Pellagra - it systemic pathology of the human body, which is manifested in the appearance of symptoms of the digestive and nervous systems, as well as obvious changes in the skin, the appearance of which is caused by severe deficiency of vitamins of all subgroups inand nicotinic acid.
There are a number of pathological conditions that are the background conditions for the development of symptoms of pellagra, but the development of this disease is often formed at sub-alimentary lack of vitamins B, nicotinic acid, as well as organic pathologies severe abdominal organs.
Currently, the incidence of the classical version of pellagra dropped significantly, and pellagra in children is probably a historical fact.
in the development of symptoms of pellagra as the main manifestation of the lack of content of nicotinic acid, and the main groups of vitamin B, the greatest pathogenetic importance defeat of the digestive tract, due to the fact that most of the diseases of
In addition, a severe form of pellagra is accompanied during acute infections localized in the intestine, the most common form of which is intestinal tuberculosis and dysentery.With long-term alcohol abuse and the conditions for the oppression of the suction capacity of the small intestine, which inevitably leads to the development of vitamin A deficiency of certain categories of vitamins.
As with any form of vitamin A deficiency, pellagra can not develop because of a lack of vitamin B, and in excess of their consumption that takes place even in the normal course of pregnancy and lactation, as well as on the background of increased physical activity, combined with starvation.
If we consider the pathogenetic mechanisms of pellagra, the main role in the formation of lesions of the internal organs, the structures of the nervous system and the skin has a metabolic disorder of vital elements, especially carbohydrates, what is happening at the cellular level.However, the trigger mechanism in the pathogenesis of typical clinical manifestations of pellagra is the lack of content in the human amino acid tryptophan.
With the progression of disease in a patient developing irreversible processes in the skin and the structures of the nervous system, wearing a degenerative character.In a situation where pellagra occurs in completely healthy people on the background of eating disorders should involve the primary version of the disease.If you develop symptoms of pellagra provoked pathological changes of the internal organs of a chronic nature, then a diagnosis of secondary options pellagra.
Due to the fact that pellagra is accompanied by severe metabolic disorders in the body of the patient, pathological manifestations of it are quite broad.Degenerative changes observed in tissues of different origin (skin, endocrine organs, skeletal muscle, the structure of the nervous system and organs of the digestive tract).
With the development of the developed clinical picture, patients suffering from pellagra note the appearance of a wide range of symptoms.Due to the large list of complaints of the patient during the initial contact with the patient is difficult to establish the correct diagnosis, however, detailed medical history suggests the presence of a person of this disease.As a rule, the primary treatment the patient's medical care is established if there had various kinds of signs dyspeptic symptom complex (complete lack of appetite, and sometimes even aversion to food intake, sensation of dryness and burning sensation in the mouth area, perversion of taste preferences), and with the progression of the disease the patientcomplained of disruption of the functioning of the intestine in the form of alternating periods of loose stools and constipation.
With an increase in toxic syndrome patient noted progressive weakness, inability to perform usual physical activity, dizziness and lack of interest in life.Most often, patients with pellagra take a passive position "lying on his back."
The diagnosis of pellagra importance takes primary objective examination of the patient, which is accompanied by the discovery of a whole range of pathognomonic symptoms that allow the diagnosis right.Visual inspection of the oral cavity of the patient a marked hyperemia of not only the language but also the mucous of the cheeks, gums, the presence of small ulcers, which in some cases may have symptoms of hemorrhagic impregnation.Such changes of the mucous membranes are observed in the projection of the esophagus and stomach, but for visualizing patient needs to perform ezofagogasteroskopiyu.
In the long pellagra noted the appearance of many small bleeding erosions in the large and small intestine, which can be accompanied by the appearance of blood in the stool, detected by fecal "occult blood".
Anemic syndrome in pellagra usually quite pronounced and is accompanied by all the clinical manifestations that characterize a given pathological condition.
primary endpoint destruction of structures of the nervous system while pellagra is the appearance of signs of polyneuritis various sites, which are primarily accompanied by violation of all kinds of sensitivity without significant pain component.With the progression of the degenerative processes of pellagra affect the structure of the brain, and therefore, the patient developed cerebral and focal neurological symptoms (headache, incoordination, vomiting, blurred vision, memory, hearing and so on.).
If it affects the endocrine structures the patient develops polyglandular failure as the appearance tendency to hypotension, weakness, progressive muscle weakness, polyuria, and osteoporotic bone lesions of common nature.
Violation of protein and vitamin metabolism largely reflected in the laboratory values and is accompanied by the development of severe hypoproteinemia due to lower albumin fraction.
Note that pellagra can occur both in acute and protracted clinical variants, each of which has its own characteristics.For the development of the acute form of pellagra trigger must be expressed nutritional deficiency exogenous nature.Onset of the disease in this situation is a dramatic increased frequency and loose stools, frequency of urgency to defecation can be up to 20 times per day.After a few days the patient develops severe neuropsychiatric disorders (delirium), significantly aggravating circumstances the patient's condition.With continued vitamin deficiency in a patient manifested typical skin symptoms of pellagra.
protracted course of pellagra is difficult for early diagnosis, since a long time, this category of patients seen by a neurologist on the sluggish polyneuritis.Later joined by neuropsychiatric symptoms character not differ specificity.Only after developing symptoms of cutaneous manifestations of the classic version of the flow of pellagra.
primary lesion of the skin when pellagra is their increased dryness and discoloration in the direction of gray shades.In more symptoms localized above on the side surfaces of the abdomen and the back, and on the extensor surfaces of the limbs.Against the background of these changes enough contrast, see the redness of the skin of the upper half of the body and distal extremities, resulting from exposure to ultraviolet radiation.A characteristic feature of erythema in this case, it is clear contours, is the boundary between the affected and intact skin.If the patient has an acute clinical variant of pellagra, the above-mentioned skin changes are complemented by events exudative inflammation, manifested in the form of the appearance of bubbles with hemorrhagic content.The healing process of inflammatory skin elements has a long period and is accompanied by the development of massive scar deformities.
Changes skin on his face when pellagra accompanied by characteristic changes pathognomonic of education "pellagroznyh points" (brown hyperpigmentation century with peeling) and "Casal's collar" (erythema strip on the neck and chest).
When pellagra may cause skin and secondary elements in the form of follicular papules, localized in the projection of hip and thigh, with a clear flat hemorrhagic rim.
complications of pellagra is to move in the acute form of the disease, often ending in death.In this situation the diagnosis of the disease is extremely difficult, since the patient has a lightning rise phenomena neurological, sometimes no different from other intracranial pathologies (increased tendon reflexes, convulsive readiness, severe degree of impairment of consciousness, stiffness of limbs, visual hallucinations, vomiting and lockjaw masticatory muscles).In this case, a reliable diagnosis is possible only in the study of sectioned material.
Patients diagnosed with pellagra necessarily be treated in a hospital under the conditions of complete physical and psycho-emotional rest.The only pathogenetically substantiated direction of medical treatment is the replacement therapy with the drug nicotinic acid amide in oral or parenteral form.Saturates the daily dose should be 0.3 g rate of not less than six weeks, followed by a switch to a maintenance dose of 50 mg mainly by oral administration.
Parenteral (intramuscular) administration of nicotinamide limited weight of adverse reactions in the form of a painful sensation of heat, redness pronounced upper body and itching of the skin, although this method of administration is much more efficient.
Considering the pathogenetic mechanisms of pellagra, replacement therapy should be supplemented with preparations of B vitamins in the parenteral form (Thiamine in a daily dose of 20 mg, 10 mg riboflavin and pyridoxine 50 mg).Indications for use of vitamin B12 is macrocytosis signs, glossitis and hyperchromia.The presence of anemia should be expressed Cropped fractional blood transfusions, 100 ml 1 time in five days.
During elimination of acute manifestations of pellagra and background replacement therapy should be used to hold a conversation with the patient on the topic of eating behavior correction.The main criterion of proper diet in this situation is to saturate the daily menu foods with a high concentration of B vitamins, ascorbic and nicotinic acid, and protein food.