Cases Of Scurvy Research Articles

Modern-day limeys: Clinical, laboratory, and radiological profile of 10 paediatric scurvy patients

ABSTRACT Scurvy is often considered a disease of the past and well described in children with neurodevelopment and autistic spectrum disease. Clinicians overlook the diagnosis of scurvy, leading to unwarranted laboratory investigations and, unfortunately, significant delays in diagnosis. This study aims to describe 10 cases of scurvy in a tertiary hospital setup with their clinical profile, comorbidities, radiological, and subsequent disease course in children presenting to the pediatric rheumatology department at Amrita Hospital, Kochi, from 2017 to 2022. Demographic, imaging, and associated comorbid conditions including neuropsychiatric abnormalities were documented. They were all reviewed in 2 weeks for improvement of symptoms. A total of 10 children (3 females) were included in this study. The disease manifested predominantly in early childhood (median age: 5.5 years). All patients had unexplained bone pain and inability to bear weight. The referral diagnosis of 8/10 patients was juvenile idiopathic arthritis. Two patients had autism as a comorbidity. Selective eating habits and food faddism were present in 2/10 children. All patients have made a full functional recovery at review. All patients had imaging findings suggestive of scurvy. Pediatricians and rheumatologists alike must consider scurvy in a child with unexplained bone pain and symptoms masquerading as primary rheumatological diseases. Selective eating habits need to be treated with timely and appropriate psychological rehabilitation and dietary education. Resolution of symptoms and radiographic features with vitamin C supplementation is the strongest evidence for scurvy.

Evidence of non-adult vitamin C deficiency in three early medieval sites in the Jaun/Podjuna Valley, Carinthia, Austria

ObjectiveThis study aims to determine and discuss the prevalence of non-adult scurvy cases from the early medieval Jaun/Podjuna Valley in southern Austria. Materials86 non-adult individuals were assessed from three early medieval sites. MethodsMorphological characteristics associated with suggestive and probable scurvy were observed macroscopically and under 20–40x magnification. ResultsA significant relationship between the prevalence of scurvy and age group was observed. Perinates (46%, 6/13) and children (27.5%, 8/28) showed a high prevalence of skeletal features indicating a diagnosis of scurvy, while no cases of scurvy were observed in adolescents and adults. ConclusionsIn this Alpine region, scurvy occurred frequently in infants and children. Seasonal fluctuations of diet are discussed as factors triggering scurvy. SignificanceThis study sheds new light on the prevalence of scurvy in the Alpine region and how the region developed after the fall of the Roman Noricum. It also models ways in which multiple lines of evidence can contribute to the diagnostic process. LimitationsPoor preservation posed a challenge to identifying probable cases of scurvy. Likewise, non-adult remains are difficult to diagnose due to their developing nature and it is not always possible to distinguish between normal bone growth and pathological growth. Suggestions for further researchFuture applications of biomolecular studies will help illustrate changes in diet that may have contributed to vitamin deficiencies.

Scurvy: A Rare Disease or a Rare Diagnosis?

Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness's sake. We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the mid-Eastern United States. Presenting signs and symptoms, known scurvy risk factors, Vitamin C levels, clinical course, and outcome for each patient are described. There were 14 presentations by 12 patients diagnosed with scurvy who were initially evaluated in the ED between 1993 and 2023. Each patient had a known risk factor for inadequate Vitamin C intake. All had clinical findings suggestive of scurvy and all but one had a subnormal serum Vitamin C level detected on serum samples sent from the ED. The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies.

MRI as an aid to diagnosis of scurvy in absence of classic clinical and radiographic signs

Scurvy, a Vitamin C deficiency disorder leads to impaired synthesis of collagen, osteoid, and dentine, causing cutaneous, dental, and skeletal manifestations, respectively. The radiographic features of scurvy are very well established but the increasing use of magnetic resonance imaging (MRI) in limb pathologies warrants radiologists to be aware of its common as well as atypical magnetic resonance findings. Two children who presented with pain and swelling of the thigh and were proven to have scurvy were included in the study. The first child had cerebral palsy and MRI was performed as radiographs were suspicious for physeal subluxation. MRI confirmed physeal separation of the distal femur with subperiosteal collection. The second patient was developmentally normal and had non-traumatic painful thigh swelling. Radiographs showed a fracture at the distal metaphyseal–diaphyseal junction of the femur. Subperiosteal collection and surrounding muscle edema with heterogenous marrow signal were seen in both the patients on MRI. Inflammatory markers were normal. Follow-up with radiographs after treatment with vitamin C supplementation showed ossification of the subperiosteal hematomas and resolution of the symptoms. These two cases highlight the significance of MRI in reaching a diagnosis in atypical cases of scurvy which has excellent response to Vitamin C supplementation.

Analysis of periosteal lesions from commingled human remains at the Xagħra Circle hypogeum reveals the first case of probable scurvy from Neolithic Malta

AbstractObjectivesPalaeopathological analysis is key for characterising population health at the individual level and across large assemblages but is rarely exploited to unite the remains of disarticulated individuals. This study explores the potential for individual identification through differential diagnosis of periosteal lesions in a commingled deposit, both to ascertain the number of individuals represented and provide a differential diagnosis.Materials and MethodsThe late Neolithic Xagħra Circle hypogeum on Gozo contains the remains of more than 800 individuals, most of which were transformed to a collective disarticulated assemblage. Across the excavated population, pathological observations are strikingly low. In one specific 1 × 1‐m area in a single stratigraphic context, fragmented and disarticulated cranial and post‐cranial non‐adult bones were identified that displayed periosteal new bone formation. To aid differential diagnosis, macroscopic analysis, taphonomic analysis and micro‐computed tomography (μCT) imaging were integrated.ResultsThis approach, when combined with osteobiographical analyses, reveals that the elements most likely derive from one individual, a young child, who presents a probable case of scurvy. The potential for micronutrient co‐morbidities are explored, but without further microscopic study it cannot be determined if this individual also experienced iron‐deficiency anaemia and/or rickets.DiscussionIn the context of the Mediterranean and Europe in later prehistory, reported cases of scurvy are currently low and often reveal periods of environmental instability and resource insufficiency. Our finding of non‐adult scurvy in late 3rd millennium BC Malta contributes to a developing picture of an increasingly unstable palaeoenvironment and declining population health at this time, although it may also indicate an individual case of poor childhood health within this broader context.

An Epidemic of Scurvy, Identified Based on Lower Extremity Swelling, in a Southern Ethiopian Prison.

In October 2016, we received reports of five deaths among prisoners with leg swelling of unknown etiology in southwestern Ethiopia. A descriptive cross-sectional study was conducted to investigate the outbreak. A suspected case was defined as a prisoner with leg swelling of unknown etiology noted between May 15, 2016 and November 29, 2016. A total of 118 suspected cases were identified with unilateral or bilateral leg swelling without an identifiable cause from a total of 2,790 prisoners. Eight of the suspected cases were thoroughly examined, and seven of these suspected cases had clinical findings consistent with scurvy. Three of the clinical cases had undetectable vitamin C levels in the serum. The attack rate for the prison was 4.2% (118/2,790), and 11 deaths were identified, making the case fatality rate 9.3% (11/118). Clinical cases of scurvy had symptoms of fatigue, myalgia, arthralgia, and signs of follicular hyperkeratosis, petechiae, peripheral edema, and oral lesions. All clinical cases had severe anemia with hemoglobin < 6.0 g/dL. The diet provided by the prison excluded fruits and vegetables. Scurvy was determined to be the cause of the outbreak, and vitamin C supplementation was promptly initiated. All symptomatic prisoners improved, and no further cases were identified in a 4-week follow-up period of active surveillance.

The possible manifestation of scurvy on skeletal remains dated to 3800–3700 BC

The presented report describes the skeletal remains of a young man with multiple pathological changes, dated to between 3800-3700 BC. The studied skeletal remains were subjected to classical anthropological analysis. The palaeopathological study was based on detailed macroscopic examination supplemented by histological and radiological examinations. In addition to the disorder of flat cranial bones, dental developmental defects, traces after periodontal and sinus maxillaris inflammation, partially fractured left rib and fracture of the first lumbar vertebra were found on this skeleton. Based on the mentioned examinations, this finding was evaluated as one of the possibly oldest cases of scurvy in Europe.

ПАЛЕОПАТОЛОГИЧЕСКИЕ ИНДИКАТОРЫ «КАЧЕСТВА ЖИЗНИ» ДЕТЕЙ СРУБНОГО ВРЕМЕНИ ЮЖНОГО ПРИУРАЛЬЯ

This article presents results of paleopathological study of non-adult skeletons from three Srubnaya culture cemeteries (Karanaevskiy, Nikolaevskiy and Chumarovo-1) located in the southwest of the Republic of Bashkortostan. The analyzed sample includes skeletal remains of 41 individuals from burials dated to the 1600–1400 BC. In this study solely skeletal pathologies are discussed without dental pathologies. The following groups of pathologies were recorded: abnormal cortical porosities and subperiosteal new bone formation, endocranial lesions, traces of chronic sinusitis, mastoiditis and otitis media, as well as markers of “physical stress” (including skeletal traumas). This work attempts to assess the “quality of life” of the non-adult Srubnaya culture population of the Southern Ural. The sample is characterized by an underrepresentation of infants and young children and increased proportion of adolescents, indicating that the burial grounds were formed according to some socially selective principles. The studied group is characterized by the absence of macroscopical manifestations of specific infections and reliably diagnosable cases of scurvy or rickets. High frequencies of anemia markers (cribra orbitalia) and chronic maxillary sinusitis are likely indicative not of a maladaptation, but, on the contrary, of the good enough adaptation of the non-adults of the Srubnaya culture population to the environmental factors. Well expressed “physical stress” markers (cortical defects, osteochondritis dissecans and Schmorl’s nodes), observed for the studied osteological sample, suggest that children as young as 6–7 years old were likely involved in household activities.

The risk for scurvy in children with neurodevelopmental disorders.

Scurvy, the disease resulting from vitamin C deficiency, is perceived as being rare and occurring predominantly in the past. However, scurvy continues to exist and may be encountered in children with medical/developmental conditions and/or restricted diet. Diagnosis can be challenging given the perceived rarity of the condition and nonspecific symptoms, including gingival disease. We present a series of two cases of scurvy in which the affected children presented to medical attention with dental complaints. Additional cases of scurvy are described, based on the literature review of case reports/series published in the last 10 years. Literature review yielded 77 relevant case reports published in the English language since 2009. Most affected children had a previous diagnosis of a medical or developmental condition (especially autism spectrum disorder). Intraoral features (gingival swelling, pain, and bleeding) were noted in most of the identified cases of scurvy. Improvement in the oral features of scurvy occurred within days of vitamin C therapy initiation. Recognizing classic signs and symptoms of scurvy enables prompt diagnosis and avoids invasive investigations. Dentists may be in a unique position to facilitate prompt and accurate diagnosis of a condition that is relatively easy and safe to treat once identified.

Cook's Endeavour, ship of discovery or ship of distemper: an assessment after 250 years.

The 250-year anniversary of Cook's landfall at Botany Bay on 28 April 1770, approximately half way through a global circumnavigation, was an extraordinary maritime undertaking. An enterprise of astronomy, cartography, cultural-botanical documentation and revelation achieved without a death from infectious disease and only 10 mild cases of scurvy in a ship's company of 95 men. The subsequent homeward journey was far less endurable, marked by shipwreck, unforeseen prolonged delays and fatal epidemics of flux and malaria. Mild scurvy within a handful of souls in a crew experimenting with several putative antiscorbutics, yet at voyage's end the precise treatment of scurvy remained enigmatic.

Scurvy as a Sequela of Avoidant-Restrictive Food Intake Disorder in Autism: A Systematic Review.

To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy. We searched MEDLINE, CINAHL, and PsycINFO databases (1990-2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high. The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement. Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.

Evidence of infectious disease, trauma, disability and deficiency in skeletons from the 19th/20th century correctional facility and asylum «Realta» in Cazis, Switzerland.

As a reaction to widespread poverty, a system of coercive welfare developed in Switzerland during the 19th century. Poverty was often thought to result from an individual’s misconduct rather than from structural, economic or political circumstances. People whose lifestyle deviated from the desired norm or who were unable to make a living for themselves were subjected to so-called administrative detention at institutions such as workhouses and poorhouses. The excavation of the cemetery of the correctional facility/workhouse and asylum «Realta» in Cazis offered the opportunity to gain insight into the living conditions of a marginalized group of people and to shed light on aspects of coercive welfare that have hardly been addressed in historical studies. A comprehensive study of pathological alterations was used to assess possible physical causes and effects of administrative detention. Skeletal samples from regular contemporaneous cemeteries provided data for the general population and thus allowed us to detect peculiarities in the «Realta» assemblage. Possible cases of Stickler Syndrome, microcephaly, congenital syphilis, endemic hypothyroidism and disabilities secondary to trauma may have been the reason for the affected individuals’ institutionalisation. The high prevalence of tuberculosis was linked to the socioeconomic status and the living conditions at the facility. Several cases of scurvy and osteomalacia may have resulted from various risk factors such as poverty, alcoholism, mental illness or institutionalisation. The fracture rates, especially of ribs, were extremely high. A large proportion of the fractures were incompletely healed and most likely occurred during detention due to interpersonal violence. Underlying diseases further contributed to the high fracture rates. This first study on skeletons from an institution of administrative detention in Switzerland demonstrated how pre-existing health conditions and the socioeconomic background contributed to the chance of being detained, and how detention led to further deterioration of health.

Food cooking methods contribute to the reduced vitamin C content of foods prepared in hospitals and care facilities: a systematic review

SummaryRecent cases of scurvy within health care have been reported internationally. One potential reason is vitamin C losses associated with food cooking methods. This review systematically synthesised the published literature to determine the extent that vitamin C in food is lost secondary to food cooking methods used in hospitals or care facilities. The review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, and was prospectively registered in the Prospective Register for Systematic Reviews. Searches were run in three databases with no date restrictions, complemented by an internet search and reference checking. Search terms focused on the intervention and outcome. The final review included seven publications including longitudinal studies and comparison to reference standards. All studies identified vitamin C losses between preparation and service resulting from food cooking methods. Quality was rated as positive for four papers and neutral for the remainder of the included library.

Scurvy mimicking juvenile idiopathic arthritis in two pediatric patients

Scurvy, though previously reported from developing countries, is now being increasingly reported from developed countries. Although rare in pediatric population, it is well known to cause lower-extremity pain and refusal to walk in children. Here, we summarize two cases of scurvy in young children who presented with difficulty to walk. Both of them came with a provisional diagnosis of oligoarticular juvenile idiopathic arthritis. The first case underwent extensive evaluation before the diagnosis of scurvy was made. Dietary histories eventually revealed that both had limited intake of fruits and vegetables, as first patient existed on a diet of milk products and a nutritional supplement provided by the state government. The second patient had autism. Radiographic changes of long bones were observed in both patients. Both of them had a Vitamin C level of

Probable Cases of Scurvy in Subadults Crania from Archaeological Sites, South Korea

Probable Cases of Scurvy in Subadults Crania from Archaeological Sites, South Korea

Modern American scurvy - experience with vitamin C deficiency at a large children's hospital.

Until recently scurvy has been viewed in developed countries as a disease of the past. More recently there have been reports of case series of children with scurvy who have had a delayed diagnosis after an extensive diagnostic workup that included imaging. Most of these children have had underlying neurologic conditions such as autism. To review the medical records of children diagnosed with vitamin C (ascorbic acid) deficiency based on serum ascorbic acid levels at a large pediatric health care system, to determine imaging findings and utility of imaging in management, and to identify at-risk pediatric populations. We retrospectively identified cases of vitamin C deficiency in children tested for serum ascorbic acid levels during the last 5years. We used the criteria of normal ascorbic acid >23μmol/L and included children with ascorbic acid levels <23μmol/L. We evaluated their clinical history, underlying medical condition, imaging studies obtained and imaging findings. We identified 32 children with vitamin C deficiency. All of these children had underlying medical conditions, most commonly iron overload from multiple transfusions related to sickle cell anemia or thalassemia (20), neurologic disorders (4) and bone marrow transplant/chemotherapy (3). No cases of scurvy from dietary deficiency in otherwise normal children were identified. All except two children had multiple imaging studies, primarily related to their underlying conditions. Three of these children had extensive imaging workups related to diffuse musculoskeletal pain. Imaging findings included ill-defined sclerotic and lucent metaphyseal bands (mainly at the knee) on radiography and MRI studies that showed diffuse increased T2-weighted signal in the bilateral lower-extremity long-bone metaphyses, periosteal reaction and adjacent soft-tissue edema. Vitamin C deficiency is not uncommon in large pediatric health care facilities, and it is frequently missed on clinical evaluation and diagnostic imaging. At-risk populations include those with iron overload, neurologic conditions and history of chemotherapy. Scurvy related to dietary deficiency in otherwise normal children was not encountered. When characteristic MRI findings are seen, particularly in children with a predisposing condition for vitamin C deficiency, scurvy should be considered and a serum ascorbic acid level checked to potentially confirm a diagnosis prior to further invasive tests.

First probable case of scurvy in ancient Egypt at Nag el-Qarmila, Aswan

To date there has been a lack of palaeopathological evidence for the presence of scurvy in ancient Egypt. In this paper we describe one of, if not the first, differentially diagnosed bioarchaeological cases of subadult scurvy in the region in the skeleton of a 1-year +/− 4-month old infant recovered from the Predynastic site of Nag el-Qarmila (c. 3800–3600 BCE) in Aswan, Egypt. Bony change was observed on the left maxilla and greater wing of the sphenoid bone, left and right mandibular rami, orbits, and zygomatic bones, as well as on the humeri, radii, and femora, all of which appear to be suggestive of scurvy. While the cause of this infant's probable scorbutic state is unknown, various circumstances such as diet and cultural behaviors may have contributed to the condition. Given the current lack of evidence of scurvy from ancient Egyptian contexts, this case study informs on the antiquity of ascorbic acid deficiency in the Old World.

Approaches to co-occurrence: Scurvy and rickets in infants and young children of 16–18th century Douai, France

Disease co-occurrence is defined as the presence and interaction of multiple diseases in a single individual. The phenomenon occurred in the past, but detailed analyses of individuals affected by co-occurrence seldom appear. This paper presents 12 possible cases of scurvy and rickets co-occurrence from the Saint-Amé skeletal collection in Douai, France, dated to the 16–18th century. Each individual was evaluated for evidence of both diseases using macroscopic and radiographic techniques. Additional backscatter scanning electron microscopy evaluation for evidence of rickets was completed on a sub-sample of seven co-occurrence cases. Co-occurrence detection increased with the use of multiple techniques. No unique features identifying scurvy and rickets co-occurrence were observed; instead features associated with both diseases were present. Following clinical expectations, scurvy features were clearly developed while rickets features were subtle. Possible disease sequence and socio-cultural implications are suggested. The study’s findings are important to further research on disease co-occurrence as information on cases enhances our ability to understand site context.

Joint effusions and purpura in multiply-transfused adult beta-thalassemia- clinical pointers to diagnosis of scurvy.

Periodic transfusions and effective chelation have ensured that thalassemics survive in to adulthood but their life is punctuated by peculiar problems in adulthood. Three cases of scurvy are being reported presenting uniquely as purpura, right hip joint effusion and right knee joint effusion with haemorrhage in prepatellar and retropatellar bursae, respectively over an 18 month period (2009-2010). The first two cases did give a history of gum bleed. None had any coagulation disturbance or transfusion-transmitted infections or connective tissue disorder. All the three cases responded dramatically to vitamin C supplementation. It is imperative to keep in mind that recurrent blood transfusions are associated with a state of subclinical vitamin C deficiency and overt scurvy may manifest as cumulative number of transfusions increase, as in adult thalassemics.

Újkőkori népességek csonttani leletei a Dél-Alföldről – A makroszkópos megfigyelések alkalmazási lehetőségei történeti népességek demográfiai és patológiai vizsgálata során

The osteological evidence of Neolithic populations from the Southern Great Plain of Hungary – An insight into the potential of macroscopic observations for the demographic and pathological analyses of past populations. This doctoral research provides a unique contribution to our knowledge of the Early Farmers of Europe in general and the Neolithic populations from the Southern Great Plain of Hungary in particular. The potential of macroscopic observations for the demographic and pathological analyses of past populations was demonstrated on this exceptional Neolithic sample, revealing despite the lack of contextual data, the damaged and fragmentary skeletal remains, and the restriction to morphological analyses, a mostly non-violent population prone to infections, with a physically stressful way of life and a diet leading to a high rate of dental disease and (at least occasionally) lack of vitamin C. In particular, the palaeopathological analysis uncovered the oldest cases of tuberculosis in Europe so far, as well as the probable oldest cases of scurvy. In addition, a potential case of leprosy and one of cancer were also discovered, which would be of great significance for the palaeopathological record if these can be confirmed by further studies.