Beriberi classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Abdelrahman Ibrahim Abushouk, MD[2]

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Overview

Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype. Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.

Classification

Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype. Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.[1][2][3]

Affected Site Course Population Presentation
Classification based on main organ-system affected Wet beriberi Cardiovascular System
  • Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal).
  • Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure.
Individuals with chronic thiamine deficiency
  • Peripheral edema: due to weakened capillary beds in peripheral tissues leading to fluid leakage.
Dry beriberi Peripheral nervous system Usually follows a chronic disease course Individuals with chronic thiamine deficiency Polyneuritis and symmetric, ascending paralysis of the peripheral nerve systems. It first affects the sensory system (parasthesia), then the motor system (loss of tendon reflexes, followed by foot and wrist drop)
Based on patient risk factor exposure Infantile beriberi Cardiovascular or nervous system Usually follows a progressive disease course and has three distinct forms:
  • Cardiac or pernicious: Rapid onset, progressive course, and poor prognosis.
  • Aphonic form: Subtle onset and a mild course.
  • Pseudomeningitic form: Progressive course.
Infants nursed by thiamine-deficient mothers.
  • Cardiac: 1 to 3 months of old.
  • Aphonic:4 to 6 months old.
  • Pseudomeningitic: 7 to 9 months old.
Early signs include restlessness, constipation, and vomiting.
  • Cardiac form: Acute cardiac failure (edema and cyanosis). Once heart failure develops, the infant may die in two to four hours.
  • Aphonic form: hoarseness, weak cry, and even loss of voice due to vocal cord paralysis.
  • Pseudomeningitic form: The classic presentation of meningitis (nystagmus, vomiting and seizures); however, CSF analysis reveals no infectious organisms.
Wenicke-Korsakoff Syndrome Brain Two conditions: Chronic alcoholics (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency)
  • Wernicke's encephalopathy: Confusion, ataxia, ptosis, and double vision.


References

  1. Meurin P (1996). "[Shoshin beriberi. A rapidly curable hemodynamic disaster]". Presse Med. 25 (24): 1115–8. PMID 8868953.
  2. "StatPearls". 2019. PMID 30725889.
  3. Sinha S, Kataria A, Kolla BP, Thusius N, Loukianova LL (2019). "Wernicke Encephalopathy-Clinical Pearls". Mayo Clin Proc. 94 (6): 1065–1072. doi:10.1016/j.mayocp.2019.02.018. PMID 31171116.


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