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{{Beriberi}}
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{{CMG}}; {{AE}}; {{AIA}}
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==Overview==
==Overview==
Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype.
Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype. Other forms as infantile beriberi or [[Wernicke-Korsakoff syndrome]] occur in special populations.
Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.


==Classification==
==Classification==
Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype.
 
Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.<ref name="pmid8868953">{{cite journal| author=Meurin P| title=[Shoshin beriberi. A rapidly curable hemodynamic disaster]. | journal=Presse Med | year= 1996 | volume= 25 | issue= 24 | pages= 1115-8 | pmid=8868953 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8868953  }}</ref><ref name="pmid30725889">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume=  | issue=  | pages=  | pmid=30725889 | doi= | pmc= | url= }}</ref><ref name="pmid31171116">{{cite journal| author=Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL| title=Wernicke Encephalopathy-Clinical Pearls. | journal=Mayo Clin Proc | year= 2019 | volume= 94 | issue= 6 | pages= 1065-1072 | pmid=31171116 | doi=10.1016/j.mayocp.2019.02.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31171116  }}</ref>  
* Beriberi is usually classified into two types based on the main system affected (Wet and dry).  
* The two forms may appear in the same patient, but one form dominates the disease phenotype.  
* Other forms as infantile beriberi or [[Wernicke-Korsakoff syndrome]] occur in special populations.<ref name="pmid8868953">{{cite journal| author=Meurin P| title=[Shoshin beriberi. A rapidly curable hemodynamic disaster]. | journal=Presse Med | year= 1996 | volume= 25 | issue= 24 | pages= 1115-8 | pmid=8868953 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8868953  }}</ref><ref name="pmid30725889">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume=  | issue=  | pages=  | pmid=30725889 | doi= | pmc= | url= }}</ref><ref name="pmid31171116">{{cite journal| author=Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL| title=Wernicke Encephalopathy-Clinical Pearls. | journal=Mayo Clin Proc | year= 2019 | volume= 94 | issue= 6 | pages= 1065-1072 | pmid=31171116 | doi=10.1016/j.mayocp.2019.02.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31171116  }}</ref><ref name="pmid23747642">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH et al.| title=2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 62 | issue= 16 | pages= e147-239 | pmid=23747642 | doi=10.1016/j.jacc.2013.05.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23747642  }}</ref><ref name="pmid18948797">{{cite journal| author=Aasheim ET| title=Wernicke encephalopathy after bariatric surgery: a systematic review. | journal=Ann Surg | year= 2008 | volume= 248 | issue= 5 | pages= 714-20 | pmid=18948797 | doi=10.1097/SLA.0b013e3181884308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18948797  }}</ref>
 
{| class="wikitable"
{| class="wikitable"
|+
|+
!
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
!
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
!Affected Site
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Affected Site
!Course
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Course
!Population
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Population
!Presentation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Presentation
|-
|-
| rowspan="2" |Classification based on main organ-system affected
! rowspan="2" |Classification based on main organ-system affected
|Wet beriberi
!Wet beriberi
|Cardiovascular System
!Cardiovascular System
|
|
* Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal).
* Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal).


* Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure.
* Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure.
|Individuals with chronic thiamine deficiency
|
* Individuals with chronic [[thiamine deficiency]].
|
|
*[[Heart failure]] (acute or chronic).
*[[Heart failure]] (acute or chronic).


* Peripheral [[edema]]: due to weakened capillary beds in peripheral tissues leading to fluid leakage.
* Peripheral [[edema]]: Due to weakened capillary beds in peripheral tissues leading to fluid leakage.
|-
|-
|Dry beriberi
!Dry beriberi
|Peripheral nervous system
!Peripheral nervous system
|Usually follows a chronic disease course
|
|Individuals with chronic [[thiamine]] deficiency
* Usually follows a chronic disease course.
|[[Polyneuritis]] and symmetric, ascending paralysis of the peripheral nerve systems. It first affects the [[sensory system]] ([[Paresthesia|parasthesia]]), then the motor system (loss of tendon reflexes, followed by foot and [[wrist drop]])
|
* Individuals with chronic [[Thiamine deficiency|thiamine deficiency.]]
|
* [[Polyneuritis]] and symmetric, ascending paralysis of the [[peripheral nervous system]].  
* It first affects the [[sensory system]] ([[Paresthesia|parasthesia]]), then the motor system (loss of tendon reflexes, followed by foot and [[wrist drop]]).
|-
|-
| rowspan="2" |Based on patient risk factor exposure
! rowspan="2" |Based on patient risk factor exposure
|Infantile beriberi
!Infantile beriberi
|Cardiovascular or nervous system
!Cardiovascular or nervous system
|Usually follows a progressive disease course and has three distinct forms:
|Usually follows a progressive disease course and has three distinct forms:


Line 57: Line 62:


* Pseudomeningitic: 7 to 9 months old.
* Pseudomeningitic: 7 to 9 months old.
|Early signs include restlessness, constipation, and vomiting.
|Early signs include restlessness, [[constipation]], and [[vomiting]].


* Cardiac form: Acute cardiac failure ([[edema]] and [[cyanosis]]). Once heart failure develops, the infant may die in two to four hours.
* Cardiac form: Acute cardiac failure ([[edema]] and [[cyanosis]]). Once heart failure develops, the infant may die in two to four hours.


* Aphonic form: hoarseness, weak cry, and even loss of voice due to vocal cord paralysis.  
* Aphonic form: hoarseness, weak cry, and even loss of voice due to vocal cord paralysis.


* Pseudomeningitic form:  The classic presentation of meningitis ([[nystagmus]], vomiting and [[Seizure|seizures]]); however, CSF analysis reveals no infectious organisms.
* Pseudomeningitic form:  The classic presentation of meningitis ([[nystagmus]], vomiting and [[Seizure|seizures]]); however, CSF analysis reveals no infectious organisms.
|-
|-
|Wenicke-Korsakoff Syndrome
!Wenicke-Korsakoff Syndrome
|Brain
!Brain
|Two conditions:  
|Two conditions:  


* Acute ([[Wernicke syndrome|Wernicke]]'s encephalopathy) or
* Acute ([[Wernicke syndrome|Wernicke]]'s encephalopathy).
* Chronic ([[Wernicke-Korsakoff syndrome|Korsakoff]] psychosis)
* Chronic ([[Wernicke-Korsakoff syndrome|Korsakoff]] psychosis).
|[[Alcoholism|Chronic alcoholics]] (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency)
|
* [[Alcoholism|Chronic alcoholics]] (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency).
|
|
* Wernicke's encephalopathy: Confusion, [[ataxia]], ptosis, and double vision.
* Wernicke's encephalopathy: Confusion, [[ataxia]], ptosis, and double vision.


* Korsakoff psychosis: [[Hallucination|Hallucinations]], confabulation, and [[amnesia]].
* Korsakoff psychosis: [[Hallucination|Hallucinations]], confabulation, and [[amnesia]].
|-
!
!Bariatric beriberi
!Nervous system
|The condition may lead to:
* Dry beriberi
*[[Wernicke-Korsakoff syndrome]]
|Bariatric surgeries
* Common: Roux-en Y gastric bypass
* Less common: post-adjustable gastric banding
|Within the first 6 months of surgery, patients may present with the manifestations of dry beriberi or more acutely, [[Wernicke-Korsakoff syndrome]].
|}<br />
|}<br />
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 15:30, 24 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Abdelrahman Ibrahim Abushouk, MD[2]

Overview

Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype. Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.

Classification

  • Beriberi is usually classified into two types based on the main system affected (Wet and dry).
  • The two forms may appear in the same patient, but one form dominates the disease phenotype.
  • Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.[1][2][3][4][5]
Affected Site Course Population Presentation
Classification based on main organ-system affected Wet beriberi Cardiovascular System
  • Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal).
  • Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure.
  • Peripheral edema: Due to weakened capillary beds in peripheral tissues leading to fluid leakage.
Dry beriberi Peripheral nervous system
  • Usually follows a chronic disease course.
Based on patient risk factor exposure Infantile beriberi Cardiovascular or nervous system Usually follows a progressive disease course and has three distinct forms:
  • Cardiac or pernicious: Rapid onset, progressive course, and poor prognosis.
  • Aphonic form: Subtle onset and a mild course.
  • Pseudomeningitic form: Progressive course.
 Infants nursed by thiamine-deficient mothers.
  • Cardiac: 1 to 3 months old.
  • Aphonic:4 to 6 months old.
  • Pseudomeningitic: 7 to 9 months old.
 Early signs include restlessness, constipation, and vomiting.
  • Cardiac form: Acute cardiac failure (edema and cyanosis). Once heart failure develops, the infant may die in two to four hours.
  • Aphonic form: hoarseness, weak cry, and even loss of voice due to vocal cord paralysis.
  • Pseudomeningitic form: The classic presentation of meningitis (nystagmus, vomiting and seizures); however, CSF analysis reveals no infectious organisms.
Wenicke-Korsakoff Syndrome Brain Two conditions:
  • Chronic alcoholics (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency).
  • Wernicke's encephalopathy: Confusion, ataxia, ptosis, and double vision.
Bariatric beriberi Nervous system The condition may lead to: Bariatric surgeries
  • Common: Roux-en Y gastric bypass
  • Less common: post-adjustable gastric banding
 Within the first 6 months of surgery, patients may present with the manifestations of dry beriberi or more acutely, Wernicke-Korsakoff syndrome.


References

  1. ↑ Meurin P (1996). "[Shoshin beriberi. A rapidly curable hemodynamic disaster]". Presse Med. 25 (24): 1115–8. PMID 8868953.
  2. ↑ "StatPearls". 2019. PMID 30725889.
  3. ↑ Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL (2019). "Wernicke Encephalopathy-Clinical Pearls". Mayo Clin Proc. 94 (6): 1065–1072. doi:10.1016/j.mayocp.2019.02.018. PMID 31171116.
  4. ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH; et al. (2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 62 (16): e147–239. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.
  5. ↑ Aasheim ET (2008). "Wernicke encephalopathy after bariatric surgery: a systematic review". Ann Surg. 248 (5): 714–20. doi:10.1097/SLA.0b013e3181884308. PMID 18948797.


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