Scurvy: Symptoms, Causes and Treatment

Scurvy is a disease resulting from a deficiency of vitamin C (ascorbic acid), which is essential for collagen synthesis, a vital component of connective tissues. Historically, scurvy has been notorious for its impact on sailors who had limited access to fresh fruits and vegetables during long voyages. Despite being rare in modern times due to the availability of vitamin C-rich foods, scurvy can still occur in certain populations with poor nutrition.

Symptoms

The symptoms of scurvy can develop after one to three months of inadequate vitamin C intake. They range from mild to severe and include:

1. Fatigue and Weakness: One of the earliest signs of scurvy, resulting from the body’s inability to synthesize collagen, affecting muscle strength and energy levels.
2. Gum Disease: Swollen, spongy, and bleeding gums are hallmark symptoms. Gum tissue can become so weak that teeth may loosen or fall out.
3. Skin Changes: Rough, dry, and scaly skin is common. Petechiae, small red or purple spots caused by bleeding under the skin, often appear.
4. Joint Pain and Swelling: Due to collagen’s role in maintaining joint and bone health, its deficiency leads to joint pain, swelling, and even hemorrhages.
5. Poor Wound Healing: Slow healing of wounds and reopening of previously healed scars are indicative of scurvy.
6. Anemia: Vitamin C enhances iron absorption; thus, its deficiency can lead to iron-deficiency anemia, causing pallor and further fatigue.
7. Mood Changes: Depression, irritability, and general malaise are common due to the overall impact on health and energy levels.
8. Corkscrew Hairs: Hairs on the body can become bent or coiled due to defects in the hair shaft.

Causes

Scurvy is caused by a deficiency of vitamin C, which can occur due to:

1. Poor Diet: Insufficient intake of fruits and vegetables rich in vitamin C is the primary cause. This is often seen in:
   • Individuals with eating disorders
   • People following restrictive diets
   • Socioeconomically disadvantaged individuals with limited access to nutritious foods
2. Malabsorption Disorders: Conditions like Crohn’s disease or ulcerative colitis that impair the absorption of nutrients can lead to scurvy.
3. Alcoholism: Chronic alcohol consumption can lead to poor dietary choices and impaired nutrient absorption, including vitamin C.
4. Elderly and Isolated Individuals: Older adults, especially those living alone or in care facilities, may not consume a balanced diet.
5. Infants on Improper Formulas: Infants fed with homemade formulas lacking vitamin C or those not receiving adequate breast milk can develop scurvy.

Types

Scurvy is generally classified based on the affected population or the context in which it occurs:

1. Adult Scurvy: Typically seen in adults with poor dietary habits or underlying health conditions affecting vitamin C absorption.
2. Infantile Scurvy (Barlow’s Disease): Occurs in infants who are not breastfed or who receive inadequate amounts of vitamin C from their diet.

Diagnosis

Diagnosis of scurvy is primarily based on clinical signs and symptoms. A detailed dietary history is essential to identify vitamin C deficiency. Laboratory tests can confirm the diagnosis:

1. Blood Tests: Measuring levels of vitamin C in the blood.
2. Radiographic Evidence: X-rays may show characteristic changes in bones, particularly in infants and young children.

Treatment

The treatment of scurvy involves replenishing vitamin C levels in the body:

1. Dietary Intake: Consuming vitamin C-rich foods such as citrus fruits (oranges, lemons), strawberries, kiwi, bell peppers, broccoli, and tomatoes.
2. Vitamin C Supplements: In cases of severe deficiency, oral vitamin C supplements are administered. The typical dosage is 1-2 grams per day for the first few days, followed by 500 mg daily for a week, and then a maintenance dose of 100 mg daily.
3. Monitoring and Supportive Care: Regular follow-up to ensure symptoms resolve and to address any complications such as anemia. In severe cases, hospitalization may be necessary for intravenous vitamin C administration.

Prevention

Preventing scurvy is straightforward with adequate dietary intake of vitamin C:

1. Balanced Diet: Ensuring a diet rich in fruits and vegetables.
2. Education and Awareness: Educating at-risk populations about the importance of vitamin C and sources of the vitamin.
3. Supplementation: Providing vitamin C supplements to individuals at risk, such as those with malabsorption issues or restrictive diets.

Conclusion

Scurvy, once a common affliction among sailors, is now a rare but entirely preventable disease. Awareness of its symptoms, causes, and treatment is crucial, particularly among healthcare providers and at-risk populations. Ensuring a diet rich in vitamin C can effectively prevent and treat scurvy, promoting overall health and well-being.

References

• Mayo Clinic. (n.d.). Scurvy: Symptoms and causes. Retrieved from https://www.mayoclinic.org
• National Institutes of Health. (n.d.). Vitamin C – Health Professional Fact Sheet. Retrieved from https://ods.od.nih.gov
• World Health Organization. (n.d.). Scurvy. Retrieved from https://www.who.int