Pellagra

1. Name of condition

Pellagra could be a nutritionary disorder that affects each developing and developed
countries' vulnerable individuals. the first reason for avitaminosis could be a B complex,
tryptophan, or each deficiency, that generally manifests as a triad of eczema, diarrhea,
and insanity, each of which might cause death. diagnosis avitaminosis is troublesome
within the absence of skin lesions, however it's created easier by the looks of distinctive
ones. 

2. Etiology: causative agent

The primary cause may be a lack of niacin within the diet.
1. Nutritional:
• Lower intake
• Maize and sorghum (jowar) diet
• Secondary to niacin absorption or processing problems
2. Inadequate absorption:
• regional enteritis
• Inflammatory bowel disease
• Major gastrointestinal surgery
• Impaired absorption of tryptophan and niacin by the gastric mucosa
• Chronic alcoholism
•HIV infection is an infection caused by the human immunodeficiency virus (HIV).
3.Drug induced:
 Isoniazid, Ethionamide, 6-mercaptopurine, 5-fluorouracil, pyrazinamide, phenytoin,
azathioprine, phenobarbitone, phenytoin, azathioprine.
4.Metabolic:
• Hartnup's disease (metabolic)
• Carcinoid syndrome could be a style of cancer.

3. Organ affected
is a condition marked by 3 sorts of symptoms: connective tissue signs like pigmentary squamous
erythroderma, organic process organ disturbances, and funiculus system disturbances. eczema
affects principally uncovered skin areas, beginning as pruritic skin erythroderma and going to a
thick band of eczema across the neck. The looseness of the bowels is commonly serious, bloody,
and sometimes within the course of redness and inflammation. insanity is also a late symptom of
avitaminosis, however individuals with the illness additionally expertise agitation, exhaustion,
tremulousness, hyporeflexia, and, inside the foremost serious cases, brain disorder.

4-Stages of the disease development

Main Alpine scurvy produces a cellular B deficit due to a lack of vitamin B complex and/or its
precursor, the essential organic compound tryptophane, in the diet. B may be an alkali acid that
the bod transforms into an organic compound. Nicotinamide is a B derivative that occurs
naturally in the human body. B is essential for proper cellular function and metabolism as a
component of molecules I and II, which contribute or settle for H ions in important chemical
reaction reactions.
Secondary pellagra happens once decent amounts of B complex are found within the diet
however different disorders or illnesses, love excessive diarrhea, disorder Nervosa, persistent
alcoholism, chronic colitis, extreme lesion colitis, colitis, viscus cirrhosis, tumor, Hartnups
syndrome, and TB of the channel, interfere with its consumption, absorption, and/or production.
12, 16, and nineteen neoplasm cells remodel tryptophane to 5-hydroxytryptamine in patients with
carcinoid syndrome, lowering endogenous niacin output. Isoniazid, an antituberculosis drug
that's a niacin analog, will suppress
endogenous niacin development and cause pellagra. Furthermore, one among the assorted
complications of HIV infection can be a serious plasma tryptophane and niacin deficit, which
might contribute to pellagra-like symptoms.

-5Diagnosis modalities
Diagnosis of Pellagra is based totally on taking note to the sufferer's account of the ailment, his
diet, and a bodily exam. to realize a final analysis, the sufferer's response to remedy is examined.
additionally, even though the analysis of the ailment relies upon the medical symptoms, the
analysis can also be confirmed, based totally on the exam of the urine niacin degradation
products.
6- Treatment choices

It has been recognized for a protracted term that pellagra is characterized via way of means of
remissions and relapses which the moderate instances directly enhance after the assimilation of a

good enough diet. Goldberger and his co-employees,1 have produced, averted, and occasionally
cured pellagra and have advocated yeast as a particular healing agent.1c Many diets, drugs, and
minerals are recommended via way of means of others as sure treatments for the disorder.2 In
spite of the utility of those advocated strategies of treatment, all employees agree that the
analysis is incredibly grave for the seriously sick pellagra which the mortality fee within the
superior ranges of the disorder is very high. that the mortality fee during a sequence of seventy-3
instances of pellagra became fifty-four percent, despite the truth that everyone among the
sufferers has been given sanatorium care and provided a highly nutritious.

-7Follow up strategies

the dose is 300 mg of nicotinamide in divided doses, and remedy need to continue for 3–four
weeks. Large healing quantities of niacin have to be supplied withinside the form of
nicotinamide, which doesn't produce the aspect outcomes encountered whilst B complex is run.
Acute infection of the tongue and mouth, additionally to diarrhea, subside in a very few days.
Dementia and dermatitis typically enhance appreciably inside the first week of therapy. In
persistent cases, an extended restoration length is required, however, the urge for food and
popular bodily fitness enhances rapidly. it's likewise recommended to manage a nutrition B
complicated guidance or a yeast product seeing that patients with pellagra very frequently have a
deficiency of various Nutrition compounds.

References:

 SEAL, A. J., CREEKE, P. I., DIBARI, F., CHEUNG, E., KYROUSSIS, E., SEMEDO, P., &
VAN DEN BRIEL, T. (2007). Low and deficient niacin status and pellagra are endemic in
postwar angola. The American Journal of Clinical Nutrition, 85(1), 218-
224. https://doi.org/10.1093/ajcn/85.1.218

 Prabhu, D., Dawe, R. S., & Mponda, K. (2021). Pellagra a review exploring causes and
mechanisms, including isoniazid‐induced pellagra. Photodermatology, Photoimmunology &
Photomedicine, 37(2), 99-104. https://doi.org/10.1111/phpp.12659

 Samuel, E., Anyim, O., Thomas, N., & Umezurike, O. (n.d.). Pellagra: A Possible
dermatological complication of Hiv Infection: A case report. Retrieved April 13, 2021,
from https://www.amhsr.org/articles/pellagra-a-possible-dermatological-complication-of-
hiv-infection-a-case-report-5582.html

 Pitche P. T. (2005). Pellagre et érythèmes pellagroïdes [Pellagra]. Sante

(Montrouge, France), 15(3), 205–208.

 Spies, Tom D. “The Treatment Of Pellagra.” JAMA: The Journal of the American

Medical Association, vol. 104, no. 16, 1935, p. 1377.,
doi:10.1001/jama.1935.02760160001001.