Thiamine deficiency and cardiac dysfunction in Cambodian infants.

OBJECTIVES: To compare blood thiamine concentrations, echocardiography findings, and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in infants with clinically diagnosed beriberi and healthy matched controls, and to evaluate changes after thiamine treatment. STUDY DESIGN: Sixty-two Cambodian infants (20 cases and 42 controls), aged 2-47 weeks, were enrolled in this prospective study. Echocardiography and phlebotomy were performed at baseline and after thiamine treatment. RESULTS: Both cases and controls were thiamine-deficient, with median blood thiamine diphosphate (TDP) concentrations of 47.6 and 55.1 nmol/L, respectively (P = .23). All subjects had normal left ventricular ejection fraction. The median NT-proBNP concentration in cases (340 pg/mL [40.1 pmol/L]) was higher than previously reported normal ranges, but not statistically significantly different from that in controls (175 pg/mL [20.7 pmol/L]) (P = .10), and was not correlated with TDP concentration (P = .13). Two cases with the lowest baseline TDP concentrations (24 and 21 nmol/L) had right ventricular enlargement and elevated NT-proBNP levels that improved dramatically by 48 hours after thiamine administration. CONCLUSION: Only a minority of thiamine-deficient Cambodian infants demonstrate abnormal echocardiography findings. Thiamine deficiency produces echocardiographic evidence of right ventricular dysfunction, but this evidence is not apparent until deficiency is severe. NT-proBNP concentrations are mildly elevated in sick infants with normal echocardiography findings, indicating possible physiological changes not yet associated with echocardiographic abnormalities.

Outbreak of beriberi among illegal mainland Chinese immigrants at a detention center in Taiwan.

OBJECTIVE: The authors describe an outbreak of beriberi in a detention center in Taiwan and examine risk factors for illness. METHODS: A survey was conducted among a sample of 176 randomly selected detainees. A menu-assisted dietary recall method was used to obtain diet information from nine hospitalized detainees. A probable case patient was defined as an individual who had at least two of the following characteristics: leg edema, weakness of the extremities, poor appetite, and dyspnea. Possible case patients were those who had only one of these characteristics. RESULTS: Of the 176 survey respondents, 19% were classified as probable case patients and 40% as possible case patients. The mortality rate based on probable cases was 1.1%. Body Mass Index (BMI) was negatively associated with illness (p < 0.0001), and length of stay in the detention center was independently positively associated with illness (p < 0.05). The average intake of dietary thiamine among the nine hospitalized case patients who completed three-day dietary recall surveys was 0.49 +/- 0.1 mg/day. After thiamine administration, all symptoms and signs of beriberi resolved. CONCLUSION: This outbreak is a reminder of the importance of ensuring adequate diets for poor, institutionalized, or refugee populations who are unable to supplement their diets.

Beriberi in a well-nourished Amazonian population.

Beriberi is an endemic disease among the Naporuna indigenous people of Ecuadorean Amazonia (annual morbidity rate of 1.5%). A total of 47 patients with dry beriberi were seen at the Franklin Tello Hospital, Napo, during 1995-1996; a similar incidence was observed in previous years. No wet beriberi was found. Although the diagnosis of the disease was made clinically, an effective and quick response to thiamine treatment excluded other differential diagnoses, such as tropical ataxic neuropathy. Although indigenous people have several possible dietetic risk factors, none of them adequately explain the disease's high incidence. Some suggestions are made for the high incidence of beriberi among this Amazonian people but its cause remains unknown.

[A case of beriberi on the threshold of the year 2000]. / Un caso di Beri-beri alle soglie del 2000.

The authors report a case of beriberi due to a deficit in thiamine, which became apparent in a young Chinese woman with polyneuropathy, distal oedema and epigastralgia. Parenteral administration of thiamine lead to the virtually complete resolution of symptoms.