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Infantile Scurvy

Cheadle Moeller Barlow Syndrome


Presentation

  • A five year old girl presented with short femora, cupped distal metaphyses and flexion deformity of the knees suggesting previous epiphyseo-metaphyseal damage.[ncbi.nlm.nih.gov]
  • There may be present an irregular fever as in the adult, though generally the temperature is normal. Rickets is frequently associated with the disease. Diarrhea is generally present. Diagnosis .—This is not usually difficult.[henriettes-herb.com]
  • "Early Vitamin History," presented in a humorous way, is his most favorite topic.[books.google.com]
  • Affected infants present with irritability, failure to thrive, swollen and painful extremities with restriction of movements (pseudoparalysis), frog posture, gum bleeding, and scorbutic rosary.[indianpediatrics.net]
Easy Bruising
  • Skin changes with roughness, easy bruising and petechiae, gum disease, loosening of teeth, poor wound healing, and emotional changes occur. Dry mouth and dry eyes similar to Sjögren syndrome may occur.[medcaretips.com]
  • Signs and symptoms include fatigue, malaise, anemia, myalgia, bone pain, easy bruising, swelling, petechiae, gingivitis, perifollicular hemorrhages, corkscrew hairs, and poor wound healing.[emedicine.medscape.com]
  • bruising Gingivitis (inflammation of the gums) Nosebleeds Possible weight gain because of slowed metabolism Rough, dry, scaly skin Swollen and painful joints Weakened tooth enamel Associated Co-morbidities [5] Osteopenia - osteopenia is defined by bone[physio-pedia.com]
Anemia
  • Sepper Roxadustat Treatment for Anemia in Patients Undergoing Long-Term Dialysis N. Chen et al. Roxadustat and Anemia of Chronic Kidney Disease J. Kaplan Roxadustat for Anemia in Patients with Kidney Disease Not Receiving Dialysis N. Chen et al.[nejm.org]
  • A fatal anemia, pernicious anemia, was a vitamin B-12 deficiency. The disease resulted by only consuming plant foods, or lack of a factor produced by the stomach needed for absorption of the vitamin.[books.google.com]
  • […] of vitamin C deficiency ( E64.2 ) anemia D53.2 ICD-10-CM Diagnosis Code D53.2 Scorbutic anemia 2016 2017 2018 2019 Billable/Specific Code Type 1 Excludes scurvy ( E54 ) gum E54 ICD-10-CM Diagnosis Code E54 Ascorbic acid deficiency 2016 2017 2018 2019[icd10data.com]
  • Treatment of iron-deficiency anemia complicated by scurvy and folic acid deficiency. Nutr Rev 1992 May; 50 (5): 134–7 PubMed Google Scholar 12. Clemeston C. Barlow’s disease. Med Hypotheses 2002; 59: 5–56 Google Scholar 13. Hess AF, Unger LJ.[link.springer.com]
Fever
  • Rickets predisposes to scurvy, and many writers believe that infantile scurvy is but a hemorrhagic fever of rachitis. Pathology .—The osseous changes are similar to those of rickets.[henriettes-herb.com]
  • All these conditions can generally be distinguished by the presence of associated clinical features such as fever, rash, or trauma. Ancillary investigations and radiography help in confirming the diagnosis. Copyright 1999-2017 Indian Pediatrics[indianpediatrics.net]
  • ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PECULIAR TO "WOMEN. Selected from the writings of British Authors previous to the close of the Eighteenth Century. In one neat octavo volume, extra cloth, of about 450 pages. ‏[books.google.com]
  • The signs of fever, irritability, tenderness upon palpation, and hemorrhage generally takes seven days or less to resolve. Diet: Adequate vitamin C intake can prevent the development of scurvy.[diseasesymptoms.weebly.com]
  • He feels that the real killers at sea were fevers, especially gaol/camp/ship fever (typhus), and malaria (Rodger 2004). However prevalent scurvy may or may not have been, Lind’s A treatise of the scurvy. In three parts.[jameslindlibrary.org]
Tachypnea
  • […] of Scurvy Hemorrhage, hyperkeratosis, hypochondriasis, and hematologic abnormalities sum up the scurvy The initial symptoms of scurvy are nonspecific and include the following: Malaise Lethargy Loss of appetite Ill-tempered Poor weight gain Diarrhea Tachypnea[medcaretips.com]
Overeating
  • Public health measures almost always occur on contested ground; accordingly, controversies and recriminations over past failures often persist.[books.google.com]
  • On his 90th birthday, Barlow was presented with a special copy of a text devoted entirely to the condition that he had described over 50 years earlier.[agris.fao.org]
  • The two doctors who wrote this paper summarise: A previously health 2-year-old Caucasian girl presented with refusal to walk secondary to pain in her lower extremities progressing over 1 week.[scicrit.wordpress.com]
Loss of Appetite
  • […] of appetite, listlessness, and other symptoms similar to those seen in adult scurvy.[whonamedit.com]
  • Clinical Presentation of Scurvy Hemorrhage, hyperkeratosis, hypochondriasis, and hematologic abnormalities sum up the scurvy The initial symptoms of scurvy are nonspecific and include the following: Malaise Lethargy Loss of appetite Ill-tempered Poor[medcaretips.com]
  • Initially there may be nonspecific symptoms such as-Loss of appetite, poor weight gain, and diarrhea. The Specific symptoms occur later which include irritability, pain and tenderness of the legs, swelling over the long bones and hemorrhage.[ispub.com]
Failure to Thrive
  • Affected infants present with irritability, failure to thrive, swollen and painful extremities with restriction of movements (pseudoparalysis), frog posture, gum bleeding, and scorbutic rosary.[indianpediatrics.net]
Failure to Thrive
  • Affected infants present with irritability, failure to thrive, swollen and painful extremities with restriction of movements (pseudoparalysis), frog posture, gum bleeding, and scorbutic rosary.[indianpediatrics.net]
Bleeding Gums
  • In adults, scurvy causes swollen and bleeding gums, looseness of the teeth, rupture of small blood vessels, and small bruises on the skin.[medical-dictionary.thefreedictionary.com]
  • Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. bleeding gums), and impaired wound healing. Unlike most other animals, humans cannot produce their own vitamin C.[radiopaedia.org]
  • gums, joint pain, and impaired wound healing.[britannica.com]
  • Signs of scurvy include tiredness, muscle weakness, joint and muscle aches, a rash on the legs, and bleeding gums. In the past, scurvy was common among sailors and other people deprived of fresh fruits and vegetables for long periods of time.[geni.com]
  • It is characterized by weakness, painful joints, and bleeding gums. Cite this article Pick a style below, and copy the text for your bibliography.[encyclopedia.com]
Gingival Swelling
  • Bleeding diathesis often results in hemarthroses and soft tissue hematomas that are produced by mild or inapparent trauma and tend to involve the legs.4,17 Interestingly, gingival findings occur only in patients with teeth and include gingival swelling[mdedge.com]
Scorbutic Rosary
  • Affected infants present with irritability, failure to thrive, swollen and painful extremities with restriction of movements (pseudoparalysis), frog posture, gum bleeding, and scorbutic rosary.[indianpediatrics.net]
  • Beading at the costochondral junctions of the ribs in children [Scorbutic rosary] is seen.[medcaretips.com]
  • This finding is known as the scorbutic rosary (ie, sternum sinks inward) and may occur in children.[emedicine.medscape.com]
  • Pediatric generalized osteopenia cortical thinning: “pencil-point” cortex periosteal reaction due to subperiosteal hemorrhage scorbutic rosary: expansion of the costochondral junctions may relate to the fracturing of the zone of provisional calcification[radiopaedia.org]
Bone Pain
  • Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. bleeding gums), and impaired wound healing. Unlike most other animals, humans cannot produce their own vitamin C.[radiopaedia.org]
  • Signs and symptoms include fatigue, malaise, anemia, myalgia, bone pain, easy bruising, swelling, petechiae, gingivitis, perifollicular hemorrhages, corkscrew hairs, and poor wound healing.[emedicine.medscape.com]
Arthralgia
  • […] dictionary of medical eponyms Related people Julius Otto Ludwig Möller Sir Thomas Barlow Walter Butler Cheadle A diseases of childhood caused by malnutrition with lack of vitamin C - ascorbic acid, and characterized by gingival lesions, haemorrhage, arthralgia[whonamedit.com]
  • He denied having fever or arthralgias at that time. The rash was dismissed as leukocytoclastic vasculitis, and the patient was sent home.[mdedge.com]
Purpura
  • A 16-year-old boy with purpura and leg pain. J Pediatr 2003; 142 (5): 560–3 PubMed CrossRef Google Scholar 3. Riepe F. Infantile scurvy. Arch Pediatr Adolesc Med 2001; 155 (5): 607–8 PubMed Google Scholar 4. Still GF. Infantile scurvy: its history.[link.springer.com]
  • D69.2 ICD-10-CM Diagnosis Code D69.2 Other nonthrombocytopenic purpura 2016 2017 2018 2019 Billable/Specific Code Applicable To Purpura NOS Purpura simplex Senile purpura scorbutic E54 Scurvy, scorbutic E54 gum E54 infantile E54 ICD-10-CM Codes Adjacent[icd10data.com]
  • Scorbut, scorbutus, sea scurvy, purpura nautica Definition Scurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet.[geni.com]
  • Cheadle: Scurvy and purpura. British Medical Journal, London, 1872, 2: 520-522. Three cases of scurvy supervening on rickets in young children. Lancet, London, 1878, 2: 685. In this article Cheadle distinguished scurvy from rickets.[whonamedit.com]
Petechiae
  • Gum swelling, friability, bleeding, and infection with loose teeth also occur, as do mucosal petechiae. Periodontal images of the patient taken before periodontal treatment.[emedicine.medscape.com]
  • Petechiae and ecchymoses are commonly present. Hyperkeratosis, corkscrew hair, and dry eyes are noted. The voluntary immobilization of the extremities is termed pseudoparalysis.[medcaretips.com]
  • Gum swelling, friability, bleeding, and infection with loose teeth also occur, as do mucosal petechiae. Loss of weight secondary to anorexia is common. Upper endoscopy may show submucosal hemorrhage.[flipper.diff.org]
  • There may be a characteristic "saddle" distribution of petechiae on the medial surface of the thighs and buttocks. Cutaneous ecchymoses may follow minor trauma.[pathopedia-india.com]
  • […] vitamin B 1, or thiamine), which were endemic in Eastern countries, either disappeared or could be remedied with the greatest of… nutritional disease: Vitamin C Symptoms of scurvy, a disease caused by vitamin C deficiency, include pinpoint hemorrhages (petechiae[britannica.com]
Delayed Wound Healing
  • The very important effect of vitamin C deficiency is delayed wound healing. There may be severe bleeding with later superimposed infection. Death occurs in untreated cases, usually from severe infection.[pathopedia-india.com]
Irritability
  • We present a case of an otherwise healthy 2-year-old Caucasian girl who presented with refusal to walk secondary to pain in her lower extremities, generalized irritability, sleep disturbance, and malaise.[ncbi.nlm.nih.gov]
  • Affected infants present with irritability, failure to thrive, swollen and painful extremities with restriction of movements (pseudoparalysis), frog posture, gum bleeding, and scorbutic rosary.[indianpediatrics.net]
  • Her irritability decreased significantly, and she was walking without complaints of pain and was more playful. The parents proved more difficult to treat.[scicrit.wordpress.com]
Sleep Disturbance
  • We present a case of an otherwise healthy 2-year-old Caucasian girl who presented with refusal to walk secondary to pain in her lower extremities, generalized irritability, sleep disturbance, and malaise.[ncbi.nlm.nih.gov]
  • The girl’s parents also noticed an increase in irritability sleep disturbance and malaise. In other words, the doctors were seeing a two-year-old girl who was suffering joint pain which eventually became so bad that she could not walk.[scicrit.wordpress.com]

Workup

  • He failed to follow-up in the outpatient clinic for workup and returned to the emergency department 4 months later with severe right thigh pain.[mdedge.com]
  • Scurvy Workup 2015 [updated Sep 23, 2015; cited 2016 April 5]. Available from: . 16.0 16.1 Lau H, Massasso D, Joshua F. Skin, muscle and joint disease from the 17th century: scurvy. International Journal of Rheumatic Diseases. 2009;12(4):361-5.[physio-pedia.com]

Treatment

  • Characteristic radiological findings and rapid response to treatment with vitamin C confirms the diagnosis.[indianpediatrics.net]
  • Once the diagnosis was made, the treatment was straightforward: The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid [aka vitamin C], iron and significant dietary modification.[scicrit.wordpress.com]
  • The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid and significant dietary modification.[ncbi.nlm.nih.gov]
  • The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus. ‏ الصفحة 467 - Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol.[books.google.com]
  • The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid and significant dietary modification. involving the skin.[link.springer.com]

Prognosis

  • Prognosis .—If recognized early, the disease in infants and children is seldom fatal. In three hundred and seventy-nine cases collected by the American Pediatric Society, the mortality was eight per cent. Treatment .[henriettes-herb.com]
  • Prognosis of Scurvy Typically, scurvy carries an excellent prognosis if diagnosed and treated appropriately.[medcaretips.com]
  • Prognosis Untreated scurvy is always fatal. However, since all that is required for a full recovery is the resumption of normal vitamin C intake, death from scurvy is rare in modern times.[cs.mcgill.ca]
  • Prognosis Treatment with vitamin C is usually successful, if the deficiency is recognized early enough. Left untreated, the condition can cause death. Prevention Eating foods rich in vitamin C every day prevents scurvy.[geni.com]
  • Prognosis Treatment with vitamin C is usually successful, if the deficiency is recognized early enough. Left untreated, the condition can cause death . Prevention Eating foods rich in vitamin C every day prevents scurvy.[medical-dictionary.thefreedictionary.com]

Etiology

  • Etiology .—The disease occurs between the ages of nine and fourteen months, and is due to an absence of mother's milk, the child being bottle-fed on some one of the many artificial foods, and which lacks some important essential to nutrition.[henriettes-herb.com]
  • The therapeutically outcome and follow-up of the boy confirmed the diagnosis and etiology. Fain O. Musculoskeletal manifestations of scurvy.[degruyter.com]
  • Etiology of Scurvy Scurvy is caused by a prolonged dietary deficiency of vitamin C.[medcaretips.com]
  • Etiology/Causes The primary cause of scurvy is inadequate intake of vitamin C.[physio-pedia.com]
  • Etiology Scurvy is caused by a prolonged dietary deficiency of vitamin C. Humans obtain 90% of their intake of vitamin C from fruits and vegetables, and cooking these sources decreases vitamin C content 20-40%.[emedicine.medscape.com]

Epidemiology

  • Scurvy in the developed world, 2011 EPIDEMIOLOGY The epidemiology of scurvy in the modern era is poorly described. Outside of infrequent epidemics, scurvy is thought to be rare.[flipper.diff.org]
  • Epidemiologic studies have reported a positive association between vitamin C intake and bone density,26 and guinea pig models of scurvy have demonstrated lower bone density in scorbutic animals.27 Impaired collagen leads to a primary disturbance in the[mdedge.com]
  • In a study of cancer patients with adequate daily intake but low serum vitamin C levels, authors proposed increased use of vitamin C possibly to scavenge lipid peroxides or vitamin C sequestration by tumor cells. [19] Epidemiology United States statistics[emedicine.medscape.com]
  • Epidemiology in food safety evaluation – past and present (James Lind, George Baker). Clinical Toxicology 1976 ;9:665-690. Wyatt HV. James Lind and the prevention of scurvy. Medical History 1976 ;20:433-439. Tröhler U.[jameslindlibrary.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Normal collagen synthesis depends upon the hydroxylation of proline and lysine to form hydroxyproline and hydroxylysine, respectively.[cdn.preterhuman.net]
  • Pathophysiology Normal collagen synthesis depends upon the hydroxylation of proline and lysine residues in the endoplasmic reticulum, to form hydroxyproline and hydroxylysine, respectively.[cs.mcgill.ca]
  • We review the biochemical basis and pathophysiology of scurvy, clinical scenarios in which it occurs, clinical signs and radiologic features of the condition, and recommendations for its diagnosis and treatment. Scurvy is prominent in world history.[mdedge.com]
  • Hemorrhaging is a hallmark feature of scurvy and can occur in any organ Pathophysiology of Scurvy Skin Hyperkeratotic papules around hair Hemorrhages around the hair Purpura, and ecchymoses Fragmentation of hair Poor wound healing and breakdown of old[medcaretips.com]
  • Pathophysiology Humans, other primates, and guinea pigs are unable to synthesize L-ascorbic acid (vitamin C); therefore, they require it in their diet. [7] The enzyme L-gluconolactone oxidase, which would usually catalyze the conversion of L-gluconogammalactone[emedicine.medscape.com]

Prevention

  • (wz) infants literature reviews disease prevention preventive nutrition breast feeding British medical journal ISSN : 0007-1447 Language : English Type : Journal Article In AGRIS since : 2013 Volume : 287 Issue : 6408 Start Page : 1862 End Page : 1863[agris.fao.org]
  • Rickets was common in northern cities and was more rampant in industrial cities as industrial pollution prevented children from sunlight exposure.[books.google.com]
  • In 1914, Alfred Hess established that pasteurization reduced the antiscorbutic value of milk and recommended supplementation of fresh fruit and vegetable juices to prevent scurvy.[ncbi.nlm.nih.gov]
  • Orange juice was efficient as a preventive or cure and did not lose its antiscorbutic property when boiled for 10 minutes. It was found that the juice of the orange peel could be substituted for that of the orange as an antiscorbutic.[chestofbooks.com]

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