The following system wise signs and symptoms are evident in cases of marasmus:
The diagnosis of marasmus as a malnutrition state will only require a comprehensive clinical evaluation of patients. The significant changes in the body composition during this protein energy malnutrition state can render laboratory tests to be unreliable at times. Laboratory test may be most useful in confirming clinical condition that may coexist with marasmus. The following laboratory tests are useful in the work of marasmus:
The medical care of marasmic cases is conveniently divided into the initial intensive phase, consolidation stage (rehabilitation), and preparing for outpatient follow-up management. The World Health Organization (WHO) recommends routine antibiotic coverage in all cases of marasmus as a preventive step . This is further supported by cohort studies that suggests that antibiotic prophylaxis in uncomplicated malnutrition has been proven to hasten recovery and reduce mortality among Malawian children . The WHO provides this guidelines in the treatment of marasmus in children:
The patient’s outlook is largely dependent on the cause of the malnutrition. Acute and less severe malnutrition is easily reversed in a hospital setting. However, malnutrition caused by an ongoing medical illness may need correction of the primary pathology before the malnutrition states are reversed. Concomitant illnesses like bacterial infection and renal failure may cause the patients to succumb rather than the malnutrition state per se.
The protein energy malnutrition in marasmus, if left untreated may complicate to either of these medical conditions:
Marasmus is a serious form of malnutrition that affects more than 50 million children below 5 years of age worldwide. Children suffering from these form of malnutrition may have a very high mortality rate when afflicted by intercurrent illnesses .
Marasmus has a higher prevalence rate in low income and developing countries. Although studies have revealed that children in developed nations may have an occurrence of such protein energy malnutrition (PEM), it is also observed especially in hospitalized patients with malignancy, cystic fibrosis, neurologic diseases, genetic diseases and end stage renal diseases . Marasmus directly affects mortality rate and morbidity rate in patients with prolonged disease . It may also hamper linear growth and neurologic development.
In the United States and in other developed countries, marasmus rarely occurs as a chronic malnutrition condition. However, acute protein energy malnutrition may still occur in hospitalized patients in lower incidence rates .
Internationally, 80% of these malnourished children reside in Asia, 15% in Africa and only 5% in Latin America . An estimated 5 million patients each year die of malnutrition.
The pathophysiology of marasmus is mainly weighted on the metabolic imbalance in the body system brought about by decreased energy intake, progressive loss of caloric intake, and increased expenditure of imbibed energy.
Chronic cases present with systemic adaptations like decrease in physical activity, decreases in basal energy metabolism, lethargy, growth stunting, and progressive weight loss. The long term effects of marasmus to the child’s body system is expressed physically in terms of change body composition, metabolic changes, and anatomical changes.
All forms of malnutrition are prevented with proper eating and a balanced diet. Prophylactic antibiotics in early uncomplicated cases of marasmus lower mortality and increases recovery rates.
Marasmus is a clinical condition characterized by severe wasting of fats, muscles, and other tissues. Marasmus is a severe form of malnutrition where the body does not get enough protein and energy (calories) from food sources.
The World Health Organization (WHO) recognizes that 49% of all children death less than 5 years of age is due to protein energy malnutrition like marasmus.
Marasmus is a type of malnutrition clinically presenting as progressive wasting of muscles, fats and bodily tissues.
Protein energy malnutrition in starvation, long term hospitalization, malignancies and chronic diseases may lead to this condition.
Comprehensive history and clinical evaluation, and ancillary laboratory tests are done to diagnose marasmus.
Treatment and follow-up
Prompt nutritional support and correction of metabolic imbalances. Patients should be carefully followed up after they are discharged.