1/16. kwashiorkor in patients with AIDS.kwashiorkor, a form of severe protein-energy malnutrition that entails loss of lean body weight, occurs endemically among children in many parts of the world but also has been documented in adults. We report a case of kwashiorkor in an hiv-positive adult male. Cutaneous findings are striking, and skin, hair, and nails are affected. Although kwashiorkor occurs in patients with hiv-AIDS, the skin manifestations have not been emphasized in the dermatologic literature. Indeed, dermatologists may play a vital role in diagnosing this treatable condition.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/16. kwashiorkor in the united states: fad diets, perceived and true milk allergy, and nutritional ignorance.BACKGROUND: kwashiorkor is the edematous form of protein-energy malnutrition. It is associated with extreme poverty in developing countries and with chronic malabsorptive conditions such as cystic fibrosis in developed countries. Rare cases of kwashiorkor in affluent countries unrelated to chronic illness have been reported. We present 12 cases of kwashiorkor unrelated to chronic illness seen over 9 years by pediatric dermatologists throughout the united states, and discuss common causative themes in this easily preventable condition. OBSERVATIONS: Twelve children were diagnosed as having kwashiorkor in 7 tertiary referral centers throughout the united states. The diagnoses were based on the characteristic rash and the overall clinical presentation. The rash consisted of an erosive, crusting, desquamating dermatitis sometimes with classic "pasted-on" scale-the so-called flaky paint sign. Most cases were due to nutritional ignorance, perceived milk intolerance, or food faddism. Half of the cases were the result of a deliberate deviation to a protein-deficient diet because of a perceived intolerance of formula or milk. Financial and social stresses were a factor in only 2 cases, and in both cases social chaos was more of a factor than an absolute lack of financial resources. Misleading dietary histories and the presence of edema masking growth failure obscured the clinical picture in some cases. CONCLUSIONS: physicians should consider the diagnosis of kwashiorkor in children with perceived milk allergies resulting in frequent dietary manipulations, in children following fad or unorthodox diets, or in children living in homes with significant social chaos. The presence of edema and "flaky paint" dermatitis should prompt a careful dietary investigation.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/16. Tropical calcific pancreatitis presenting as kwashiorkor.Tropical clacific pancreatitis can be accompanied by varying degrees of malnutrition but full-blown kwashiorkor is an extremely rare presentation. We report the case of a 10-year-old male who presented with clinical features of severe kwashiorkor. He had extensive pancreatic clacification and exocrine pancreatic deficiency. The child was treated with pancreatic enzyme replacement, and enteral nutrition supplemented with vitamins and micronutrients. Following therapy, he started gaining weight, the skin changes partly disappeared and his hair resumed its normal black colour.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
4/16. Electron microscopy of herpes simplex hepatitis with hepatocyte pulmonary embolization in kwashiorkor.We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells, with pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
5/16. Weanling diarrhea: a case report.This case report describes a 14-month-old Guatemalan boy suffering from diarrhea and malnutrition. He had been healthy and experienced normal growth until weaning, which began at six months of age. Introduction of semisolid foods at this time was accompanied by bouts of diarrhea and a reduced growth rate. After admission to hospital at 14 months of age, he was found to have protein-energy malnutrition of the edematous type (kwashiorkor) and to be infected with giardia lamblia. Therapy with metronidazole and a high-protein diet resulted in satisfactory weight gain and cessation of the diarrhea.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |
6/16. Skin changes in short-bowel syndrome. kwashiorkor-like syndrome.An infant with short-bowel syndrome developed flexural desquamation and "enamel paint" skin in pressure-bearing areas. Hyperalimentation with amino acid and lipid solution was unsuccessful in correcting the malnutrition and skin changes.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
7/16. lactose intolerance in protein-energy malnutrition: a clinical case study and family study using a hydrogen (H2) breath-analysis test for carbohydrate malabsorption.A non-invasive, interval sampling hydrogen (H2) breath-analysis test for carbohydrate malabsorption was used in a 3 year-old Guatemalan child with severe protein-energy malnutrition (kwashiorkor) and in this relatives: mother half-sister and step-father to examine genetic and nutritional factors in lactose intolerance in young children. Clinical lactose intolerance was present in the patient on admission, and lactose malabsorption, even of 0.88 g per kg of weight, persisted after complete nutritional recobly due to gastric retention of the substrate. Malabsorption of a physiological dose of lactose, 12.5 g, was detected in the mother and step-father while their daughter exhibited normal growth and development and normal lactose absorption at 8 months of age. The H2 breath test proved to be a sensitive, well-tolerated procedure for both adults and young children. Pitfalls, such as delayed gastric emptying, absence of normal bacterial flora, prior use of antibiotics, must be considered in interpreting H2 breath test results in children.- - - - - - - - - - ranking = 5keywords = malnutrition (Clic here for more details about this article) |
8/16. kwashiorkor in baltimore.Advanced cases of malnutrition are rare in the united states. Since it is rarely suspected, a correct diagnosis of malnutrition, even in extreme form, may easily be missed. We present a recent case of the kwashiorkor form of the syndrome of protein-energy malnutrition to emphasize its diagnostic features and to enhance early recognition and initiation of proper therapy. The misunderstanding of a physician's recommendations by a teen-aged mother may have initiated this illness.- - - - - - - - - - ranking = 3keywords = malnutrition (Clic here for more details about this article) |
9/16. Histopathological changes in the temporal bone in kwashiorkor.The histopathological changes in human temporal bones are described for 2 cases of kwashiorkor--a protein/calorie malnutrition (PCM) state. There is photographic evidence of severe damge to the middle and inner ears and to the vestibulocochlear nerve. The middle ear shows evidence of chronic otitis media, a common clinical finding in kwashiorkor. Significantly, the round window membranes in both cases showed thickening and infiltration with inflammatory cells. The inner ear showed the loss of cellular elements and hair cell loss in the spiral organ. A marked decrease of spiral ganglion cells and demyelination of the vestibulocochlear nerve were also seen.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
10/16. Kwashiorker in a child in central pennsylvania. A seven-year follow-up.Follow-up of a child who had severe protein malnutrition from the ages of 3 to 6 1/2 months demonstrated intellectual and social functioning within the normal range seven years after diagnosis and treatment. Treatment consisted of peripheral alimentation, followed by an elemental infant formula (lactose free), with nutritional education of the family.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
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