Beriberi classification: Difference between revisions
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==Classification== | ==Classification== | ||
Beriberi is usually classified into two types based on the main system affected. 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. | ||
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{| class="wikitable" | {| class="wikitable" | ||
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|Wet beriberi | |Wet beriberi | ||
|Cardiovascular System | |Cardiovascular System | ||
| | |<nowiki>- Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal).</nowiki> | ||
- 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). | ||
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|Infantile beriberi | |Infantile beriberi | ||
|Cardiovascular or nervous system | |Cardiovascular or nervous system | ||
| | |Usually follows a progressive disease course and has three distinct forms: | ||
|Infants | |||
| | - 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. | |||
- Pure Cardiologic: 1 to 3 months of 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 | |Wenicke-Korsakoff Syndrome | ||
|Brain | |Brain | ||
|Two | |Two conditions: Acute (Wernicke's encephalopathy) or chronic (Korsakoff psychosis) | ||
|Chronic alcoholics | |Chronic alcoholics (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency) | ||
| | |<nowiki>- Wernicke's encephalopathy: Confusion, ataxia, ptosis, and double vision.</nowiki> | ||
- Korsakoff psychosis: Hallucinations, confabulation, and amnesia. | |||
|} | |} | ||
Revision as of 18:32, 5 November 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
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.
| Affected Site | Course | Population | Presentation | |
|---|---|---|---|---|
| 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).
|
Individuals with chronic thiamine deficiency | - Heart failure (acute or chronic).
- 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 | Individuals with chronic thiamine deficiency | Polyneuritis and symmetric, ascending paralysis of the peripheral nerve systems. It first affects the sensory system (parasthesia), then the motor system (loss of tendon reflexes, followed by foot and wrist drop) |
| 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.
- Pure Cardiologic: 1 to 3 months of 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: Acute (Wernicke's encephalopathy) or chronic (Korsakoff psychosis) | Chronic alcoholics (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency) | - Wernicke's encephalopathy: Confusion, ataxia, ptosis, and double vision.
- Korsakoff psychosis: Hallucinations, confabulation, and amnesia. |
- Wet beriberi usually affects the cardiovascular system, which may cause heart failure. Moreover, it weakens the capillary walls in peripheral tissues, causing tissue water leakage and edema; hence the nomenclature "Wet".
- Dry beriberi (or endemic neuritis) usually affects the nervous system, particularly the peripheral nerves, causing partial paralysis.[1]
Based on the disease course, wet beriberi can be further classified into two forms:
- Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal). The heart is the main site affected and it usually leads to cardiovascular collapse.[2]
- Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure in three stages: Initial peripheral vasodilatation, followed by activation of the kidney renin-angiotensin system, leading to fluid overload, peripheral edema, and pulmonary effusion.
There are two forms of beriberi that occur in special populations due to their nature of risk factor exposure. "Infantile beriberi" occurs in children nursed by women deficient in thiamine and usually occurs between one and four months of age. Another form of the disease occurs mainly in chronic alcoholics "Wernicke-Korsakoff syndrome" in which the brain is the main target (cerebral beriberi). This form may have either acute (Wernicke's encephalopathy) or chronic presentations (Korsakoff psychosis).[3]
References
- ↑ "StatPearls". 2019. PMID 30725889.
- ↑ Meurin P (1996). "[Shoshin beriberi. A rapidly curable hemodynamic disaster]". Presse Med. 25 (24): 1115–8. PMID 8868953.
- ↑ Donnelly A (2017). "Wernicke-Korsakoff syndrome: recognition and treatment". Nurs Stand. 31 (31): 46–53. doi:10.7748/ns.2017.e10440. PMID 28351256.