Cardiac beriberi

Citreoviridin (79), luteoskyrin (80), and cyclochlorotine (81) are historical mycotoxins studied in Japan. Citreoviridin was isolated as a toxin from Penicillium citreoviride associated with a disease called cardiac beriberi or shoshin kakke .164 Luteoskyrin and cyclochlorotine were isolated from Penicillium islandicum, which was infected into toxic yellowed rice.165 Genes responsible for biosynthesis of these compounds are not obtained. 

Penicillium species produce various mycotoxins. Strains of Penicillium citreo-viride, which infect rice, produce the mycotoxin, dtreoviridin (9.20). This compound is the cause of a condition known as cardiac beriberi , which is characterized by cardiovascular disorders, difficulty in breathing and nausea. The mechanism of action involves the inhibition of mitochondrial ATP synthesis. Cardiac beriberi was a serious infection of people eating rice as a staple diet, causing many fatalities until the origin was identified. 

While peripheral neuritis and acute cardiac beriberi with lactic acidosis occur in thiamin deficiency associated with alcohol abuse, the more usual presentation is as the Wernicke—Korsakoff syndrome, due to central nervous system lesions. Initially there is a confused state, Korsakoff s psychosis, which is characterized by confabulation and loss of recent memory, although memory for past events may be unimpaired. Later, clear neurological signs develop — Wernicke s encephalopathy. This is characterized by nystagmus and extraocular palsy. Post-mortem examination shows characteristic brain lesions. 

Citreoviridin is a potent inhibitor of soluble mitochondrial ATPase. In experimental animals it has caused a disease called acute cardiac beriberi, whose symptoms are similar to the symptoms of classic beriberi (convulsions and paralysis), but the disease is not curable with thiamine. 

Wet Beriberi. The presence of edema distinguishes this form from dry beriberi. Other features are extreme loss of appetite, breathlessness, and disorders of the heart which range from palpitation and rapid heart rate to dilation of the heart muscle (myocardium) and congestive heart failure. When the cardiac disorders are severe, the disease may be called cardiac beriberi, or Shoshin beriberi (a name us in Asia). 

Beriberi is caused by a deficiency of thiamin (also called thiamine, aneurin(e), and vitamin Bj). Classic overt thiamin deficiency causes cardiovascular, cerebral, and peripheral neurological impairment and lactic acidosis. The disease emerged in epidemic proportions at the end of the nineteenth century in Asian and Southeast Asian countries. Its appearance coincided with the introduction of the roller mills that enabled white rice to be produced at a price that poor people could afford. Unfortunately, milled rice is particularly poor in thiamin thus, for people for whom food was almost entirely rice, there was a high risk of deficiency and mortality from beriberi. Outbreaks of acute cardiac beriberi still occur, but usually among people who live under restricted conditions. The major concern today is subclinical deficiencies in patients with trauma or among the elderly. There is also a particular form of clinical beriberi that occurs in patients who abuse alcohol, known as the Wer-nicke-Korsakoff syndrome. Subclinical deficiency may be revealed by reduced blood and urinary thiamin levels, elevated blood pyruvate/lactate concentrations and a-ketoglutarate activity, and decreased erythrocyte transketolase (ETKL) activity. Currently, the in vitro stimulation of ETKL activity by thiamin diphosphate (TDP) is the most useful functional test of thiamin status where an acute deficiency state may have occurred. The stimulation is measured as the TDP effect. 

Answer The symptoms resemble those you remember from medical school for beriberi, but you fail to see the coimection. Then a light clicks on. If the patient were consuming most of his calories as alcohol, he may have a nutritional deficiency, a beriberi-Uke syndrome, as a result of insufficient intake of thiamine. You prescribe a daily vitamin tablet and admonish the patient to cut back on alcohol intake. At the next appointment, the edema is much better and the cardiac stress tests results are normal. He has joined Alcohohcs Anonymous and indicates that he is doing better. 

High-output" failure is a rare form of heart failure. In this condition, the demands of the body are so great that even increased cardiac output is insufficient. High-output failure can result from hyperthyroidism, beriberi, anemia, and arteriovenous shunts. This form of failure responds poorly to the drugs discussed in this chapter and should be treated by correcting the underlying cause. 

The classical deficiency syndrome is beriberi, characterized by anorexia, weakness, constipation, progressive polyneuritis, cardiac insufficiency, and either edema or wasting of muscles.29 The recommended daily allowance is 1.1 to 1.4 mg.112... 

Heart failure without increased cardiac output, and no peripheral edema, may also occur acutely, associated with severe lactic acidosis. This was a common presentation of deficiency in Japan, where it was called shoshin (= acute) beriberi in the 1920s, nearly 26,000 deaths a year were recorded. 

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). 

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. 

Beriberi, a neurologic and cardiovascular disorder, is caused by adi etary deficiency of thiamine (also called vitamin B,). The disease has been and continues to be a serious health problem in the Far East because rice, the major food, has a rather low content of thiamine. This deficiency is partly ameliorated if the whole rice grain is soaked in water before milling some of the thiamine in the husk then leaches into the rice kernel. The problem is exacerbated if the rice is polished, because only the outer layer contains significant amounts ot thiamine. Beriberi is also occasionally seen in alcoholics who are severely malnourished and thus thiamine deficient. The disease is characterized by neurologic and cardiac symptoms. Damage to the peripheral nervous system is expressed as pain in the limbs, weakness of the musculature, and distorted skin sensation. The heart may be enlarged and the cardiac output inadequate. 

In the Far East, beriberi is a serious health problem. It is characterized by neurologic and cardiac symptoms. Beriberi is caused by a deficiency of... 

Long term usage of ethanol enhances the metabolic removal of vitamin B. (thiamin pyrophosphate). B deficiencies are known to result in polyneuritis, a neurological disorder, and beriberi, a cardiac problem. 

Indications Cold rheum internally amassed. Chronic tracheitis, acute and chronic bronchitis, bronchial asthma, pulmonary emphysema, chronic pulmonary obstructive disease, edema, ascites, chronic nephritis, atrophic kidney, pleurisy, beriberi, and cardiac asthma... 

Al Martini. A1 Martini presents a second time with an alcohol-related J high output form of heart failure sometimes referred to as wet beriberi, or as the beriberi heart (see Chapter 9). The term wet refers to the fluid retention which may eventually occur when left ventricular contractility is so compromised that cardiac output, although initially relatively high, cannot meet the demands of the peripheral vascular beds, which have dilated in response to the thiamine deficiency. 

Beriberi is a neurological and cardiovascular disorder that is caused by a deficiency of thiamine (also called vitamin Bj). It has been a serious health problem in Asia and continues to be in those places where rice is the main staple food. The problem is exacerbated if the rice is dehusked (polished) because only the outer layers of the seeds contain appreciable amounts of thiamine. Beriberi also occurs in some malnourished chronic alcoholics, so to avoid this problem in some countries certain alcohol-containing drinks are fortified with thiamine. Beriberi is characterized by pain in the limbs, weak muscles, abnormal skin sensation, and an enlarged heart with inadequate cardiac output. Which biochemical processes are affected by thiamine deficiency ... 

V.B] results in disturbances of carbohydrate metabolism, accompanied by an increase in the concentration of blooid oxoadds (mostly pyruvate), which reflects the role of thiamin pyrophosphate as a co-enzyme of pyruvate dehydrogenase. The typical defi-dency disease, beriberi, results from a diet excludvely of polished rice. It is characterized by disturbances of the central and peripheral nervous system (polyneitri-tis) and of cardiac function. The daily requirement for th min is about 1 mg. 

Thiamine deficiency leads to beriberi, which has a cardiac and peripheral nerve involvement. Why some patients develop beriberi without cerebral pathology and others develop Wernicke-Korsakoff syndrome without cardiac involvement is not clear. Presumably, undefined nutritional or metabolic factors play a role in both, as may the toxic effects of ethanol. 

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