ARIBOFLAVINOSIS (synonym avitaminosis of B 2 ) — the disease connected with insufficiency of Riboflavinum, which is characterized by damage of skin, mucous membranes of a mouth, organs of sight, a nervous system, etc. And. also Vost is eurysynusic in a number of the countries Southern. Asia, Africa and Latin America. In the USSR meets seldom.
And. can be primary, exogenous, at absence or sharp deficit Riboflavinum (see) in food and secondary, endogenous, at its insufficient absorption or assimilation owing to disturbance of phosphorylation of Riboflavinum.
the Pathogeny — a cellular anoxia owing to a lack of respiratory enzymes which part Riboflavinum is.
Considerably meets secondary, endogenous more often, And., developing at a pellagra, a kwasiorkor, tuberculosis, diseases of a liver and intestines, extensive trophic ulcers, etc. In some cases And. arises at prolonged treatment by massive doses of antibiotics (streptomycin, synthomycin, etc.) and pharmaceuticals — antagonists of Riboflavinum (Atebrinum, quinacrine, quinine, diethylflavin, etc.).
Early clinical symptoms — damages of mucous membranes of a mouth and skin. Arise: angular stomatitis — the defeat of mucous and skin connection in corners of a mouth which is characterized by blanching of mucous membranes, maceration of an epithelium, formation of the cross cracks covered with yellowish wet crusts, reddening and an ulceration of skin in corners of a mouth; the cheilosis — desquamation of an epithelium of a mucous membrane in the place of a smykaniye of lips, is noted the sharp reddening of a red border of lips, cracks located vertically (fig. 1 and 2), bloody crusts with the subsequent scarring; a glossitis — a surface of language in the beginning granular owing to increase in fungoid nipples, then smoothed, language of a magenta color, brilliant. Patients feel pain and burning of language, especially at meal. Further there are changes of skin in the form of seborrheal dermatitis of wings of a nose, nasolabial folds, a century and auricles with a soft peeling; keratinization of output channels of sebaceous glands («sharkskin»); dry pruritic dermatitis of hands, scrotums, vulva and anus. Damage of eyes is followed by conjunctivitis, disturbance of adaptation to darkness, an okolorogovichny injection of vessels, the centers of opacification in a cornea, a photophobia, dacryagogue, gripes and burning in eyes, a nictitating spasm. There are disturbances of a hemopoiesis — hypochromia anemia. Disturbances from a nervous system are observed: apathy, headaches, paresthesias, especially in legs («burning by a foot»), retrobulbar neuritis, a partial atrophy of an optic nerve; increase knee and akhillova of reflexes, positive symptom of Romberg, ataxy, clonic spasms. Symptoms from an organ of sight and a nervous system meet not in all cases And. Their emergence and expressiveness, apparently, are connected with duration of a disease and extent of trophic disturbances.
Riboflavinum is necessary for normal fetation. At a shortcoming it in food of pregnant women not wearing out of a fruit and childbirth was observed by a dead fruit. These phenomena were noted also if in food of women before pregnancy there was a lack of Riboflavinum. Crack initiation of nipples at the feeding women is also often connected with deficit of Riboflavinum in an organism.
Current And. — chronic, circular with aggravations in spring months. Quite often And. is followed by insufficiency of other vitamins of group B: nicotinic and pantothenic acids, rat anti-acrodynia factor (pyridoxine). And. at children proceeds easier, than at adults.
In addition to clinical manifestations, the most precursory diagnostic character is decrease in release of Riboflavinum with urine to 100 mkg and below in days (at norm of 300 — 1000 mkg). The most exact laboratory method of assessment of deficit of Riboflavinum — its allocation on an empty stomach. The lower bound of norm in an hour of 30 — 15 mkg, at expressed And. — 10 mkg and below. The so-called load method does not yield exact results owing to very big fluctuations. Along with a research of release of Riboflavinum contents it in blood decides on urine: normal in erythrocytes — 20 mkg of %, in leukocytes ~ 250 mkg of % and in serum — 0,5 — 1,5 mkg of %. Disturbance of adaptation to darkness is registered the adaptometer.
Differential diagnosis it is carried out with a pellagra, a kwasiorkor, to a spr, a hypochromia iron deficiency anemia, avitaminosis And, multiple sclerosis, diseases of a cerebellum. The triad of symptoms is characteristic of a pellagra: diarrhea, dermatitis, dementia; sharp reduction of allocation nicotinic · to - you with urine and the maintenance of nikotinamidny coenzymes (NAD and NADF) in blood. At a kwasiorkor the hypoproteinemia, fatty infiltration of a liver is noted; at a spra — the morning diarrheas, a characteristic chair (wandering fatty fecal masses), hyperchromic macrocytic anemia, decrease in contents folic to - you in blood and urine. At a hypochromia iron deficiency anemia — decrease in content of iron in blood, lack of falloff of a globin. At avitaminosis And the hemeralopia, a xerophthalmia, a follicular hyperkeratosis, decrease in content of vitamin A in blood is observed. At multiple sclerosis — intentsionny trembling, a nystagmus, a scanning speech, paralyzes. At diseases of a cerebellum — loss of balance, a cerebellar ataxy, adiadokhokinez.
the Forecast in nearby come cases at timely treatment — favorable.
At not heavy current is enough appointment in 5 — 10 mg of Riboflavinum within 15 — 20 days once a day. In more hard cases — on 10 mg on reception of 3 — 5 times a day within 15 — 20 days. At disturbances of absorption and assimilation — parenteral administration of Riboflavinum in the same doses. Topical treatment: 5 — 10% riboflavinovy ointment. Appoint pressed and beer yeast, it is better dry, rich with Riboflavinum. Along with it appoint clinical nutrition with inclusion of the foodstuff rich with animal protein and Riboflavinum.
Prevention — the balanced food with the sufficient maintenance of dairy, meat products and eggs 0,8 mg of Riboflavinum were the share of 1000 kcal of a daily diet on average. The daily need for Riboflavinum for adults — 2 — 3 mg, for children — 0,6 — 2 mg.
See also Vitamin deficiency .
Bibliography: Polyneuramins food and prevention of a vitamin deficiency, under the editorship of V. V. Efremov, page 62, 103, M., 1969, bibliogr.; Efremov V. V. Riboflavinum and its value for an organism, News medical, century 22, page 9, 1951; it, Insufficiency of Riboflavinum (hepatoflavin), Mnogotomn. the management on vnutr. to diseases, under the editorship of E. M. Tareeva, t. 8, page 543, M., 1965, bibliogr.; Shilov P. I. and Yakovlev T. N. Fundamentals of clinical vitaminology, L., 1974, bibliogr.; BicknellF. Prescott F. The vitamins in medicine, p. 285, L., 1953, bibliogr.; Stepp W., K ii h-nau J. u. Schroeder H. Die Vitamine und ihre klinische Anwendung, Bd 1, S. 218, Stuttgart, 1952, Bibliogr.
V. V. Efremov.