Decreased Serum Zinc Levels Research Articles

Zinc-deficiency dermatitis in breast-fed infants

We report ten infants (mean gestational age: 30 weeks; range: 25 to 40 weeks) with zinc deficiency dermatitis who developed erosive, impetiginized periorificial dermatitis at 10 weeks of age (corresponding to a mean gestational age of 41.4 weeks, with a range of 36-44 weeks), but who were otherwise well. Cutaneous symptoms were initially misdiagnosed as eczema or impetigo in 8/10 (80%) children who received either topical (4/8) and/or systemic (6/8) antibiotics. Topical corticosteroids were applied in 4/10 infants for a mean time of 4 weeks (range: 2 to 5 weeks) before the correct diagnosis was established by decreased serum zinc levels; skin atrophy (telangiectasia, thinning) as a complication of topical steroid treatment (class II steroids) was observed in two infants. All children responded to oral therapy with zinc sulfate or zinc gluconate (1.5-4 mg/kg/d). Skin lesions started to clear within 24 h after the initiation of therapy and had completely cleared in all infants after 14 days of therapy (range: 3-14 days). We conclude that nutritional zinc deficiency is a frequently misdiagnosed problem in thriving, fully breast-fed preterm babies. It is attributable to the decreased zinc content of human milk as compared to cow's milk, and the increased demand of zinc in rapidly thriving preterm infants. It seems advisable to routinely check serum zinc levels in fully breast-fed preterm infants who do not receive regular oral zinc supplementation once they reach a gestational age of 40 weeks.

Necrolytic migratory erythema without glucagonoma in a patient with short bowel syndrome

Necrolytic migratory erythema (NME) is an uncommon inflammatory dermatosis with a distinctive clinical and histological appearance. It shows irregular erythema, bullae, erosion, crusts and pigmentation. While it is typically associated with glucagonoma, some cases of NME without glucagonoma have been reported. Herein, we report a case of necrolytic migratory erythema associated with malabsorption 30 years after ileocolectomy. She presented erosive erythema with scale or partly flaccid bullae on her intergluteal cleft, buttock and extremities. Her laboratory data revealed essential amino acid deficiency and a slightly decreased serum zinc level, while her plasma glucagon level was low. With diagnosis of non-glucagonoma-associated NME with malabsorption due to short-bowel syndrome, she was treated and improved by i.v. amino acid supplement. Histological findings of NME include necrotic changes of keratinocytes in the upper epidermis, proliferation of those in the lower epidermis and inflammatory cell infiltration of upper dermis. We also examined the expression pattern of epidermal keratins (K6, K10) and Ki-67, one of the markers of proliferative activity, to assess the proliferation and differentiation of keratinocytes in a NME lesion by immunostaining. The findings with these immunostainings support the characteristics of HE-staining, and suggest hyponutrition may induce changing differentiation/proliferation of keratinocytes.

The role of zinc in management of tinnitus

Objective: Several therapeutic modalities have been tried in patients with tinnitus. These trials have given rise to unsatisfactory results in most of the patients since the etiology and pathophysiology of tinnitus is unclear. Significant correlation between tinnitus and decreased zinc level and also reduction in severity of tinnitus after zinc therapy has been reported in some clinical studies. The aim of this study is to find out the prevalence of hypozincemia in patients suffering from tinnitus of various origins (presbyacusis, acoustic trauma and ototoxicity) at young and elderly population and to investigate the effect of zinc therapy upon the severity of tinnitus. Methods: Forty consecutive patients with severe tinnitus were included in this study between April 1998 and May 2000. There were 32 men (80%) and eight women (20%) with an age ranging between 19 and 67 (mean 40.6 years). Eleven patients were over the age of 50. The zinc level was measured in non-diluted serum by flame atomic absorption spectrophotometry (normal values; 50–120 μg/dl) from fasting blood samples. All the patients were given zinc pills 220 mg each, once a day and 2 h before lunch for 2 months. The patients were required to fulfill a tinnitus scoring scale and a handicap questionnaire before and after treatment. The Wilcoxon rank sum test and McNemar test were used for the statistical analysis. Results: Six patients were hypozincemic and seven patients had decreased serum zinc levels. No significant change has been observed in frequency and severity of tinnitus measured by audiologic tests after zinc therapy. Twenty-three (57.5%) of these patients reported some relief of tinnitus in the tinnitus scoring scale but the rate of improvement was ignorable ( P>0.05). Decrease in severity of tinnitus after zinc therapy in elder group was better than the younger ones. Conclusion: Our study could not confirm the high incidence of hypozincemia in patients with tinnitus as reported previously. Zinc therapy for 8 weeks presented no promising effect on tinnitus in three groups of patients and the difference between the rate of improvement in severity of tinnitus after zinc intake in patients with normal and low serum zinc level was not significant. Zinc supplement provided relief of tinnitus in some of the elder people who apparently had dietary zinc deficiency.

The impaired immune response to diphtheria vaccination in elderly chronic hemodialysis patients is related to zinc deficiency.

Zinc deficiency causes abnormalities of the immune response. In chronic hemodialysis therapy abnormalities in zinc metabolism as well as an impaired immune response to vaccination have been reported. Therefore we performed a vaccination study against diphtheria and hypothesized that the response to diphtheria vaccination is related to serum zinc deficiency in hemodialysis patients. Serum zinc concentrations were assayed in 16 chronic hemodialysis patients (10 male, 6 female; mean age 65 years) without a documented vaccination history against diphtheria. Nine of these patients were triple immunized against diphtheria while seven received a single vaccination. The response to diphtheria vaccination was measured by ELISA detecting specific antibodies to diphtheria-toxoid. Seroconversion 6 and 12 months after vaccination was defined as the doubling of antibody titers in patients > or = 0.1 IU/ml prior to vaccination or as titers > 0.1 IU/ml in all other patients. Only 6/16 hemodialysis patients responded to immunization against diphtheria by specific antibody production (> 0.1 IU/ml). Twelve months after the single injection 3/7 patients seroconverted while six months after the triple vaccination 3/9 patients responded to immunization. This was not age-dependent, whereas in non-responders we detected significantly decreased serum zinc levels. In contrast, responders showed similar serum zinc levels as age-matched controls. Furthermore, we measured a decreased alpha 2-macroglobulin concentration only in the responders amongst the hemodialysis patients. Protection against diphtheria and the immune response to diphtheria vaccination in hemodialysis patients is poor. The failure to respond to active diphtheria vaccination is related to a significantly decreased serum zinc concentration in hemodialysis patients.

Serum trace elements in animal models and human depression. Part I. Zinc

In the present study we report the results of investigations into the serum zinc levels in a clinical study of 19 patients with unipolar depression; 16 normal controls and in three animal models of depression: chronic severe stress (CSS), chronic mild stress (CMS) and olfactory bulbectomy (OB) in rats. CSS model and unipolar depressed patients exhibit lower serum zinc levels than the appropriate controls. There was no effect on the value in CMS or OB models. The present findings confirm previous clinical data indicating decreased serum zinc levels in human depression. Moreover, the data indicate that differences exists in the serum zinc levels in different animal models of depression and suggest a similarity between the CSS model and human depression with regard to this marker. Copyright © 1999 John Wiley & Sons, Ltd.

Increased serum copper and decreased serum zinc levels in children with iron deficiency anemia.

In order to evaluate serum copper and zinc status in children with iron deficiency anemia (IDA), 60 children with IDA aged 1-14 yr and 64 healthy children as controls aged 1-14 yr were included the study. Serum copper levels were higher in children with IDA (189 +/- 49 micrograms/dL) than those of controls (163 +/- 37 micrograms/dL) (p = 0.001). Serum zinc levels were lower in the patient group (109 +/- 59 micrograms/dL) than those of control subjects (135 +/- 56 micrograms/dL) (p = 0.017). In addition, there were statistically significant negative correlations between hematological parameters and serum copper levels in the patient group, but not in controls. No correlation between hematological parameters and serum zinc levels were found in both patient and control groups, except positive correlation between mean corpuscular volume (MCV) and serum zinc level in patients. It was concluded that at the time of managing children with IDA, zinc deficiency must be borne in mind and if necessary treatment should be initiated with zinc.

Are Disturbances of Zinc Metabolism in Human Immunodeficiency Virus Type I (HIV-I) Infection Caused By Immune Activation?

Summary The activation of the immune system is associated with profound alteration of zinc metabolism. In human immunodeficiency type 1 (HIV-l) infection serum zinc is frequently decreased. To investigate a potential role of immune system activation on urinary zinc wasting, we compared urinary zinc and l1eopterin levels in 52 patients with HIV-J infection. In addition, serum zinc was studied in 25 of the patients. We confinned earlier reports of decreased serum zinc levels in the patients. As expected, urinary neopterin was significantly increased in HIV-l infection, the highest values being reached in AIDS patients. Urinary zinc concentrations were not statistically different between patients and controls. However, a positive correlation existed between urinary zinc and neopterin levels and between neopterin and zinc clearance coefficient in patients with more advanced stages of HIV infection. No correlation between serum zinc and urinary neopterin or urinary zinc was found. The data indicate that, in addition to malabsorption, chronic immune activation may contribute to the development of zinc deficiency by urinary zinc wasting.

Serum and Urinary Zinc Levels in Urolithiasis

Zinc has an important place amongst inhibitors of crystallisation and crystal growth. These views are supported by in vivo and in vitro studies which suggest that the urinary zinc level is a significant factor in urolithiasis. Some recent studies have given contradictory results. Blood serum and urinary zinc levels were measured in 30 normal healthy controls and 42 stone forming patients (renal, ureteric and vesical). Statistically significant levels were found in all groups, varying according to the number of calculi. Increased urinary zinc levels and decreased serum zinc levels appear to be secondary to the process of stone formation. The role of zinc as an inhibitor of urolithiasis is questionable.

Déficit isolé en zinc et érythème nécrolytique migrateur. À propos d'une observation

The case of 87-old year woman with necrolytic migratory erythematosus rash without elevated plasma enteroglucagon is discribed. Decreased serum zinc level, response to oral zinc substitution and follow up proved the zinc deficiency.

Role of zinc supplementation in type II diabetes mellitus

Zinc is required for normal immune function and taste acuity and enhances the in vitro effectiveness of insulin. Impaired immune function and taste have been reported in diabetic subjects, and decreased serum zinc levels and hyperzincuria occur in some diabetic subjects and animals. Subjects with type II diabetes were examined to determine whether the similar effects of zinc depletion and diabetes are causally related. Low serum zinc levels were found in 16 of 180 subjects (9 percent). There was no correlation between serum zinc and glycosylated hemoglobin levels. Natural killer cell activity did not differ between diabetic subjects (n = 28) and control subjects (n = 38) and did not correlate with serum zinc levels. T lymphocyte response to phytohemagglutinin was lower in diabetic subjects than in control subjects (70 ± 10 versus 103 ± 7 × 10 3 counts per minute) but was not lowest in those with the lowest zinc levels. Taste thresholds for hydrochloric acid, sucrose, sodium chloride, and urea were elevated in diabetic subjects (n = 28) versus control subjects (n = 10), but thresholds did not correlate with glycosylated hemoglobin or serum zinc levels. Zinc supplementation in nine diabetic subjects had no effect on the glycosylated hemoglobin level, natural killer cell activity, or taste thresholds, but it did increase mitogen activity in those with the lowest initial phytohemagglutinin responses. It is concluded that zinc deficiency occurs in a subset of subjects with type II diabetes but is not related to diabetes control and does not explain decreased taste acuity. Zinc deficiency may play a role in abnormal immune function in type II diabetes mellitus.

Acrodermatitis enteropathica: Recognition at long last during a recurrence in a pregnancy

A case of acrodermatitis enteropathica belatedly recognized in a pregnant 23-year-old woman is reported. The condition was not specifically diagnosed during childhood. It cleared at puberty but recurred during two of three pregnancies in the form of pustular, vesiculobullous, and psoriasiform lesions. There were no associated signs or symptoms in other organs. Initial diagnoses upon the recurrence during the third pregnancy were herpes gestationis and impetigo herpetiformis. A markedly decreased serum zinc level (18 μg/dl) was found. Treatment with zinc sulfate was instituted, and within 3 days the cutaneous lesions began to clear. Two months after the birth of a healthy child, and without further therapy, all lesions had resolved and the serum zinc level was nearly normal. Acrodermatitis enteropathica should be considered in the differential diagnosis of unresponsive bullous dermatoses occurring during pregnancy.

Altered development of brain by neonatal ethanol exposure: zinc levels during and after exposure.

Neonatal rats, exposed to ethanol by use of an artificial rearing technique during the first postnatal week, have been shown to have a 20% reduction in brain weight compared to littermate controls. The mechanisms responsible for this deficit remain to be determined. One hypothesis, which has been suggested that could be responsible for the microcephaly observed in the Fetal Alcohol Syndrome is that human alcoholics have decreased serum zinc levels. It is well documented that zinc deficiency in rats results in microcephaly. Thus, ethanol administered in the diet could result in lowered zinc levels in serum and brain, and hence be the underlying factor for the brain growth deficiency reported. In these studies, serum and brain zinc levels were determined for animals exposed to ethanol using the artificial rearing procedure, and for their littermate controls, artificially reared on the same formula without ethanol. No differences at any time were found in either serum or brain zinc levels. This would suggest that zinc availability could not account for the effects found on brain growth.

Vitamin A and zinc therapy in primary biliary cirrhosis

Eleven patients with primary biliary cirrhosis were surveyed for evidence of vitamin A and zinc deficiencies. Vitamin A deficiency manifested as a low serum vitamin A concentration and abnormal dark adaptation was present in 9 of the 11 patients. A low serum zinc level was present in four patients who were also vitamin A deficient. All seven patients who received p.o. vitamin A therapy with 25,000 to 50,000 units per day for 4 to 12 weeks achieved normal vitamin A levels. Normalization of serum vitamin A was associated with significant improvement in dark adaptation (p less than 0.01). In three patients, normalization of serum vitamin A level did not correct the abnormal dark adaptation. These three patients also had decreased serum zinc levels and dark adaptation abnormalities were corrected following p.o zinc supplementation. These studies suggest high dose and long term p.o. vitamin A and zinc therapy may be required to correct abnormalities in dark adaptation in patients with primary biliary cirrhosis.

Hereditary Acrodermatitis Enteropathica in an Adult

The condition of a 33-year-old woman who had a history of blisters following trauma on the hands, knees, and feet since 1 year of age previously had been diagnosed as epidermolysis bullosa. She also had psoriasiform plaques, a pustular crusted periorificial eruption, paronychia, alopecia, and photophobia. She had had minimal history of diarrhea. A markedly decreased serum zinc level was found, and treatment with zinc sulfate was instituted, resulting in clearing of all clinical manifestations. Since patients with hereditary acrodermatitis enteropathica may have minimal or no diarrhea and the correct diagnosis may be long delayed, the condition should not be considered strictly a disease of children.

Hereditary acrodermatitis enteropathica in an adult

The condition of a 33-year-old woman who had a history of blisters following trauma on the hands, knees, and feet since 1 year of age previously had been diagnosed as epidermolysis bullosa. She also had psoriasiform plaques, a pustular crusted periorificial eruption, paronychia, alopecia, and photophobia. She had had minimal history of diarrhea. A markedly decreased serum zinc level was found, and treatment with zinc sulfate was instituted, resulting in clearing of all clinical manifestations. Since patients with hereditary acrodermatitis enteropathica may have minimal or no diarrhea and the correct diagnosis may be long delayed, the condition should not be considered strictly a disease of children.

Prostatic antibacterial factor identity and significance

Normal human prostatic fluid possesses pronounced antibacterial activity. This activity is absent or markedly diminished in the fluid of men with chronic bacterial prostatitis. Ion-probe and mass spectrographic analysis of this antibacterial factor has shown it to be a zinc salt. Prostatic fluid zinc levels in 15 men with chronic bacterial prostatitis averaged 50 μg. per milliliter (range 0 to 139 μg. per milliliter). The zinc level in the expressed prostate secretion (EPS) of 49 control men averaged 448 μg. per milliliter (range 150 to 1,000 μg. per milliliter). There was no overlap in the range of zinc values between the two groups. The decrease in EPS zinc concentration in the patient population was not secondary to a decreased serum zinc level. Exogenous zinc given orally did not increase the EPS zinc level. The decrease in EPS zinc was not limited to infected prostatic fluid cultures and may precede the entry of bacteria into the prostate. The data presented suggest that zinc may serve as an in vivo defense mechanism against prostatic invasion and subsequent urinary tract infections in men.