Scurvy
Introduction
Scurvy is a disease resulting from a deficiency of vitamin C, also known as ascorbic acid. This condition has been historically significant, particularly among sailors and soldiers who had limited access to fresh fruits and vegetables during long voyages or campaigns. The disease is characterized by symptoms such as anemia, debility, exhaustion, spontaneous bleeding, pain in the limbs, and especially the legs, swelling in some parts of the body, and ulceration of the gums and loss of teeth.
History
Scurvy has been known since ancient times, with records of the disease dating back to the time of the ancient Egyptians. However, it became particularly notorious during the Age of Exploration, when long sea voyages led to widespread outbreaks among sailors. The British naval surgeon James Lind is often credited with discovering the cure for scurvy in the mid-18th century, through his experiments with citrus fruits.
Pathophysiology
Vitamin C is essential for the synthesis of collagen, a protein that helps maintain the integrity of connective tissues. A deficiency in vitamin C impairs collagen synthesis, leading to weakened blood vessels, skin, and bones. This results in the characteristic symptoms of scurvy, such as bleeding gums, joint pain, and anemia.
Symptoms
The initial symptoms of scurvy include fatigue, malaise, and inflammation of the gums. As the disease progresses, more severe symptoms develop, including:
- Petechiae, or small red or purple spots on the skin caused by minor bleeding.
- Ecchymosis, or larger areas of bruising.
- Hyperkeratosis, or thickening of the outer layer of the skin.
- Corkscrew hairs, or twisted, coiled hairs.
- Anemia, due to impaired iron absorption and blood loss.
- Joint pain and swelling.
- Poor wound healing.
- Subperiosteal hemorrhage, or bleeding under the periosteum of bones.
Diagnosis
The diagnosis of scurvy is primarily clinical, based on the patient's history and physical examination. Laboratory tests can support the diagnosis by showing low levels of vitamin C in the blood. Imaging studies, such as X-rays, may reveal characteristic changes in the bones, particularly in children.
Treatment
The treatment for scurvy is straightforward: replenishing the body's stores of vitamin C. This can be achieved through dietary changes, such as increasing the intake of fresh fruits and vegetables, or through vitamin C supplements. Symptoms typically begin to improve within days of starting treatment, and full recovery can be expected within a few weeks.
Prevention
Scurvy is easily preventable with an adequate intake of vitamin C. The recommended daily allowance (RDA) for vitamin C varies by age, sex, and life stage, but generally ranges from 75 to 90 milligrams per day for adults. Good dietary sources of vitamin C include citrus fruits, berries, kiwi, bell peppers, tomatoes, and leafy greens.
Epidemiology
While scurvy is rare in developed countries today, it can still occur in populations with limited access to fresh produce, such as the elderly, individuals with restrictive diets, or those living in food deserts. It is also seen in individuals with certain medical conditions that affect nutrient absorption, such as Crohn's disease or ulcerative colitis.