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Reference Manager
BibTeX
Zotero
EndNote
-
1.
Magiorkinis E , Beloukas A , Diamantis A , 2011. Scurvy: past, present, and future. Eur J Intern Med 22: 147–152.
-
2.
WHO , 1999. Scurvy and Its Prevention and Control in Major Emergencies 1999. Available at: who.int/nutrition/publications/emergencies/WHO_NHD_99.11/en/. Accessed September 23, 2020.
-
3.
Ortner DJ , Butler W , Cafarella J , Milligan L , 2001. Evidence of probable scurvy in subadults from archeological sites in North America. Am J Phys Anthropol 114: 343–351.
-
4.
Paladin A , Wahl J , Zinc A , 2018. Evidence of probable subadult scurvy in the Early Medieval cemetery of Catel Tirolo, South Tyrol, Italy. Int J Osteoarchaeol 28: 714–726.
-
5.
Pitre M , Stark R , Gatto M , 2016. First probable case of scurvy in ancient Egypt at Nag el-Qarmila, Aswan. Int J Paleopathol 13: 11–19.
-
6.
Halcrow SE et al., 2014. First bioarchaeological evidence of probable scurvy in Southeast Asia: Multifactorial etiologies of vitamin C deficiency in a tropical environment. Int J Paleopathol 5: 63–71.
-
7.
Padayatty SJ , Levine M , 2016. Vitamin C: the known and the unknown and Goldilocks. Oral Dis 22: 463–493.
-
8.
Hodges RE et al., 1971. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr 24: 432–443.
-
9.
Burns JJ , 1957. Missing step in man, monkey and guinea pig required for the biosynthesis of L-ascorbic acid. Nature 180: 553.
-
10.
WHO and FAO , 1997. Vitamin and Mineral Requirements in HumanN: Report of a Joint FAO/WHO Expert Consultation. Geneva, Switzerland: World Health Organization.
-
11.
Lamb J , 2016. Scurvy: The Disease of Discovery. Princeton, NJ: Princeton University Press.
-
12.
Bollet AJ , 1992. Scurvy and chronic diarrhea in Civil War troops: were they both nutritional deficiency syndromes? J Hist Med Allied Sci 47: 49–67.
-
13.
Carpenter KJ , 2012. The discovery of vitamin C. Ann Nutr Metab 61: 259–264.
-
14.
Milne I , Chalmers I , 2004. Documenting the evidence: the case of scurvy. Bull World Health Organ 82: 791–796.
-
15.
Szent-Györgyi A , 1928. Observations on the function of peroxidase systems and the chemistry of the adrenal cortex: description of a new carbohydrate derivative. Biochem J 22: 1387–1409.
-
16.
Levavasseur M et al., 2015. Severe scurvy: an underestimated disease. Eur J Clin Nutr 69: 1076–1077.
-
17.
Branquinho DF et al., 2015. From past sailors' eras to the present day: scurvy as a surprising manifestation of an uncommon gastrointestinal disease. BMJ Case Rep 2015: bcr2015210744.
-
18.
Agarwal A et al., 2015. Scurvy in pediatric age group: a disease often forgotten? J Clin Orthop Trauma 6: 101–107.
-
19.
Gabb G , Gabb B , 2015. Scurvy not rare. Aust Fam Physician 44: 438–440.
-
20.
Velandia B et al., 2008. Scurvy is still present in developed countries. J Gen Intern Med 23: 1281–1284.
-
21.
Desenclos JC et al., 1989. Epidemiological patterns of scurvy among Ethiopian refugees. Bull World Health Organ 67: 309–316.
-
22.
Halestrap P , Scheenstra S , 2018. Outbreak of scurvy in Tana River County, Kenya: a case report. Afr J Prim Health Care Fam Med 10: e1–e3.
-
23.
Hafez D et al., 2016. Clinical problem-solving: a deficient diagnosis. N Engl J Med 374: 1369–1374.
-
24.
Domingo AE et al., 2016. Now you see/C it. Postgrad Med 128: 629–631.
-
25.
Cheung E et al., 2003. An epidemic of scurvy in Afghanistan: assessment and response. Food Nutr Bull 24: 247–255.
-
26.
CNN, 2002. Congo Fever Fears in Afghanistan. CNN. com, March 12, 2002. Available at: http://www.cnn.com>2002>WORLD>asiapcf>central. Accessed October 20, 2019.
-
27.
Giday A , 2012. Outbreak of scurvy among prisoners in South Ethiopia. Ethiop J Health Dev 26: 60–62.
-
28.
Hodges RE et al., 1969. Experimental scurvy in man. Am J Clin Nutr 22: 535–548.
-
29.
Schorah CJ , 1981. The level of vitamin C reserves required in man: towards a solution to the controversy. Proc Nutr Soc 40: 147–154.
-
30.
Watson W , 1956. An outbreak of either scurvy or possibly tropical phlebitis. Cent Afr J Med 2: 365–366.
-
31.
Singh S et al., 2015. An underdiagnosed ailment: scurvy in a tertiary care academic center. Am J Med Sci 349: 372–373.
-
32.
Pailhous S et al., 2015. Scurvy, an old disease still in the news: two case reports. Arch Pediatr 22: 63–65.
-
33.
Lessing JN et al., 2015. Perifollicular haemorrhage with corkscrew hair due to scurvy. Postgrad Med J 91: 719–720.
-
34.
Fain O , 2005. Musculoskeletal manifestations of scurvy. Joint Bone Spine 72: 124–128.
-
35.
Hirschmann JV , Raugi GJ , 1999. Adult scurvy. J Am Acad Dermatol 41: 895–906, quiz 907–910.
-
36.
Smith A , Di Primio G , Humphrey-Murto S , 2011. Scurvy in the developed world. CMAJ 183: E752–E755.
-
37.
Marshall R , 2002. Oral lesions in scurvy. Aust Dent J 47: 82–83.
-
38.
Packer L , Fuchs J , 1997. Vitamin C in Health and Disease. New York, NY: Marcel Dekker, Inc.
-
39.
Weise Prinzo Z , de Benoist B , 2002. Meeting the challenges of micronutrient deficiencies in emergency-affected populations. Proc Nutr Soc 61: 251–257.
-
40.
Ververs M et al., 2019. Scurvy outbreak among South Sudanese adolescents and young men – Kakuma Refugee Camp, Kenya, 2017–2018. MMWR Morb Mortal Wkly Rep 68: 72–75.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 4199 | 2889 | 34 |
| Full Text Views | 259 | 11 | 0 |
| PDF Downloads | 223 | 21 | 0 |
An Epidemic of Scurvy, Identified Based on Lower Extremity Swelling, in a Southern Ethiopian Prison
Wondwossen Amogne
Wondwossen Amogne
Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia;
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Meskerem Nimani
Meskerem Nimani
Addis Ababa Emergency Burn & Trauma Hospital, Addis Ababa, Ethiopia;
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Ishmael Shemsedin
Ishmael Shemsedin
Addis Ababa Emergency Burn & Trauma Hospital, Addis Ababa, Ethiopia;
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Wadu Marshalo
Wadu Marshalo
Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia;
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Daddi Jima
Daddi Jima
Ethiopian Public Health Institute, Addis Ababa, Ethiopia;
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Adamu Addissie
Adamu Addissie
Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia;
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John Fogarty
John Fogarty
Department of Family & Community Medicine, University of New Mexico, Albuquerque, New Mexico
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ABSTRACT.
In October 2016, we received reports of five deaths among prisoners with leg swelling of unknown etiology in southwestern Ethiopia. A descriptive cross-sectional study was conducted to investigate the outbreak. A suspected case was defined as a prisoner with leg swelling of unknown etiology noted between May 15, 2016 and November 29, 2016. A total of 118 suspected cases were identified with unilateral or bilateral leg swelling without an identifiable cause from a total of 2,790 prisoners. Eight of the suspected cases were thoroughly examined, and seven of these suspected cases had clinical findings consistent with scurvy. Three of the clinical cases had undetectable vitamin C levels in the serum. The attack rate for the prison was 4.2% (118/2,790), and 11 deaths were identified, making the case fatality rate 9.3% (11/118). Clinical cases of scurvy had symptoms of fatigue, myalgia, arthralgia, and signs of follicular hyperkeratosis, petechiae, peripheral edema, and oral lesions. All clinical cases had severe anemia with hemoglobin < 6.0 g/dL. The diet provided by the prison excluded fruits and vegetables. Scurvy was determined to be the cause of the outbreak, and vitamin C supplementation was promptly initiated. All symptomatic prisoners improved, and no further cases were identified in a 4-week follow-up period of active surveillance.
Author Notes
Disclosure: The Ministry of Health of Ethiopia gave the directive and approval to investigate this outbreak. In agreement with the International Ethical Guidelines for Epidemiological Studies by the Council for International Organizations of Medical Sciences and the World Health Organization (2009), IRB at the college of health sciences, Addis Ababa University, determined that this activity was not human subjects research and its primary intent was public health practice and a disease control activity. Verbal informed consent before examination was obtained from each participant who received a clinical evaluation in Addis Ababa. The purpose of the investigation was explained to all participants. Participants were also informed that their involvement was entirely voluntary and their refusal to answer any question would not result in any negative consequences. To protect participants’ confidentiality, personal information was de-identified during data analysis.
Authors’ addresses: Wondwossen Amogne, Addis Ababa University, College of Health Sciences, Internal Medicine, Addis Ababa, Ethiopia, E-mail: wonamogne@yahoo.com. Meskerem Nimani and Ishmael Shemsedin, Addis Ababa Emergency Burn & Trauma Hospital, Emergency Medicine, Addis Ababa, Ethiopia, E-mails: nimamesk@gmail.com and ishmael.shemsedin@sphmmc.edu.et. Wadu Marshalo, Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia, E-mail: marshwadu2013@gmail.com. Daddi Jima, Ethiopian Public Health Institute, Epidemiology, Addis Ababa, Ethiopia, E-mail: daddi_jima@yahoo.com. Adamu Addissie, Addis Ababa University, College of Health Sciences, Department of Epidemiology, School of Public Health, Addis Ababa, Ethiopia, E-mail: adamuaddissie@gmail.com. John Fogarty, Family & Community Medicine, University of New Mexico, Albuquerque, NM, E-mail: johnfogarty@me.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Magiorkinis E , Beloukas A , Diamantis A , 2011. Scurvy: past, present, and future. Eur J Intern Med 22: 147–152.
-
2.
WHO , 1999. Scurvy and Its Prevention and Control in Major Emergencies 1999. Available at: who.int/nutrition/publications/emergencies/WHO_NHD_99.11/en/. Accessed September 23, 2020.
-
3.
Ortner DJ , Butler W , Cafarella J , Milligan L , 2001. Evidence of probable scurvy in subadults from archeological sites in North America. Am J Phys Anthropol 114: 343–351.
-
4.
Paladin A , Wahl J , Zinc A , 2018. Evidence of probable subadult scurvy in the Early Medieval cemetery of Catel Tirolo, South Tyrol, Italy. Int J Osteoarchaeol 28: 714–726.
-
5.
Pitre M , Stark R , Gatto M , 2016. First probable case of scurvy in ancient Egypt at Nag el-Qarmila, Aswan. Int J Paleopathol 13: 11–19.
-
6.
Halcrow SE et al., 2014. First bioarchaeological evidence of probable scurvy in Southeast Asia: Multifactorial etiologies of vitamin C deficiency in a tropical environment. Int J Paleopathol 5: 63–71.
-
7.
Padayatty SJ , Levine M , 2016. Vitamin C: the known and the unknown and Goldilocks. Oral Dis 22: 463–493.
-
8.
Hodges RE et al., 1971. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr 24: 432–443.
-
9.
Burns JJ , 1957. Missing step in man, monkey and guinea pig required for the biosynthesis of L-ascorbic acid. Nature 180: 553.
-
10.
WHO and FAO , 1997. Vitamin and Mineral Requirements in HumanN: Report of a Joint FAO/WHO Expert Consultation. Geneva, Switzerland: World Health Organization.
-
11.
Lamb J , 2016. Scurvy: The Disease of Discovery. Princeton, NJ: Princeton University Press.
-
12.
Bollet AJ , 1992. Scurvy and chronic diarrhea in Civil War troops: were they both nutritional deficiency syndromes? J Hist Med Allied Sci 47: 49–67.
-
13.
Carpenter KJ , 2012. The discovery of vitamin C. Ann Nutr Metab 61: 259–264.
-
14.
Milne I , Chalmers I , 2004. Documenting the evidence: the case of scurvy. Bull World Health Organ 82: 791–796.
-
15.
Szent-Györgyi A , 1928. Observations on the function of peroxidase systems and the chemistry of the adrenal cortex: description of a new carbohydrate derivative. Biochem J 22: 1387–1409.
-
16.
Levavasseur M et al., 2015. Severe scurvy: an underestimated disease. Eur J Clin Nutr 69: 1076–1077.
-
17.
Branquinho DF et al., 2015. From past sailors' eras to the present day: scurvy as a surprising manifestation of an uncommon gastrointestinal disease. BMJ Case Rep 2015: bcr2015210744.
-
18.
Agarwal A et al., 2015. Scurvy in pediatric age group: a disease often forgotten? J Clin Orthop Trauma 6: 101–107.
-
19.
Gabb G , Gabb B , 2015. Scurvy not rare. Aust Fam Physician 44: 438–440.
-
20.
Velandia B et al., 2008. Scurvy is still present in developed countries. J Gen Intern Med 23: 1281–1284.
-
21.
Desenclos JC et al., 1989. Epidemiological patterns of scurvy among Ethiopian refugees. Bull World Health Organ 67: 309–316.
-
22.
Halestrap P , Scheenstra S , 2018. Outbreak of scurvy in Tana River County, Kenya: a case report. Afr J Prim Health Care Fam Med 10: e1–e3.
-
23.
Hafez D et al., 2016. Clinical problem-solving: a deficient diagnosis. N Engl J Med 374: 1369–1374.
-
24.
Domingo AE et al., 2016. Now you see/C it. Postgrad Med 128: 629–631.
-
25.
Cheung E et al., 2003. An epidemic of scurvy in Afghanistan: assessment and response. Food Nutr Bull 24: 247–255.
-
26.
CNN, 2002. Congo Fever Fears in Afghanistan. CNN. com, March 12, 2002. Available at: http://www.cnn.com>2002>WORLD>asiapcf>central. Accessed October 20, 2019.
-
27.
Giday A , 2012. Outbreak of scurvy among prisoners in South Ethiopia. Ethiop J Health Dev 26: 60–62.
-
28.
Hodges RE et al., 1969. Experimental scurvy in man. Am J Clin Nutr 22: 535–548.
-
29.
Schorah CJ , 1981. The level of vitamin C reserves required in man: towards a solution to the controversy. Proc Nutr Soc 40: 147–154.
-
30.
Watson W , 1956. An outbreak of either scurvy or possibly tropical phlebitis. Cent Afr J Med 2: 365–366.
-
31.
Singh S et al., 2015. An underdiagnosed ailment: scurvy in a tertiary care academic center. Am J Med Sci 349: 372–373.
-
32.
Pailhous S et al., 2015. Scurvy, an old disease still in the news: two case reports. Arch Pediatr 22: 63–65.
-
33.
Lessing JN et al., 2015. Perifollicular haemorrhage with corkscrew hair due to scurvy. Postgrad Med J 91: 719–720.
-
34.
Fain O , 2005. Musculoskeletal manifestations of scurvy. Joint Bone Spine 72: 124–128.
-
35.
Hirschmann JV , Raugi GJ , 1999. Adult scurvy. J Am Acad Dermatol 41: 895–906, quiz 907–910.
-
36.
Smith A , Di Primio G , Humphrey-Murto S , 2011. Scurvy in the developed world. CMAJ 183: E752–E755.
-
37.
Marshall R , 2002. Oral lesions in scurvy. Aust Dent J 47: 82–83.
-
38.
Packer L , Fuchs J , 1997. Vitamin C in Health and Disease. New York, NY: Marcel Dekker, Inc.
-
39.
Weise Prinzo Z , de Benoist B , 2002. Meeting the challenges of micronutrient deficiencies in emergency-affected populations. Proc Nutr Soc 61: 251–257.
-
40.
Ververs M et al., 2019. Scurvy outbreak among South Sudanese adolescents and young men – Kakuma Refugee Camp, Kenya, 2017–2018. MMWR Morb Mortal Wkly Rep 68: 72–75.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 4199 | 2889 | 34 |
| Full Text Views | 259 | 11 | 0 |
| PDF Downloads | 223 | 21 | 0 |