Pellagra

Pellagra is a disease caused by low levels of niacin, also known as vitamin B-3. It's marked by dementia, diarrhea, and dermatitis, also known as “the three Ds”. If left untreated, pellagra can be fatal.
There are two types of pellagra, known as primary pellagra and secondary pellagra.
Primary pellagra is caused by diets low in niacin or tryptophan
Secondary pellagra occurs when your body can’t absorb niacin

1. PELLAGRA Vyan Barzan Lava Ali Gashbin Farhad Hawnaz Osman

2. outlines VITAMIN B3 ( NIACIN ) PELLAGRA Definition Types History Symptoms Diagnosis Treatment Prevention Incidence Of Pellagra Reference NAMES OF VITAMIN B3 History Sources Of Vitamin B3 Properties Structure Biosynthesis Function Recommended Daily Allowance

3. VITAMIN B3 ( NIACIN )

4. NAMES OF VITAMIN B3 Niacin Nicotinamide Vitamin P or (pellagra preventive) Anti black tongue factor Nicotinic acid

5. Properties Niacin is odorless, white crystalline substance Soluble in water and ethyl alcohol Less soluble in ether and benzene Resistance to heat , air , oxidation and alkalis Nicotinamide , when pure occurs as white needle like crystals

6. White crystalline niacin

7. STRUCTURE: Organic compound with formula C6H5NO2 Niacin has carboxyl group (COOH) at 3-position , whereas , in nicotinamide the carboxyl group is replaced by carboxamide group (CONH2)

8. Plant form Animal form

9. HISTORY First isolated in 1911 by Funk Called it as anti black tongue factor

10. Discovered By Joseph Goldberger in 1928 An Austrian- Amirican physician of the U.S. Public Health Service

11. Isolates by Conrad Arnold Elvehjem In 1938

12. SOURCES OF VITAMIN B3

13. BIOSYNTHESIS The liver can synthesize niacin from essential amino acid tryptophan requiring 60mg of tryptophan to make one mg of niacin . Dietary nicotinamide , niacin and tryptophan contribute to the synthesis of the coenzymes NAD+ and NADP +. 60mg tryptophan : 1 mg niacin

14. FUNCTION Helps body to break down carbohydrates , fats , and proteins into energy Has a role in producing certain hormones in the adrenal glands Helps remove harmful chemicals from the liver Normally in body:

15. For healthy function of nervous system Helps to maintain a healthy skin Helps to increase the flow of blood to the peripheral capillary system

16. THERAPUTIC USES: For lipid disorder and cardiovascular disease Vascular anti-inflammatory effect A specific niacin receptor in adipocyte and immune cells Niacin non competitively inhibits hepatocyte DGAT2,a key enzyme for TG synthesis

17. RECOMMENDED DAILY ALLOWANCE Adult (men) 15-20 mg/day Adult (women) 13-15mg/day Children 8-15mg/day Infant 650mcg Lactating women 20 mg Upper level is 35 mg

18. PELLAGRA

19. DEFINITION Systemic disease Nutritional disease , Result from niacin deficiency Affect digestive system, skin and nerves Characterized by diarrhea , dermatitis and dementia

20. TYPES Primary Results from inadequate amount of niacin and / or tryptophan in the diet Secondary Occurs when there is enough niacin in the diet but something prevents its absorption. This type occur in :

21. Chronic alcoholism Prolonged diarrhea

22. Gastrointestinal disease Liver cirrhosis

23. Carcinoid tumor Hartnup disease(tryptophan metabolism disorder ) Drugs(isoniazid , phenytoin , azathioprine , antidepressant …)

24. HISTORY Pelle → skin , Agra → Sour First discovered by Spanish Don Gasper Casal in 1735 as a disease of 3D In 1937 discovered that pellagra caused by nicotinamide deficiency

25. SYMPTOMS The most common symptoms : 3Ds Dermatitis Dementia Diarrhea

26. 1.DERMATITIS Also known as eczema Is a group of diseases that results in inflammation of the skin Characterized by itching , red skin ,rash and lesion In cases of short duration , there maybe small blisters and swelling But in long duration , the skin may become thickened

27. Red skin with blister

28. On the neck ,the dermatitis lesions appear in the form of a necklace called Casals necklace.

29. Rash of Pellagra Bilateral and symmetrical Usually start in sun expose area Then classically dorsa of hands , face , neck and chest. Can have intense pruritus Start as well demarcated erythematous patches Second stage – dry , scaley , hyperkeratotic

30. 2.DEMENTIA Is a brain disease Cause long term decrease in the ability to think and remember And also cause emotional problems Difficulties with language and decrease in motivation It does not affect level of persons consciousness

31. The most common type of dementia is Alzheimer ‘s disease in %70 of cases Other type of dementia include : (vascular dementia , frontotemporal dementia and Parkinson‘s disease dementia )

32. 3.Diarrhea Is a condition of having loose , liquid or watery bowel movements each day Lead to dehydration du to fluid lose And also cause urination , loss of skin color and fast heart rate

33. Other common symptoms CNS symptoms: - Psychosis - Depression - Impair consciousness - Paranoia - Headache - Tremor

34. GIT symptom: (during early deficiency )may include: - Burning sensation of the pharynx and esophagus - Abdominal discomfort - Anorexia - Dysphagia (later symptoms) - N ausea - Vomiting

35. Sensitivity to sunlight Hair loss

36. Smooth beefy red glossitis Dilated cardiomyopathy

37. Ataxia Psychomotor disturbance

38. Trouble sleeping Weakness

39. diagnosis P ellagra is difficult to diagnose because it causes a range of symptoms Also in most cases diagnosis of pellagra delay and lead to death

40. Clinical diagnosis: Go to toilet often Easy to forget something Hard to sleep

41. Laboratory diagnosis: include: Low level of serum niacin ,tryptophan and NAD Anemia , hypoproteinemia , hypercalcemia Liver function test Serum porphyrin Skin biopsy Addition to that tests we also need neurologic and psychiatric examinations

42. Histological diagnosis : Hyperkeratosis Acanthosis Dilatation of capillaries Epidermal atrophy Hyperpigmentation of the basal layer Mild , superficial dermal infiltrate of lymphocyte

43. There is partial necrosis and hemorrhage involving the superficial epidermis with underlying psoriasiform acanthosis .

44. The epidermis shows mild hyperplasia with characteristic pale cytoplasm of the cells in the upper epidermis 

45. treatment Primary pellagra By give Nicotinamide supplement by tab Or can also give intravenously in severe case 100-300 mg/day orally

46. Also provide the patient with dietary protein rich specially tryptophan rich If the patient have other vitamin B deficiency give them vitamin B complex supplement

47. Secondary pellagra Depended on first diagnoses the cause then resolve it and with resolution give supplement and provide dietary protein rich In primary and secondary sunblock can help the patient to protect the skin However if left untreated pellagra can be fatal

48. prevention Eating food rich in tryptophan, which play a role in make niacin such as( seafood,meat,yeast,eggs,peanut ) Following a healthy food plan that include a variety of foods from each food groups Practicing moderation if you drink alcohol

49. For secondary prevention avoid sun exposure during the a ctive phase of disease Adequate rest, rest is very important in curing pellagra as s tress is bound to worsen the symptoms and complicate the pellagra condition

50. Incidence of pellagra Alcoholism ,not eating green vegetables and meats Common in Africa and north Korea No racial predilection is reported No sex predilection is described Pellagra is a disease of adult and also may happen In child if they exposed to pellagra genic diet Rarely happen in infants

51. Reference Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications . Weedon's Skin Pathology (Third Edition)2010 , Pages 481-500.e15 Aminoff's Neurology and General Medicin ( Fifth Edition ) 2014 , Pages 237-253 https://www.sciencedirect.com / https://www.healthline.com/health/pellagra