Diagnosis of pellagra disease (niacin deficiency) is very difficult, whereas its treatment and prevention are simple.
Diagnosis of pellagra
For diagnosis of pellagra, earlier we had to rely on the symptoms narrated by the patient, signs observed and the nutritional deficiency status and diet of the patient.In the early stages fewer of the niacin deficiency signs may be present and it becomes very difficult for the diagnosis of pellagra.
It will be easier for diagnosis and confirmation of the presence of pellagra disease, if all the three "D" symptoms (dermatitis, diarrhea and dementia) are present.
Nowadays the diagnosis can be confirmed by the measurement of excretion of N-methylnicotinamide per day in urine and treatment can be started.
However the facilities may not be easily available for the analysis and diagnosis in the developing and underdeveloped countries to start pellagra treatment with niacin supplements to remove deficiency.
If the patient has some of the signs and symptoms of pellagra the following steps may help in treatment and prevention.
The first step in diagnosis, treatment and prevention is to find out whether the patient is coming from pellagra prevalent region with niacin deficiency.
Next step in diagnosis and prevention is to ascertain the patient's food habits and find out whether maize is his staple food.
Persons afflicted by pellagra disease generally appear weak, underweight and poorly nourished.
It has to be ascertained whether the patient has dermatitis, diarrhea or dementia and nervous impairment.
Therapeutic doses of nicotinamide may be given for a few days to investigate for improvement in the condition.
If the disease is pellagra there will be marked improvement and the diagnosis of the disease is complete and treatment can be started.
Low serum levels of niacin and tryptophan may also confirm the disease and treatment can be started.
Low levels of pyridone and N-methylnicotinamide in urine can be due to niacin deficiency confirming the diagnosis for pellagra.
If less than 1.5mg of these organic compounds are excreted in a day, diagnosis of severe niacin deficiency is confirmed and immediate treatment is required.
The presence of three "Ds" (dermatitis, diarrhea and dementia) confirms the diagnosis of pellagra disease.
Dermatitis in pellagra patients has a characteristic appearance.
The exposed regions of the skin to sunlight get inflamed and red in appearance initially with marked margin with the unexposed skin.
This is a clear cut diagnosis of pellagra.
The swelling of tongue and mouth and oral sores also help in the diagnosis.
The chronic diarrhea and bleeding from intestine also help in diagnosis and treatment.
Symptoms like diminished sensitivity to touch, irritability, and tremor help in diagnosis.
Treatment for pellagra disease
If the patient is fairly in the advanced stage of pellagra, hospitalisation is required for of acute niacin deficiency.Patient with milder symptoms may undergo treatment at home for niacin deficiency.
Patients with dementia are preferably given treatment at hospital for prevention of complications with niacin deficiency.
Oral administration of nicotinamide or nicotinic acid helps in the reversal of symptoms of niacin deficiency.
The exact dosage will be recommended by physician considering the stage of the disease and the age and weight of the patients.
Persons who are comatose, uncooperative or with severe swelling and blocking of the mouth may be given injections of vitamin B3 to resolve niacin deficiency.
For patients with dementia and severe pain tranquilizers may be given.
Anti-inflammatory antibiotic creams must be applied to skin conditions till the niacin deficiency resolves.
During treatment, prevention to exposure to sunlight is very important.
There can be dramatic change and healing after a few days of treatment for niacin deficiency.
With the treatment dermatitis slowly disappears, the gastrointestinal inflammation goes and the patient will be able to eat.
The neurological disorders slowly disappear and the patient becomes normal.
As the pellagra afflicted person will be malnourished, he should be given easily digestible protein rich, well balanced diet followed by multivitamin supplement.
Though the primary pellagra responds well to treatment the secondary pellagra disease is harder because of the causes for its occurrence.
Prevention of pellagra disease
In the maize eating population relying on maize only as staple food has to be discouraged and addition of other cereals has to be encouraged for prevention of pellagra disease, affecting populations as a whole.An inducement and requirement to fortify milled maize flour with niacin must be emphasised and regulated for prevention of pellagra.
For the prevention of nutritional deficiency caused diseases, it is very important to have diversity in the food consumed.
Food from animal sources like milk, egg, meat and fish is rich in vitamin B complex and tryptophan and this resource is to be included in daily consumption for prevention of deficiency.
Niacin rich plant food like nuts especially groundnuts must be included in diet for prevention deficiency and pellagra.
Prisoners, refugees and famine affected may not have balanced and protein rich food and they are to be given nicotinamide supplements for prevention of pellagra disease.
Education on nutrition must be emphasised to spread awareness among people for prevention of Pellagra disease.
Current topic:
Diagnosis of niacin deficiency and pellagra and its treatment and prevention.
