Ariboflavinoz

Ariboflavinoz (synonym vitamin B2) is a disease caused by a deficiency in the body of Riboflavin (vitamin B2). Ariboflavinoz especially widespread in India, Thailand, Burma, Malaya, Africa. In the USSR is rare; the number of cases was observed in the years of the great Patriotic war in blockaded Leningrad. Ariboflavinoz can be primary, exogenous (in the absence or deficiency of Riboflavin in food), and secondary, endogenous [if any intake, absorption (phosphorylation) Riboflavin or at destruction in the body]. Much more common secondary endogenous, ariboflavinoz tuberculosis, diseases of the intestines and liver, trophic ulcers.; during therapeutic use of certain antibiotics (streptomycin, syntomycin), pharmaceuticals Akrikhin, thallium). As a concomitant disease A. occurs when pellagra and kwashiorkor.
Ariboflavinoz often accompanied by the failure of other b vitamins (Niacin, Pantothenic acid, pyridoxine), which is explained by linking them to the enzyme systems of the body.
The pathogenesis of ariboflavinosis - cell anoxia due to lack of respiratory enzymes, which include Riboflavin.
Early clinical signs of ariboflavinosis: angular stomatitis - defeat Muco-cutaneous connection of the corners of his mouth with a pale mucous membranes, maceration of the epithelium, the formation of transverse cracks, covered with a yellowish damp skin, redness and ulceration of the mouth corners (Fig. 1); Hales - desquamation of the epithelium of the mucous membrane in the place of closing the lips with a sharp red, cracked and bloody crust (Fig. 2), with the subsequent scarring; glossitis - language first grainy due to the increase in mushroom buds, then smooth, shiny, purple; patients experience pain and burning language, especially when eating. In the future, there are changes in the skin - seborrheic eczematoid the wings of the nose, naso-lip folds, eyelids and ears with soft peeling, keratinization of the excretory duct of the sebaceous glands (the shark skin); dry itchy dermatitis of the hands, scrotum, vulva and anus, vaginitis; violations of blood (hypochromic anemia).
With long-term illness and deep trophic violations in ariboflavinoz there is damage to the eyes: phlyctenular conjunctivitis, violation of dark adaptation, okoloogiline vascular injection, corneal vascularization, the centers of turbidity in it, photophobia, tearing, pain, stinging in the eyes, blepharospasm disturbance, optic neuritis, partial atrophy of the optic nerve. There are abnormalities of the nervous system: fatigue, headache, paresthesia, especially in the legs ("burning feet"), increasing the knee and Achilles tendon reflexes, positive symptom Romberg, ataxia, clonic convulsions.
Ariboflavinoz in children occurs with more blurred symptoms than in adults; for chronic, with exacerbations in the spring and summer months.
Early diagnosis A. - reducing allocation of Riboflavin with urine with 1000-500 μg per day to 100 mcg and below. The most convenient method of assessment - hour allocation Riboflavin on an empty stomach: the lower bound of the norm 30-15 mcg; explicit A. 10 ug and below.
The so-called load method in the establishment of Riboflavin deficiency due to a very large fluctuations does not give accurate results.
It is also necessary to determine the content of Riboflavin in the blood (norm - about 0.5 microgram/g, A,- reduction of up to 0.1 ug/g, and below). Violation of dark adaptation is logged in adaptometry (Riboflavin, like vitamin a increases light sensitivity of the eye).
Differential diagnosis of ariboflavinosis is from pellagra, kwashiorkor, sprue, avitaminosis A, hypochromic anemia, multiple sclerosis, a disease of the cerebellum. When pellagra is characterized by a triad: diarrhea, dermatitis, dementia, reduced allocation of nicotinic acid in the urine. Kwashiorkor is a disease of liver fatty infiltration, cirrhosis), hypoproteinemia. When sprue - morning diarrhea roaming fat feces, hyperchromic macrocytic anemia, a decrease in the allocation of folic acid in the urine. In avitaminosis A. - xerophthalmia, follicular hyperkeratosis, a decrease in the content of vitamin a in the blood. When hypochromic anemia is the absence of all symptoms of ariboflavinosis. Multiple sclerosis - intentsionnogo tremor, nystagmus, staccato speech, paralysis. At diseases of a cerebellum - loss of balance, cerebellar ataxia, diazoketones.
Forecast of ariboflavinosis in far advanced chronic cases favourable.
Treatment. In most mild cases daily inside on the 5-10 mg of Riboflavin for 15 to 20 days; in more severe phenomena and 10 mg 3-5 times a day. When violations of absorption and assimilation - of parenteral introduction of Riboflavin in the same doses. Local treatment is 5-10% riboflavina ointment. In the absence of Riboflavin used bakery yeast and beer, the best dry; along with this, clinical nutrition with the introduction of foods rich in Riboflavin and high-grade protein.
Prevention: an introduction with food products containing a sufficient number of Riboflavin (dairy and meat products, eggs, spinach, soybeans, lentils, peas, mushrooms). The minimum daily requirement of adults and children in Riboflavin, 2 mg
Cm. also Vitamin deficiency.

Fig. 1. Angular stomatitis.
Fig. 2. Hales