In developing countries such as northern India, the incidence can be as high as Scurvy develops when sustained dietary deficiency of Vitamin C for several months reduces total body stores from g to less than g.
Unlike nearly all other animals, humans are unable to synthesise Vitamin C which must be obtained from the diet. As the condition progresses, shortness of breath, wasting, anaemia , oedema , mucocutaneous changes, ocular and musculoskeletal symptoms develop. Cutaneous signs of scurvy Purpura. Scurvy, starvation, and flea infestation - a case report from 21st century Europe. Other nutritional deficiencies are commonly associated with scurvy and clinical features may therefore be mixed and therefore confusing.
Perifollicular haemorrhages and ecchymoses may appear dusky blue or a violaceous colour in patients with dark skin types. Scurvy should be considered on the clinical presentation and confirmed with recovery after Vitamin C supplementation. Serum levels of Vitamin C reflect recent intake rather than body stores, so are unreliable. Investigation of other nutritional deficiencies should be undertaken. Anaemia is common, and may be due to decreased iron absorption, bleeding, haemolysis , and other dietary deficiencies.
X-ray of childhood scurvy Frankel sign green arrow , Trummerfeld zone red arrow. Fortunately, you have access to a bounty of fresh fruit and vegetables.
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The deficiency leads to symptoms of weakness, anemia, gum disease , and skin problems. This is because vitamin C is needed for making collagen , an important component in connective tissues. Connective tissues are essential for structure and support in the body, including the structure of blood vessels. A lack of vitamin C will also affect the immune system, absorption of iron, metabolism of cholesterol and other functions.
It is also needed for synthesizing dopamine, norepinephrine, epinephrine, and carnitine, needed for energy production. Symptoms of vitamin C deficiency can start to appear after 8 to 12 weeks.
Early signs include a loss of appetite, weight loss, fatigue , irritability, and lethargy. Within 1 to 3 months , there may be signs of:. In time, the person will show signs of generalized edema, severe jaundice , destruction of red blood cells, known as hemolysis, sudden and spontaneous bleeding, neuropathy , fever , and convulsions.
It can be fatal. Infants with scurvy will become anxious and irritable. They may experience pain that causes them to assume a frog-leg posture for comfort. There may also be subperiosteal hemorrhage, a type of bleeding that occurs at the ends of the long bones.
Animal studies have shown that vitamin C deficiency in a woman during pregnancy can lead to problems with fetal brain development. Humans cannot synthesize vitamin C. The patient's medical history included coronary artery bypass graft, stroke, nephrectomy, anaemia, osteoarthritis and dementia. There were no known allergies or use of alcohol and the patient had stopped smoking 40 years ago.
Clinical examination revealed blood crusted lips and generalised confluent ulceration affecting the buccal mucosa which also involved the gingiva. An elevated blood urea was noted, suggestive of renal dysfunction or poor fluid intake and her vitamin C levels were low. Clinical symptoms coupled with low ascorbic acid levels led to a diagnosis of scurvy. The patient was started on vitamin C supplements and a review a week later showed complete resolution of the oral lesions.
In another case, a year-old female presented reporting a one month history of poor eating with reported weight loss due to swollen and bleeding gums. There was no relevant medical or social history except for a diet consisting mainly of plain pasta, devoid of fresh fruit and vegetables. Clinical examination revealed the gingiva were swollen and bled spontaneously or on minor trauma Fig.
All teeth were mobile. Initial blood tests revealed a Hb 7. Medical examination revealed dependent oedema of the lower legs with bruising, perifollicular haemorrhaging and corkscrew hairs, Fig. A diagnosis of scurvy with secondary anaemia was made.
The patient was admitted for further investigations and vitamin C supplementation was commenced. No other intervention was needed.
At a four week review weight had been gained and only mild gingival inflammation secondary to her underlying periodontal disease was present. As the UK's population is ageing, with increasing numbers residing in care homes, we feel it is important for clinicians to be aware that scurvy could be affecting our patients and particularly those who may be visited on a domiciliary basis.
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