KWASHIORKOR,MARASMUS AND STARVATION

PLURI-DEFICIENCY SYNDROME

[KWASHIORKOR,MARASMUS AND STARVATION].

Pluri-deficiency means more than one deficiency or multiple deficiency of nutrient. Syndrome is from the Greek word meaning “run together” diseases and symptoms. Clinical pluri-deficiency syndrome [PDS] which results from more than one deficiency such as deficiency of calories [energy], protein and probably other nutrients such as vitamins and minerals.
PDS is the most extreme form of malnutrition [under nourished].
The basic cause of PDS is an imbalance between energy, protein, and vitamins intake and expenditure. In other words: the body expends more energy, protein and vitamins than it takes in as food. The imbalance can come from one or more medical condition causes and socio-economic condition causes.
Medical causes: Anorexia nervosa, digestive diseases, depression and coma.
Socio-economic causes: famine, poverty, uneducated, deprivation and observed in various countries, especially in war-torn areas where starvation is common.
We can identify 3 types of extreme PDS:
1.Kwashiorkor
2. Marasmus
3. Starvation.

KWASHIORKOR

Kwashiorkor is the term applied to a clinical syndrome which results from an extreme deficiency of protein, and probably deficiency of other nutrients, especially those of vitamins B-complex and vitamin A, , C and K.
The term “kwashiorkor” is said to mean “red boy” in the language of Gold Coast Africa. Another interpretation is the “syndrome of the changeling”
The syndrome of kwashiorkor as it has been described signs among the children consist of :

Picture 1: A. Kwashiorkor in a two year-old boy. Note the generalized edema and the skin lesions.B. Close-up of the same child the showing hair changes ; the edema of the face and the skin lesions can be seen more clearly.

Source: Waldon E.Nelson,M.D.,D.Sc.
Textbook of PEDIATRICS. Seven Edition,W.B.SaundersCompany,Philadelphia,USA,1959, p 358.
1. Retarded growth in the weaning and post-weaning under 3 years old children.
2. Edema usually associated with hypo-proteinemia [low protein in the plasma of the blood].

Picture 2: Left, infant with "sugar-baby" kwashiorkor,showing stunting, edema of feet and hands,moon face and depigmentation of the hair.
Right, normal infant of same age and racial group.Source: Ibid, p 360
3. Alteration in skin and hair pigmentation.
4. The frequent association of a variety of dermatoses [skin disorders] such as pellagra.
5. Gastrointestinal disorders, including anorexia, vomiting, and diarrhea.
6. Irritability and apathy.
7. Fatty infiltration, cellular necrosis or fibrosis of the liver.
8. A high mortality rate.

Diagnosis:
Some combinations of these signs is essential for diagnosis.
Edema usually starts in the feet, but soon involves the face, hands, arms and genitals; ascites [accumulation of fluid in the abdominal cavity] is rare.
The hair loses its luster and in Negro tends to lose its curl and become straight and fine; it becomes pale or almost reddish.
If there is vitamin A deficiency with symptoms of night blindness, xerophthalmia [ocular disease] appear late in the disease.

Picture 3: Recovery from xerophthalmia, showing permanent eye lesion.
Source : Opcit, p 361



Vitamin B-complex deficiency is a common , often leading to anemia, beri-beri and pellagra.

Vitamin C deficiency there may be a "rosary" at the costochondral junctions and a depression of the sternum.Rickets due to vitamin D deficiency. Hemorrhagic jaundice of vitamin K deficiency.
Picture 4: Vitamin C deficiency scorbutic rosary,depression of sternum and the so-called frog position. Source: Opcit, p 369

Treatment:
Kwashiorkor is usually treated with the diet rich in proteins of high biological value, vitamins and minerals, adequate energy ; and the treatment of the coexisting infections.

Prevention:
It can be accomplished by feeding an adequate diet during the post-weaning phase. Nutrient diet rich in source of protein such as dried milk, skim milk, fish meal and legume [soy beans]; adequate energy, vitamins and minerals

Picture 5: Hemorrhagic jaundice due to vitamin K deficiency.Source: Cecil & Loeb. A Textbook of MEDICINES. W.B.Saunders Company, Philadelphia,USA,1959, p 540