Scurvy: a disease almost forgotten

Department of Dermatology, Division of Regional and International Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA.
International Journal of Dermatology (Impact Factor: 1.23). 09/2006; 45(8):909-13. DOI: 10.1111/j.1365-4632.2006.02844.x
Source: PubMed

ABSTRACT Although much decreased in prevalence, scurvy still exists in industrialized societies. Few recent large studies have examined its pathogenesis, signs, and symptoms.
After we diagnosed scurvy in a 77-year-old female patient in 2003, we conducted a retrospective records review to identify patients with scurvy treated between 1976 and 2002 at Mayo Clinic (Scottsdale, Arizona; Rochester, Minnesota; or Jacksonville, Florida). We also searched the English-language medical literature for published reports on scurvy.
In addition to our patient, seven of 11 patients whose records in the institutional database mentioned vitamin C deficiency were women. The age ranged from a neonate to 77 years (mean, 48 years). The most common associated causes were concomitant gastrointestinal disease, poor dentition, food faddism, and alcoholism. Vitamin or mineral deficiencies other than vitamin C deficiency were also found in our patients who had scurvy. The most common symptoms were bruising, arthralgias, or joint swelling. The most common signs were pedal edema, bruising, or mucosal changes. Four patients had vague symptoms of myalgias and fatigue without classic findings, and five had concomitant nutritional deficiencies. Follow-up available for six of 12 patients treated by vitamin C supplementation showed complete resolution of symptoms in five.
Patients with scurvy may present with classic symptoms and signs or with nonspecific clinical symptoms and an absence of diagnostically suggestive physical findings. Concomitant deficiency states occur not uncommonly. Taking a thorough dietary history and measuring serum ascorbic acid levels should be considered for patients with classic signs and symptoms, nonspecific musculoskeletal complaints, or other vitamin or mineral deficiencies.

  • 04/2014; 5:1-8. DOI:10.1016/j.ijpp.2014.04.005
  • [Show abstract] [Hide abstract]
    ABSTRACT: Over the last four decades, bioarchaeology has experienced significant technical growth and theoretical maturation. Early 21st century bioarchaeology may also be enhanced from a renewed engagement with the concept of biological stress. New insights on biological stress and disease can be gained from cross-disciplinary perspectives regarding human skeletal variation and disease. First, pathophysiologic and molecular signaling mechanisms can provide more precise understandings regarding formation of pathological phenotypes in bone. Using periosteal new bone formation as an example, various mechanisms and pathways are explored in which new bone can be formed under conditions of biological stress, particularly in bone microenvironments that involve inflammatory changes. Second, insights from human biology are examined regarding some epigenetic factors and disease etiology. While epigenetic effects on stress and disease outcomes appear profoundly influential, they are mostly invisible in skeletal tissue. However, some indirect and downstream effects, such as the developmental origins of adult health outcomes, may be partially observable in bioarchaeological data. Emerging perspectives from the human microbiome are also considered. Microbiomics involves a remarkable potential to understand ancient biology, disease, and stress. Third, tools from epidemiology are examined that may aid bioarchaeologists to better cope with some of the inherent limitations of skeletal samples to better measure and quantify the expressions of skeletal stress markers. Such cross-disciplinary synergisms hopefully will promote more complete understandings of health and stress in bioarchaeological science. Am J Phys Anthropol, 2014. © 2014 Wiley Periodicals, Inc.
    American Journal of Physical Anthropology 10/2014; 155(2). DOI:10.1002/ajpa.22574 · 2.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Scurvy is caused by the lack of vitamin C, typically due to dietary deficiency, but often exacerbated by diseases or conditions that increase the destruction of the vitamin. Although vitamin C has many cellular and biochemical functions, it is best known as an antioxidant and for its ability to enhance the synthesis of collagen that is necessary for bones, cartilage, ligaments, tendons and blood vessels. Nevertheless, many of the early symptoms of scurvy such as fatigue, listlessness, apathy, depressed mood and even psychiatric disturbances may be caused by the need for the vitamin in the synthesis of brain neurotransmitters and key metabolic intermediates. As scurvy progresses in humans in the absence of intake after two to three months, physical signs of collagen deficiency become manifest, including inflammation and bleeding of hair follicles and more extensive bleeding under the skin. These are followed by inflammation of the gums – leading to the eventual loosening and loss of teeth – and finally by haemorrhage into organs and death. Fortunately, intakes of only a few milligrams of the vitamin a day are able to prevent and rapidly reverse most of these signs and symptoms. Even in the current era, a surprisingly high percentage of people living in western societies have low intakes and thus subnormal levels of the vitamin. Although this may not result in overt scurvy, if coupled with conditions or diseases that also deplete the vitamin, early signs and symptoms of scurvy will occur, but may be missed by healthcare providers (so-called ‘occult’ scurvy). Although overt scurvy is uncommon today, its early manifestations, known so well in the seafaring era, are still important to understand and recognise, especially in the face of complex illness.
    05/2013; 15(1):95-105. DOI:10.1080/21533369.2013.783168