32. 32.  The most common type of dementia is Alzheimer‘s disease in %70 of cases  Other type of dementia include : (vascular dementia , frontotemporal dementia and Parkinson‘s disease dementia )
  33. 33. 3.Diarrhea Is a condition of having loose , liquid or watery bowel movements each day Lead to dehydration du to fluid lose And also cause urination , loss of skin color and fast heart rate
  34. 34. Other common symptoms  CNS symptoms: -Psychosis -Depression -Impair consciousness -Paranoia -Headache -Tremor
  35. 35. GIT symptom: (during early deficiency )may include: -Burning sensation of the pharynx and esophagus -Abdominal discomfort -Anorexia -Dysphagia (later symptoms) -Nausea -Vomiting
  36. 36.  Sensitivity to sunlight Hair loss
  37. 37. Smooth beefy red glossitis  Dilated cardiomyopathy
  38. 38.  Ataxia  Psychomotor disturbance
  39. 39.  Trouble sleeping  Weakness
  40. 40. DIAGNOSIS Pellagra is difficult to diagnose because it causes a range symptoms Also in most cases diagnosis of pellagra delay and lead to death
  41. 41. Clinical diagnosis:  Go to toilet often  Easy to forget something  Hard to sleep
  42. 42. Laboratory diagnosis: include: 1. Low level of serum niacin ,tryptophan and NAD 2. Anemia ,hypoproteinemia , hypercalcemia 3. Liver function test 4. Serum porphyrin 5. Skin biopsy o Addition to that tests we also need neurologic and psychiatric examinations
  43. 43. Histological diagnosis:  Hyperkeratosis  Acanthosis  Dilatation of capillaries  Epidermal atrophy  Hyperpigmentation of the basal layer  Mild , superficial dermal infiltrate of lymphocyte
  44. 44.  There is partial necrosis and hemorrhage involving the superficial epidermis with underlying psoriasiform acanthosis.
  45. 45.  The epidermis shows mild hyperplasia with characteristic pale cytoplasm of the cells in the upper epidermis
  46. 46. TREATMENT Primary pellagra By give Nicotinamide supplement by tab Or can also give intravenously in severe case 100-300 mg/day orally
  47. 47. Also provide the patient with dietary protein rich specially tryptophan rich If the patient have other vitamin B deficiency give them vitamin B complex supplement
  48. 48. Secondary pellagra  Depended on first diagnoses the cause then resolve it and with resolution give supplement and provide dietary protein rich  In primary and secondary sunblock can help the patient to protect the skin  However if left untreated pellagra can be fatal
  49. 49. PREVENTION Eating food rich in tryptophan, which play a role in make niacin such as(seafood,meat,yeast,eggs,peanut)  Following a healthy food plan that include a variety of foods from each food groups Practicing moderation if you drink alcohol
  50. 50. For secondary prevention avoid sun exposure during the active phase of disease Adequate rest, rest is very important in curing pellagra as stress is bound to worsen the symptoms and complicate the pellagra condition
  51. 51. INCIDENCE OF PELLAGRA Alcoholism ,not eating green vegetables and meats Common in Africa and north Korea No racial predilection is reported No sex predilection is described  Pellagra is a disease of adult and also may happen In child if they exposed to pellagra genic diet Rarely happen in infants
  52. 52. REFERENCE Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications. Weedon's Skin Pathology (Third Edition)2010, Pages 481-500.e15 Aminoff's Neurology and General Medicin ( Fifth Edition ) 2014, Pages 237-253 https://www.sciencedirect.com/ https://www.healthline.com/health/pellagra

Notizen

  • Water soluble vitamin
  • , anxiety , confusion, irritability, or mood changes )
  • Sensitivity to sunlight
    Hair loss
    Swelling
    Smooth beefy red glossitis ( tongue inflammation )
    Trouble sleeping
    Ataxia lack of coordination , paralysis of extremitis
    Dilated cardiomyopathy
  • Serum tryptophan
    Decreased N- methylnicotinamide in urine
    Cbc anemia
  • Histopathology
    Parakeratosis
  • Pellagra can be cured by a good diet containing adequate amounts of protien, tryptophan and/or niacin as well as other members of B-complex group of vitamins.
    A moderately severe case requires nicotinic acid or amide in doses of 100-300 mg/day orally.
    • Mental symptoms respond within 24-48 hours & the dermal lesions require 3-4 weeks of therapy
    Most cases of pellegra require riboflavin & pyridoxine particularly for neurological manifestation
    • Oral terapy is satisfactory in all cases exceptin those with very severe diarrhoea.
    Low dose , high dose is toxic
    Skin lesion may bbe treated with topical emollients
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