Cases Of Scurvy Research Articles

Subadult scurvy in Andean South America: Evidence of vitamin C deficiency in the late pre-Hispanic and Colonial Lambayeque Valley, Peru

Scurvy is a disease caused by vitamin C deficiency and is a key paleopathological indicator of subadult health and nutritional status in the past. Yet, little is known about scurvy in human remains from South America and the Peruvian Central Andes in particular. In the Lambayeque Valley Complex on the north coast of Peru, a sample of 641 archaeologically recovered subadults (A.D. 900–1750) were scored for the skeletal manifestations of vitamin C deficiency, testing the hypotheses that scurvy was common in this region and that prevalence increased following European contact. The findings reveal only five convincing cases of scurvy; overall prevalence appears extremely low, and scurvy did not become perceptibly more common following conquest. Of diagnostic interest, complex ectocranial vascular impressions were documented in two cases. Though rarely attributed to scurvy, examination suggests they formed during scorbutic episodes. Another Colonial Period subadult may demonstrate comorbidity between scurvy and rickets. This work also provides new questions for the investigation of scurvy in Andean South America.

Dietary Dilemmas, Delusions, and Decisions

One of the most frequent questions gastroenterologists are asked about is diet, health, and disease; and some of the questions gastroenterologists are least comfortable answering are about diet, health, and disease. This disconnect occurs for several reasons. Although the subject of nutrition is taught in medical school, it usually covers malabsorption of nutrients, vitamins, and minerals that have limited relevance to the concerns of most patients. The modern physician does not see many cases of scurvy or beri beri. Physicians make decisions and recommendations from evidence-based medicine. Unfortunately, there is a dearth of sound data on diet and gastrointestinal diseases, forcing physicians to operate outside their comfort zone.

A Forgotten Disease in the Land of Citrus Fruit

Scurvy is a nearly-forgotten disease in developed countries where adequate nutrition is easily available, the few cases of scurvy reported in the 21st century have mainly occurred in the neglected elderly, alcoholics and food faddist. Nutritional deficiency, however, may be a presenting sign of undiagnosed psychiatric illness (eating disorders, psychotic depression and Obsessive Compulsive Disorder-OCD). We report the case of a 15-year-old patient with depression who developed scurvy as a secondary complication to a primary psychiatric pathology regarding depression. With vitamin C replacement, psychiatric medication and behavioural therapy there was an improvement in his condition. We strongly recommend a high index of suspicion for this disease in the specific populations at risk, described as the socially isolated adult or elderly patient with a history of destructive behavior, who lives alone, and is mentally or chronically ill. The early identification of a psychiatric pathology and a good and prompt treatment can, in fact, improve the course of the illness and its prognosis.

Rheumatic Manifestations of Scurvy: A Report of Three Recent Cases in a Major Urban Center and a Review

To report 3 cases of scurvy seen in a large urban medical center over a 6-month period, referred for evaluation of rheumatologic symptoms and findings in the presence of elevated inflammatory markers. The relevant literature is reviewed and unusual manifestations highlighted. Descriptive case reports of 3 patients ultimately diagnosed with scurvy and a review of the relevant literature with an emphasis on rheumatologic manifestations (PubMed search, 1965 through August 2009). Three patients presented with symptoms including fatigue, purpuric rash, synovitis with effusion, anemia, and markedly elevated erythrocyte sedimentation rate and C-reactive protein levels. One patient presented with severe pulmonary hypertension. Careful nutritional history revealed a diet deficient in vitamin C. Examination revealed hemarthrosis, skin findings characteristic of scurvy, and deficiency in vitamin C on laboratory analysis. Symptoms resolved with vitamin C supplementation. Characteristics and frequency of rheumatologic manifestations are reviewed. While scurvy is usually described in poorer countries, individuals who have psychiatric disorders, or alcoholics with poor nutrition, it can occur even in otherwise normal populations in affluent countries. Such patients often present to rheumatologists with rheumatologic symptoms and awareness of the disease is necessary to make the proper diagnosis.

Infantile Scurvy: Two Case Reports

Background. Ascorbic acid (vitamin C) is necessary for the formation of collagen, reducing free radicals, and aiding in iron absorption. SCURVY, a disease of dietary ascorbic acid deficiency, is uncommon today. It still exists in high risk groups including economically disadvantaged populations with poor nutrition. The incidence of SCURVY in the pediatric population is very low. Cases Report. Here we report two cases of SCURVY revealed by subperiosteal hematoma in children with cerebral palsy and developmental delay. Conclusion. SCURVY is extremely rare in children. Musculoskeletal manifestations are prominent in pediatric SCURVY. Multiple subperiosteal hematomas are an important indicator for diagnosis.

Skin, muscle and joint disease from the 17th century: scurvy

We report three cases of scurvy, with differing musculoskeletal presentations, from a tertiary teaching hospital in Sydney, Australia. Case 1 was a man with cerebral palsy who presented with knee swelling following a minor injury. In Case 2, a patient with thalassaemia major presented with purpuric rash, difficulty walking and distal thigh swelling and ecchymosis. Case 3 was a man with Down's syndrome who presented with acute ankle arthritis. Scurvy in Cases 1 and 3 were related to abnormal dietary preferences, whereas in Case 2, scurvy was thought to be related to thalassaemia. All three cases responded rapidly to vitamin C replacement. The subjects did not appear malnourished as they had adequate carbohydrate and protein intake.

SCURVY

Hypervitaminosis and hypovitaminosis occur in children in our country mainly due to socioeconomic reasons. Most commonbeing the rickets due to vitamin D deficiency, however scurvy is also not uncommon and radiological changes suggestive of scurvy areoccasionally seen. Three cases of scurvy are presented here, between one and three years of age, showing typical radiological changesespecially in knees. Good history, physical examination and quality X-rays are essential for making diagnosis of scurvy.

Molecularly imprinted polymer-based solid-phase microextraction fiber coupled with molecularly imprinted polymer-based sensor for ultratrace analysis of ascorbic acid

Clinical manifestations owing to ascorbic acid deficiency demand an easy-to-use, rapid, robust and inexpensive technique, which can measure serum ascorbic acid at ultratrace level to attend the problem of hypovitaminosis C and acute cases of scurvy. In the present work, a novel molecularly imprinted polymer (MIP)-coated solid-phase microextraction (SPME) fiber that could be coupled to a complementary MIP-sensor was prepared with ascorbic acid as a template molecule. The characteristics and applications of this fiber were investigated. The same MIP receptor for both SPME and the corresponding sensor was able to enhance the preconcentration of analyte substantially so as to attain the stringent level of sensitivity in highly diluted aqueous, blood serum and pharmaceutical samples. The extraction yield of ascorbic acid (AA) with the MIP-coated fiber was found to be quantitative (detection limit 0.0396 ng mL −1, RSD = 2.3%, S/N = 3) in aqueous samples without any problem of non-specific false positive results and cross-reactivity.

Scurvy and Rickets Masked by Chronic Neurologic Illness: Revisiting “Psychologic Malnutrition”

The North American epidemic of overeating, combined with a sedentary lifestyle, has led to a growing prevalence of obesity, diabetes, and the "metabolic syndrome" in children. Excessive caloric intake does not imply adequate nutrition, and vitamin-deficiency syndromes still occur in some American children. Here we describe cases of scurvy and vitamin D deficiency in 2 children with cognitive disorders. Thorough dietary histories suggested the diagnosis in each patient and, had they been obtained at presentation, would likely have obviated invasive diagnostic workup, unnecessary stress to the patients and their families, and significant functional disability. Overnutrition and malnutrition may coexist, particularly among those with abnormal cognition or autistic spectrum disorders. Classic nutritional deficiencies must not be omitted from the differential diagnosis. A comprehensive dietary history and screening for vitamin deficiencies in at-risk children are important aspects of preventive health care and are essential for prompt diagnosis and treatment.

Skeletal manifestations of infantile scurvy

Recent investigations of human skeletal material from the historic St. Martin's cemetery, England, found a range of abnormal lesions in six infants that are almost certainly related to scurvy. Porous and proliferative bone lesions affecting the cranial bones and scapulae were found, and this paper presents images obtained using both macroscopic and scanning electron microscope examination of the lesions. Previous work on infantile scurvy (Ortner et al., 1997-2001) relied heavily on changes at the sphenoid, which is often missing in archaeological bone, so the identification of changes attributable to scurvy on other cranial bones and the scapulae is encouraging. The ability to recognize changes related to scurvy on a range of bones will ensure an enhanced potential for recognition of this disease in future research involving archaeological bone. Research on historical documents from Birmingham dating to the eighteenth and nineteenth centuries, combined with the probable cases of scurvy identified, supports the view that the paucity of cases of infantile scurvy from the archaeological record reflects a lack of understanding and recognition of bone manifestations, rather than a lack of occurrence in this period. Changes linked to scurvy were only found in infants from the poorer sections of the community from St. Martin's, and this is almost certainly linked to patterns of food consumption and may be related to shortages of potatoes, due to blight, experienced during this period.

Intragenic deletion in the gene encoding L-gulonolactone oxidase causes vitamin C deficiency in pigs.

The absence of L-ascorbic acid (L-AA, or AA) synthesis in scurvy-prone organisms, including humans, other primates, guinea pigs, and flying mammals, was traced to the lack of L-gulonolactone oxidase (GULO) activity. GULO is a microsomal enzyme that catalyzes the terminal step in the biosynthesis of L-AA. Clinical cases of scurvy were described in a family of Danish pigs. This trait is controlled by a single autosomal recessive allele designated od (osteogenic disorder). Here we demonstrate that the absence of GULO activity and the associated vitamin C deficiency in od/od pigs is due to the occurrence of a 4.2-kbp deletion in the GULO gene. This deletion includes 77 bp of exon VIII, 398 bp of intron 7 and 3.7 kbp of intron 8, which leads to a frame shift. The mutant protein is truncated to 356 amino acids, but only the first 236 amino acids are identical to the wild-type GULO protein. In addition, the od allele seems to be less expressed in deficient and heterozygous pigs compared with the normal allele in heterozygous and wild-type animals as determined by ribonuclease protection assay. We also developed a DNA-based test for the diagnosis of the deficient allele. However, we failed to identify the mutated allele in other pig populations.

Hypovitaminosis C in hospitalized patients

Background: In recent years, cases of scurvy have mainly been described in populations at risk. The prevalence and risk factors for hypovitaminosis C among hospitalized patients in a department of internal medicine are largely unknown. Methods: We determined serum ascorbic acid level (SAAL) and searched for clinical and biological signs of scurvy in 184 patients hospitalized during a 2-month period. Results: The prevalence of hypovitaminosis C (depletion: SAAL<5 mg/l or deficiency: SAAL<2 mg/l ) was 47.3%. Some 16.9% of the patients had vitamin C deficiency. There was a strong association between hypovitaminosis C and the presence of an acute phase response ( p=0.002). Other univariate risk factors for vitamin C depletion were male sex ( p=0.02), being retired ( p=0.037), and infectious diseases ( p=0.002). For vitamin C deficiency, the significant univariate risk factors included the same ones found for vitamin C depletion, plus being unemployed ( p=0.003) and concomitant excessive alcohol and tobacco consumption ( p<0.0001). Logistic regression showed that being retired ( p=0.015) and concomitant excessive alcohol and tobacco consumption ( p=0.0003) were significant independent risk factors. Hemorrhagic syndrome and edema were described more often in patients with vitamin C deficiency than in those with vitamin C depletion or without hypovitaminosis. Clinical signs were more frequent for an ascorbic acid level below 2.5 mg/l. Conclusion: Hypovitaminosis C is frequent in hospitalized patients but should be interpreted according to the presence or absence of an acute phase response. The main risk factors are living conditions and excessive alcohol and tobacco consumption.

Food patterns during an economic crisis among pregnant women in Purworejo District, Central Java, Indonesia.

A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

An epidemic of scurvy in Afghanistan: assessment and response.

In March 2002, there were reports of a hemorrhagic fever outbreak in western Afghanistan. It was later confirmed that the hemorrhagic symptoms and increased mortality were actually due to scurvy. Most aid workers did not include scurvy in the initial differential diagnosis because it is uncommon throughout the world and has mainly been reported in refugee populations in recent times. A rapid assessment confirmed the cases clinically, estimated a prevalence rate of 6.3% (a severe public health problem), and determined that the attack rates peaked each year in January and February (the end of the winter). Many Afghans have limited dietary diversity due to isolated locations, lengthy winters, the continuing drought of the last four years, asset depletion, and loss of livelihood. After numerous food and fortification options to prevent future outbreaks had been considered, vitamin C tablet supplementation was selected because of the relatively rapid response time as compared with other prevention methods. A three-month course of vitamin C tablets was distributed to 827 villages in at-risk areas. The tablets were acceptable and compliance was good. No cases of scurvy were reported for the winter of 2002-03. The case study from Afghanistan demonstrates that scurvy can occur in nonrefugee or nondisplaced populations; vitamin C supplementation can be an effective prevention strategy; there is an urgent need to develop field-friendly techniques to diagnose micronutrient-deficiency diseases; food-security tools should be used to assess and predict risks of nutritional deficiencies; and the humanitarian community should address prevention of scurvy in outbreak-prone areas.

Probable evidence of scurvy in subadults from archeological sites in Peru

Subadult scurvy is not well documented in archeological human remains despite the existence of many biomedical references indicating that bone changes do occur in some cases and, because of this, should be observable in human burials. There are several potential reasons for this gap in our knowledge of scurvy. Not all children who suffered from scurvy died of the disease or from other causes when they had scurvy. Scurvy may not leave characteristic bone changes in every case of the disease. Some of the pathological conditions associated with scurvy have been known for many years, but these features may be rare or difficult to differentiate from other pathological conditions. Recently a lesion of the skull has been described (Ortner and Ericksen [1997] International Journal of Osteoarchaeology 7:212–220) that is probably pathognomonic for scurvy, specifically porous and sometimes hypertrophic lesions of the greater wing of the sphenoid. This lesion is bilateral and highly associated with evidence of inflammation at other anatomical sites in the skull. A survey of subadult skulls (N = 363) in the human skeletal collection from Peru at the National Museum of Natural History, Smithsonian Institution, reveals a prevalence of 10% of skulls that exhibit plausible evidence of scurvy. Some cases of scurvy also have cribra orbitalia that has been attributed to anemia. In most of the Peruvian scurvy cases, anemia is an unlikely possibility because there is no evidence of marrow hyperplasia. This highlights the need for caution in using lesions of the orbit as an indicator of anemia when there is no other evidence of this disease elsewhere in the skeleton. Anatomical evidence of scurvy offers the potential of providing new and important evidence of diet in archeological human populations. Am J Phys Anthropol 108:321–331, 1999. © 1999 Wiley-Liss, Inc.

Probable evidence of scurvy in subadults from archeological sites in Peru.

Subadult scurvy is not well documented in archeological human remains despite the existence of many biomedical references indicating that bone changes do occur in some cases and, because of this, should be observable in human burials. There are several potential reasons for this gap in our knowledge of scurvy. Not all children who suffered from scurvy died of the disease or from other causes when they had scurvy. Scurvy may not leave characteristic bone changes in every case of the disease. Some of the pathological conditions associated with scurvy have been known for many years, but these features may be rare or difficult to differentiate from other pathological conditions. Recently a lesion of the skull has been described that is probably pathognomonic for scurvy, specifically porous and sometimes hypertrophic lesions of the greater wing of the sphenoid. This lesion is bilateral and highly associated with evidence of inflammation at other anatomical sites in the skull. A survey of subadult skulls (N = 363) in the human skeletal collection from Peru at the National Museum of Natural History, Smithsonian Institution, reveals a prevalence of 10% of skulls that exhibit plausible evidence of scurvy. Some cases of scurvy also have cribra orbitalia that has been attributed to anemia. In most of the Peruvian scurvy cases, anemia is an unlikely possibility because there is no evidence of marrow hyperplasia. This highlights the need for caution in using lesions of the orbit as an indicator of anemia when there is no other evidence of this disease elsewhere in the skeleton. Anatomical evidence of scurvy offers the potential of providing new and important evidence of diet in archeological human populations.

The incidence and value of radiological signs in scurvy.

The Incidence and Value of Radiological Signs in ScurvyP. McCannP. McCannOur Lady's Hospital for Sick Children, DublinSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/0007-1285-35-418-683SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutAbstractTwenty-nine cases of scurvy as diagnosed by clinical and laboratory findings are reviewed. The incidence and value of the various radiological signs are discussed. Previous article Next article FiguresReferencesRelatedDetailsCited byReferencesMetabolic DiseaseA proposed framework for the study of paleopathological cases of subadult scurvyInternational Journal of Paleopathology, Vol. 5Scurvy in the Greater American Southwest: Modeling micronutrition and biosocial processes in contexts of resource stressInternational Journal of Paleopathology, Vol. 5Magnetic resonance imaging appearance of scurvy with gelatinous bone marrow transformation6 January 2012 | Skeletal Radiology, Vol. 41, No. 3BibliographyInfantile ScurvyAmerican Journal of Clinical Dermatology, Vol. 8, No. 2Case report 406Skeletal Radiology, Vol. 16, No. 1Effect of growth rate on the strength of the growth plate-shaft junctionSkeletal Radiology, Vol. 1, No. 2Neonatal scurvyPediatric Radiology, Vol. 4, No. 4Pathological Fractures in the Immature Skeleton Volume 35, Issue 418October 1962Pages: 653-724 © The British Institute of Radiology History ReceivedMarch 01,1962Published onlineJanuary 28,2014 Metrics Download PDF

INFANTILE SCURVY AND NUTRITIONAL RICKETS IN THE UNITED STATES

During the summer of 1960, the Committee on Nutrition of the Canadian Pediatric Society requested co-operation of the Committee on Nutrition of the American Academy of Pediatrics in evaluation of the problem of scurvy in Canada. Reports in the Canadian literature in 1958 and 19591-6 recorded occurrence of 180 cases of scurvy during the 15 years from 1945 through 1959, and personal communications accounted for 142 cases not recorded in the literature. It was somewhat difficult to derive a satisfactory estimate of the true incidence of scurvy from these figures. However, an unpublished report by Dr. J. W. Davies, Chief Medical Officer of Health, Newfoundland, indicated that 77 cases of scurvy had been diagnosed in 1959 for an estimated 30,000 children less than 2 years of age, an incidence of 2.5 cases per 1,000 children. As an aid in evaluation of the problem of scurvy in Canada and to obtain information concerning the magnitude of the problem in the United States, a survey was carried out concerning incidence of scurvy in the United States during the years 1956 through 1960, inclusive. Questionnaires concerning the incidence of scurvy and rickets among children admitted to the hospital were mailed to 294 hospitals that maintain approved7 residency programs in pediatrics. Replies were received from 176 of the 294 hospitals (60%). Preliminary tabulation and analysis of results were then carried out, and a brief summary was mailed to each hospital. At the time of this mailing a second questionnaire was sent to those hospitals that had not responded to the initial questionnaire.

Abdominal apoplexy simulating acute appendicitis in a fourteen year old boy

ABDOMINAL apopIexy is the spontaneous rupture of a viscera1 vesse1 into the peritonea1 cavity and occasionahy between the Ieaves of the mesentery. This phenomenon according to the review of the Iiterature is very infrequent. Its etioIogy has been associated with trauma, intra-abdomina1 disease and maIignant growths, but usuaIIy it is a catastrophe of oId peopIe with hypertension and arterioscIerosis. Hickenl has reported one case in an eight year oId gir1, which was caused by stranguIation and rupture of an ovary. Hines2 cites three cases of scurvy due to Iack of vitamin c. Bunch3 and Bosch4 each mention spontaneous rupture of a vesse1 in uterine Ieiomyoma. Taniguch? reports it present in sixteen cases of rupture of corpus Iuteum. MengerV introduced bIood into the peritonea1 cavity experimentaIIy in sixteen cases. The youngest case in the Iiterature was reported by GarIand;r this patient was a two year oId femaIe with a retroperitonea1 hemorrhage which was suspected preoperativeIy to be an acute appendicea1 abscess. The diagnosis in reported cases has aiways been made by Iaparotomy or autopsy, except one case of CriIe’s.* Hawk9 states that they are greater in maIes than femaIes, with a ratio of 3: I, mostly between 27 and 30 degrees. Treatment of interna hemorrhage is surgery with supportive measures such as bIood transfusions whenever necessary. The bIeeding point shouId be found and controIIed. The branches of the superior mesenteric or ceIiac arteries are the most common vesseIs of rupture. In our case the abdomina1 apopIexy occurred in a fourteen year oId boy. He was admitted to the Port AIIegany HospitaI on June 27, rg5 I, with a preoperative diagnosis of acute appendicitis and the foIIowing history: While fishing with his father he had waIked across a I but since it was norma in appearance, further abdomina1 expIoration reveaIed an abundance of adhesions at the mesenteric attachment of the smaI1 intestines near the iIeum. AIso, in the right ceca1 area considerabIe oId and fresh bIood was present which was removed and the source studied. It was seen that one of the IateraI branches of the coIic ceca1 artery was ruptured and bIeeding. This was tied with Iigature and the lymph nodes at the base of the mesentery in this area were removed for microscopic study. The pathologic report was oxyuriasis of the appendix, with no pathoIogic disease of the Iymph node. The patient had an uneventfu1 recovery and was discharged on JuIy 2, 1951.

Vitamin Supplementation in Health and Disease

nutritional Surveys and Subclinical Vitamin DeficiencyWith the exception of one report,68 nutritionists in general note that frank deficiency diseases, especially vitamin-deficiency diseases, have almost disappeared during the last decade in the United States.12, 72 73 74 The majority of cases of clinical vitamin deficiency now seen are in association with chronic alcoholism or some debilitating disease,72 and a moderate number of cases of scurvy occur in infants because mothers boil the orange juice or cater to dietary dislikes.75 The cause of this reduced incidence of gross vitamin deficiency in the United States is unexplained. Blankenhorn72 observes that deficiency began to disappear before . . .