Pellagra in South Africa from 1897 to 2019: a scoping review

Abstract

Objective: Pellagra is a nutritional deficiency disease associated with niacin (vitamin B3) deficiency. The history of pellagra is well documented for Europe and the USA, but less is known about the prevalence in sub-Saharan African countries. This study documents the history of pellagra in South Africa, as diagnosed based on dermatological symptoms. Design: Narrative review of information from scientific databases, library archives, other archives and record services and from Statistics South Africa. Setting: South Africa, 1897-2019. Participants: South African Results: Pellagra was first officially recorded in South Africa in 1906, but there are earlier indications of the disease. The prevalence of pellagra peaked after it was all but eradicated in the USA and Europe. Pellagra was never as prevalent in South Africa as in Europe, the USA and Egypt, where special hospitals for pellagrins were established. However, studies on urinary excretion of metabolites conducted in 1960s and 1970s suggested a high prevalence of subclinical (sub-pellagra) niacin deficiency, especially in previously disadvantaged Black populations. As in Europe and the USA, pellagra was associated with poverty and an overdependence on maize as staple food. Malnutrition was the main cause of the disease, but alcohol abuse might have been a contributing factor. In South Africa, reports of pellagra had declined by the late 1980s/early 1990s, and hardly any cases were reported by the year 2000. Conclusions: Although pellagra, diagnosed based on dermatological symptoms, appears to be largely eradicated in South Africa, it does not rule out the potential for subclinical niacin deficiency.

A rash on sun‐exposed skin

“…The main foods are maize and sorghum millet, and in both, niacin is present primarily in a bound form that cannot be utilized by the body. 1 The initial pruritic skin lesions are strictly confined to sun-exposed areas and resemble solar erythema. Symmetric skin lesions on the dorsum of the hands, often with a glove-like overall appearance, are characteristic.…”

“…Deficiencies from an unbalanced diet, as in the case shown here, are not uncommon, especially in Malawi. 1 Another reason for the frequent occurrence of pellagra in Malawi is the frequent use of isoniazid as tuberculosis prevention therapy in HIV patients. 7 In Central Europe, pellagra occurs only as a result of marked eating disorders, extreme malnutrition, alcohol abuse, malabsorption, and long-term drug use (isonicotinic acid hydrazide, broad-spectrum antimicrobial therapy, hydantoins and other anticonvulsants, 5-fluorouracil).…”

Exanthem auf sonnenexponierter Haut

“…Die Hauptnahrungsmittel sind Mais und Sorghumhirse und in beiden liegt Niacin vor allem in gebundener Form vor und kann daher vom Körper nicht verwertet werden. 1 Die initial juckenden Hautveränderungen sind streng auf die sonnenexponierten Areale beschränkt und gleichen einem solaren Erythem. Charakteristisch sind symmetrische Hautveränderungen der Handrücken, die oft handschuhartig konfiguriert sind.…”

“…Mangelzustände durch einseitige Ernährung wie im hier gezeigten Fall sind speziell in Malawi keine Seltenheit. 1 Eine weitere Ursache für das gehäufte Auftreten einer Pellagra in Malawi ist auch der häufige Einsatz von Isoniazid als Tuberkulose-Präventionstherapie bei HIV-Patienten. 7 In Zentraleuropa kommt Pellagra nur als Folge von ausgeprägten Essstörungen, extremer Fehlernährung, Alkoholabusus, Resorptionsstörungen und langjähriger Medikamenteneinnahme (Isonicotinsäurehydrazid, breitbandantimikrobielle Therapie, Hydantoine und andere Antikonvulsiva, 5-Fluoruracil) vor.…”

Novel Quinolone Derivatives: Synthesis and Antioxidant Activity

“…Among major applications of quinoline is synthesis of nicotinic acid (niacin) [1][2][3]. Some derivatives of quinolone, including alcaloids and quinine [4], are isolated from plants and used as synthetic antimalarial drugs including mefloquine, chloroquine and amodiaquine [5].…”