ms include:
- High sensitivity to sunlight
- Dermatitis, alopecia, oedema
- Smooth, beefy red glossitis
- Red skin lesions
- Mental confusion and memory loss
- Ataxia, paralysis of extremities, peripheral neuritis
- Eventually dementia
The main results of pellagra can easily be remembered as "the four D's": diarrhea, dermatitis, dementia, and death (Hegyi et al. 2004).
Early patients may have only a light skin rash, but over time the skin becomes progressively thickened and pigmented, and may slough off in places. The mouth and tongue, and sometimes the vagina, may become progressively swollen, red, and thickened. There may be abdominal pain, nausea, and vomiting, and bloody diarrhea (Carson-DeWitt 2004).
There are a number of mental changes associated with pellagra. This includes insomnia, fatigue, and apathy, progressing to memory loss, confusion, depression and hallucination (Carson-DeWitt 2004). There also may be impressions as being painful, annoying bright lights, odors intolerance, dizziness after sudden movements, restlessness, tenseness and a desire to quarrel (Cleary and Cleary 1989). There may be the development of involuntary grasping and sucking movements and variations in level of consciousness (Carson-DeWitt 2004).
Diagnosis, treatment, and prognosis
Diagnosis is based on patient diet history as well as patients recollection of symptoms. There are no chemical tests, but the patient can be placed on a diet sufficient in niacin and seeing the response of the patient (Carson-DeWitt 2004).
Treatment of pellagra involves supplementing the diet, often with a form of niacin called niacinamide, since pure niacin has unpleasant side effects. It can be given orally or by injection (Carson-DeWitt 2004). The frequency and amount of niacinamide administered depends on the degree to which the condition has progressed.
Untreated, the disease will continue progressing and can kill within four or five years. Death often is due to complications from infections, blood loss, sever encephalophatic syndrome, or massive malnutrition from continuous diarrhea (Carson-DeWitt 2004).
The traditional food preparation method of corn, nixtamalization, by native New World cultivators who had domesticated corn required treatment of the grain with lime, an alkali. It has now been shown that the lime treatment makes niacin nutritionally available and reduces the chance of developing pellagra. When corn cultivation was adopted worldwide, this preparation method was not accepted because the benefit was not understood. The original cultivators, often heavily dependent on corn, did not suffer from pellagra. Pellagra became common only when corn became a staple that was eaten without the traditional treatment.
Pellagra was first described in Spain in 1735 by Gaspar Casal, who published a first clinical description in his posthumous "Natural and Medical History of the Asturian Principality" (1762). It was an endemic disease in northern Italy, where it was named "pelle agra" (pelle means "skin," and agra means "rough") by Francesco Frapoli of Milan (MedicineNet 2003).
Because pellagra outbreaks occurred in regions where maize was a dominant food crop, the belief for centuries was that the maize either carried a toxic substance or was a carrier of disease. It was not until later that the lack of pellagra outbreaks in Mesoamerica, where maize is a major food crop (and is processed), that the idea was considered that the causes of pellagra may be due to factors other than toxins.
In the early 1900s, pellagra reached epidemic proportions in the American South. There were 1,306 reported pellagra deaths in South Carolina during the first ten months of 1915; 100,000 Southerners were affected in 1916. At this time, the scientific community held that pellagra was probably caused by a germ or some unknown toxin in corn (Bollet 1992). The Spartanburg Pellagra Hospital in Spartanburg, South Carolina, was the nation's first facility dedicated to discovering the cause of pellagra. It was established in 1914 with a special congressional appropriation to the U.S.