Beriberi infantile

Beriberi (infantile and adult) and Wernicke s encephalopathy (WE) are clinical manifestations attributed to thiamine deficiency. Beriberi is characterized by peripheral neuropathy including sensory, motor, and reflex functions affecting the distal segments of limbs more severely than proximal ones (TanPhaichitr, 1985). WE is a metabolic disease due to thiamine deficiency and is characterized by lesions in the thalamus, hypothalamus (including mammillary nuclei), and cerebellum (Victor et al., 1971 Harper and Butterworth, 1997). 

There are three forms of this disease infantile beriberi, wet beriberi, and dry beriberi. Infantile beriberi occurs when a mother who breast feeds her child is lacking vitamin Bj thiamine. The mother who nurses the child may not manifest the disease, but the deficiency occurs through the breast feeding and the child usually dies after the fifth month. In the childhood and adult versions... 

Signs of infantile beriberi include tachycardia, vomiting, convulsions, and, if not treated, death. The deficiency syndrome can have a rapid onset in nursing infants whose mothers are deficient in thiamine. Adult beriberi is characterized by dry skin, irritability, disorderly thinking, and progressive paralysis. 

Acute infantile beriberi in infants breast-fed by deficient mothers may involve high-output cardiac failure, as in shoshin beriberi, as well as signs of central nervous system involvement similar to those seen in Wernicke s encephalopathy (Section 6.4.4). 

Three types of beriberi arc recognized dry beriberi, wet beriberi, and infantile beriberi. Dry beriberi occurs mainly in older adults and involves the wasting... 

Beriberi occurs whenever thiamine intake is less than 0.4 mg/d for an extended period of time. It occurs where polished rice is a dietary staple, and, in Western society, in poor and elderly populations and alcoholics. Beriberi has wet, dry, and cardiac types, and an individual may have more than one type. Wet refers to pleural and peritoneal effusions and edema dry refers to polyneuropathy without effusions. Cardiomyopathy is the principal feature of the cardiac type. An infantile form occurs in breast-fed infants, usually 2-5 months of age, nursing from thiamine-deficient mothers. The symptoms of beriberi remit completely upon thiamine supplementation. A subclinical deficiency of thiamine occurs in hospital patients and the elderly. Deficiency of thiamine and other vitamins may contribute to a generally reduced state of health in these populations. 

In 1910, an autopsy study of 86 children with infantile beriberi concluded that 40% of these children had convulsions during their terminal illness. Nowadays, thiamine deficiency is very rare in developed countries. It may occur in breast-fed infants of thiamine deficient mothers. The onset of symptoms may be very abrupt and dramatic with high mortality rate. 

Infantile Beriberi. This form is usually found in infants living in areas of endemic beriberi who have been breast-fed by mothers whose milk is deficient in thiamin. Signs of the disorder are weakness of voice during bawling (complete lack of sound in severe cases), lack of appetite, vomiting, diarrhea, rapid pulse, and cyanosis (in severe cases). The disease results in a high death rate of infants from 2 to 5 months of age. There may be a rapid course of the disease from mild disorders to death. 

Table 5 Features of acute infantile beriberi and frequency of occurrence...

Burgess RC (1958) VI Special problems concerning beriberi. B. Infantile beriberi. Proceedings of a conference on beriberi, endemic goitre and hypervitaminosis A entitled Nutritional Disease. Proceedings of the Federation of Association of Societies of Experimental Biology 17(supplement 2) 39 6. 

Fehily L (1940) Infantile beriberi in Hong Kong. Caduceus 19 78-93. 

---