Paper: Malignant malnutrition (Kwashiorkor)

Abstract

1. 1. Malignant malnutrition, kwashiorkor and chronic subnutrition, are defined and the recent literature is reviewed. Almost all of the 95 different authors who have contributed to the literature of malignant malnutrition consider that it presents itself in childhood at least as a very serious and distinctive clinical picture with fairly consistent pathological changes. Most consider that shortage of first-class protein of animal origin is the most significant defect, together with excess of carbohydrate.There are many who suggest that the condition may occur as a, pure malnutritional disease, unassociated with tropical parasitic disease or any bacterial infection. 2. 2. Be that as it may, there is much to suggest that in the tropics chronic parasitic and helminthic disorders most definitely cause, accompany, and accentuate this disorder, adding to it certain distinctive features such as severe anaemia and much depigmentation of black hair and of a dark skin. 3. 3. In 40 cases of malignant malnutrition studied personally in Kampala, Uganda, in young African children, 19 showed malarial parasites in the blood slide, and in addition a further 12 showed malarial pigment in the liver biopsy thread ;hookworm ova were found in 25 cases, and other cases had other infections, affecting especially the respiratory and intestinal tracts. 4. 4. The slow progress of the fatty liver to fine cirrhosis of the Laennec portal variety has been studied at 161 liver biopsies. 5. 5. The lipotrophic action of milk, meat and liver has been demonstrated and these are fundamental in any successful treatment. 6. 6. The reduction of the serum albumin is probably the most constant feature of malignant malnutrition and chronic subnutrition in childhood. 7. 7. When this disease occurs unassociated with tropical parasites, anaemia is but slight and is normocytic.Chronic blood destruction in malaria and by hookworms is apt to produce efforts at regeneration, with reticulocytosis and macrocytosis as features of the anaemia; hookworm disease may also cause iron deficiency to occur, and then the macrocytosis is “depressed” into normocytosis. 8. 8. Treatment is usually very successful if all infections are treated vigorously even if they appear quite trivial ; and at the same time animal protein in an assimilable form (chiefly milk), good cereals, and fat are required. 9. 9. The continued presence of chronic subnutrition causes subnormal development and abnormal signs at all ages; at first these deviations from normality can be repaired, later on this is not so.