A note on infantile pellagra

Abstract

There occurs largely in tropical Africa and tropical America an acute and fatal disease which commonly attacks infants in the first few years of life. It is called by a different name in almost every country. It is frequently seen shortly after weaning. It is characterized by oedema, crazy-pavement skin, diarrhoea, cheilosis and stomatitis, generalized pallor of the skin and pale, straight, scanty hair. Neurological changes may occur but are slight and are terminal. Microcytic or macrocytic anaemia and steatorrhoea are variable features. It is almost certainly due to multiple deficiency defects, the major ones being those of nicotinic acid, riboflavin and protein, the latter producing a marked nutritional oedema. All other known deficiencies of vitamins, iron and the extrinsic factor of Castle have been described in some of the cases. Possibly as yet the main deficiency is not known. Intercurrent disease is common and is frequently the cause of death and of suspected failure of treatment by dietetic measures; bronchopneumonia, heavy malarial infection, anaemia and helminthiasis all occur. It is not known if the pellagra is the primary cause of the disease or if faulty methods of weaning and other gastro-intestinal disturbance lead to secondary pellagra, or if other infections, e.g., malaria, precipitate the vitamin deficiencies. It appears to have clear relationship with a deficiency of the vitamin B₂ complex, and can best be called by the time-honoured name of pellagra, since this name has for centuries described the various clinical states which characterize in all their complexity a deficiency of the vitamin B₂ complex. Some have thought that the oedema is due to beriberi, but there is no evidence in favour of this, and injections of the pure B₁ vitamin do not decrease the oedema. Those who do not accept this view may refer to the disease as kwashiorkor or the Proctor-Williams's disease.