Infantile pellagra

Abstract

1. 1. A syndrome, whose principal signs are oedema, desquamative dermatitis, and occasional attacks of diarrhoea, occurs commonly in the infants of certain parts of the world. It is known under a wide variety of names, but is essentially the same disease or group of diseases. 2. 2. It is present in many parts of tropical Africa, in Central America and in the West Indies as an endemic disease. 3. 3. Sporadic cases have occurred in the United States and China, and under conditions of war in European countries. 4. 4. It is submitted that the major deficiency is one of acute pellagra associated probably with nutritional oedema, the latter point depending on what view one takes of the constitution of the pellagra-group of diseases. 5. 5. The skin condition resembles very closely the skin lesion of cases of pellagra in coloured infants recorded in the United States. 6. 6. The oedema is associated with a decreased serum albumin which suggests both its relationship to nutritional oedema and at the same time its treatment. 7. 7. There is no evidence to suggest that beriberi is a common cause of the oedema. It does not improve after injections of adequate amounts of crystalline vitamin B 1 . 8. 8. A hypothesis is advanced to cover the mixed and associated deficiencies commonly seen in this syndrome. 9. 9. Treatment should be by nicotinic acid injections, blood transfusions; marmite, and a diet rich in protein. Associated deficiencies of iron, P.A. factor and vitamins A, B 1 , C and D are treated accordingly. 10. 10. Two cases did not improve after large doses of pure vitamin B 1 . 11. 11. Seven cases were tried on nicotinic acid, three made a good recovery.