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Eat Citrus Fruits everyday and keep Scurvy away:

Pathology of Vitamin C deficiency

Dr Sampurna Roy MD                 

 

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In the past Scurvy affected sailors on long sea voyages. Vasco Da Gama the famous Portuguese explorer reached India by sea route and it is reported that he lost 100 men in the long voyage due to the disease.

James Lind (1716-1794), a British naval surgeon, introduced oranges, lemons and limes into his sailors diet in 1747, preventing the lethal effects of scurvy and earning the name 'limey' for his country-men.

The disease first becomes manifest about two months after a continuous deficient diet.

Human beings share with other primates, the guinea-pig, and certain birds, the inability to synthesize vitamin C.

The main dietary sources of this vitamin are citrus fruit ( orange, lemon, lime, grape fruits), black currants, berriers, guava, strawberries, tomatoes, guava, broccolli, green vegetables, and potatoes.

 

Pathology of Vitamin C deficiency:

Vitamin C is necessary for the synthesis of collagen and a deficiency leads to Scurvy.

         

 In Scurvy pathological changes are noted in the skin , bone, gingiva and muscle.

 

The main clinical effect is a bleeding tendency, the cause of which is probably poor anchorage of the smaller blood vessels in a thin, watery cellular substance devoid of adequate collagen fibres.

The site of bleeding in Vitamin C deficiency varies according to the age of the patient.

Bleeding often first takes place into the skin, being first detected around the hair follicles, which also show follicular hyperkeratosis. There may be a characteristic "saddle" distribution of petechiae on the medial surface of the thighs and buttocks. Cutaneous ecchymoses may follow minor trauma. There is also bleeding into muscles and along fascial planes, particularly at points of mechanical stress.

A very characteristic finding is gingival haemorrhage, which occurs only in those who have teeth. The gingivae become spongy, swollen, and ultimately ulcerated.

The clinical finding of corkscrew hair may be mistaken for Menkes syndrome.

Anaemia is common in patients suffering from Vitamin C deficiency, but this is probably due to multiple nutritional deficiencies. Vitamin C does not have a direct role in haematopoiesis.

The very important effect of vitamin C deficiency is delayed wound healing.

There may be severe bleeding with later superimposed infection. Death occurs in untreated cases, usually from severe infection.  

Milk and milk products are often a poor source of vitamin C, especially if the milk has been stored or processed.

Consequently scurvy can develop in infants at about the age of 8 months.

In infantile scurvy the characteristic feature is subperiosteal hemorrhages, which is very painful, these are rare in adults.

On the other hand, although bleeding can occur elsewhere, gingival lesions are not seen in infants unless the teeth have erupted.

Bone lesions are also seen in infantile and early childhood scurvy, since there is an impaired formation of osteoid.

Bone pathology in Vitamin C deficiency - An X-ray of the bone of a patient suffering from vitamin C deficiency show generalized rarefaction due to osteoporosis, which is particularly well marked at the metaphyseal ends of the shaft.

By contrast, the zones of provisional calcification are very dense, in the long bones this density appears as a transverse line at the junction between the epiphysis and the end of the shaft.

There is heavy calcification of the cartilage with foci of fragmented spicules of calcified cartilage forming during the period of retarded longitudinal growth.

The epiphysis may be fractured at the line of junction and undergo displacement and dislocation.

Microscopically, there is little evidence of bone formation either beneath the periosteum or at the margins of the calcified spicules of cartilage in the metaphyseal zone.

Instead there is an accumulation of cells of fibroblast type embedded in a loose-textured, oedematous ground substance.

These cells are osteoblasts, and they start to lay down osteoid as soon as ascorbic acid is administered.

The subperiosteal hemorrhages follow the disruption of the collagenous attachments (Sharpey’s fibres) from the cortex of the bone.

There is also an impairment in the formation of dentin and the teeth may be loosened from the alveolar bone.

Other clinical findings may include fatigue, keratitis, psychosis and pericardial effusion.

Summary:

Scurvy is a rare disease resulting from a deficiency of vitamin C.

The clinical presentation of this lesion is well recorded in the history of medicine.

The link between the dietary deficiency of ascorbic acid and scurvy has reduced the incidence for several decades.

Scurvy usually present as perifollicular hemorrhages, corkscrew hairs, large areas of ecchymoses and hemorrhagic gingivitis.

Clinicians should be aware of this potentially fatal but easily curable disease that can occasionally affect adults and children.

 

Visit: Pathology of Vitamin A deficiency: Importance of Vitamin A in our daily diet

Visit: As a doctor today I prescribe Thiamine  (Vitamin B1) rich foods :Prevent Beriberi,Wernicke’s Encephalopathy, and Korsakoff’s Psychosis.

Visit:  As a doctor today I prescribe  Riboflavin  (Vitamin B2) rich foods to prevent mucocutaneous and ocular lesions

Visit: As a doctor today I prescribe Niacin (Vitamin B3) rich foods to eradicate Pellagra - Prevent the 4 Ds - Dermatitis ; Diarrhea ; Dementia and Death

Visit: As a doctor today I prescribe Vitamin K to prevent hemorrhage -The most important health problem of Vitamin K deficiency is Hemorrhagic Disease of the Newborn

Visit: As a doctor today I prescribe nutritious food for every hungry child  

Further reading:

James Lind's treatise of the scurvy (1753)

Lind and Limeys, Part 1: a brief early history of scurvy and the search for its cure in the 18th century

A sensitive test for subclinical scurvy in man

Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance

Adult scurvy

Scurvy: forgotten but not gone

Human requirements for vitamin C and its use in clinical medicine

 

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Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

 


 

 

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