Scurvy Uncovered: Causes, Symptoms, Treatment and Prevention.

What is Scurvy?

Scurvy is a nutritional disorder caused by a severe deficiency of vitamin C (ascorbic acid), a vital nutrient for the body’s overall health. Historically known as the “sailor’s disease,” scurvy was common among sailors and explorers who had limited access to fresh fruits and vegetables during long voyages. Although rare in modern times, scurvy can still occur in individuals with poor diets or underlying health conditions.

Causes of Scurvy:

Scurvy is a disease caused by a severe deficiency of vitamin C (ascorbic acid), an essential nutrient for collagen production, tissue repair, and proper immune function. Since the human body cannot synthesize or store vitamin C, it must be obtained through diet. A prolonged lack of this vital nutrient leads to scurvy, which can have serious health consequences if left untreated. Below are the key causes of scurvy:

► Inadequate Dietary Intake of Vitamin C:

The primary cause of scurvy is insufficient consumption of foods rich in vitamin C. This can result from:

• Poor diet: Diets lacking fresh fruits and vegetables are common causes, especially in low-income populations or regions with limited access to fresh produce.
• Food shortages or famine: In areas affected by food insecurity, access to vitamin C sources is often limited.
• Overly restrictive diets: Individuals on restrictive diets (due to allergies, eating disorders, or specific health conditions) may be at higher risk.

► Malabsorption Disorders:

Some medical conditions can impair the body’s ability to absorb vitamin C from food, even if intake is adequate. These include:

• Crohn’s disease
• Ulcerative colitis
• Celiac disease
• Chronic diarrhea

► Alcoholism and Substance Abuse:

Chronic alcohol consumption and substance abuse can interfere with nutrient absorption and lead to deficiencies, including vitamin C deficiency. Individuals with alcohol dependency often have poor dietary habits, further increasing the risk of scurvy.

► Medical Conditions and Chronic Illnesses:

Certain chronic illnesses increase the body’s need for vitamin C or reduce its absorption. These include:

• Chronic kidney disease
• Cancer
• HIV/AIDS
• Hyperthyroidism

► Smoking:

Smoking depletes vitamin C levels in the body and increases the requirement for the nutrient. Smokers are more susceptible to scurvy due to reduced availability of vitamin C in their blood, even if they consume a seemingly adequate amount.

► Infant Feeding Practices:

In infants, scurvy can result from prolonged feeding with boiled milk or formula lacking sufficient vitamin C. Breast milk generally provides enough vitamin C, but issues arise when alternatives are improperly prepared or lack supplementation.

Symptoms of Scurvy:

Below are the common symptoms of scurvy, categorized by stages of severity.

► Early Symptoms:

In the initial stages, symptoms may be subtle and often go unnoticed. These include:

• Fatigue and Weakness: A general feeling of tiredness and reduced energy levels.
• Irritability: Changes in mood and increased susceptibility to frustration.
• Joint and Muscle Pain: Mild aches, especially in the legs, which may worsen over time.

► Progressive Symptoms:

As the deficiency becomes more severe, the symptoms intensify:

• Swollen, Bleeding Gums: One of the hallmark signs of scurvy, the gums may become swollen, tender, and bleed easily. In advanced cases, teeth may loosen or fall out.
• Bruising and Petechiae: Small red or purple spots (petechiae) appear on the skin due to ruptured blood vessels. Bruising occurs more frequently, even from minor impacts.
• Slow Wound Healing: Cuts and sores take longer to heal, increasing the risk of infection.
• Dry and Rough Skin: The skin becomes scaly, dry, and prone to irritation.

► Severe Symptoms:

If untreated, scurvy can lead to life-threatening complications. Severe symptoms include:

• Anemia: Due to prolonged blood loss from bleeding gums and internal hemorrhaging. Symptoms of anemia include pale skin, dizziness, and shortness of breath.
• Bone Pain and Weakness: Bones may become brittle, leading to fractures and difficulty walking.
• Swelling in the Limbs: Often accompanied by extreme pain, particularly in the legs.
• Organ Failure and Death: In the most severe cases, prolonged vitamin C deficiency can result in organ damage and death.

► Symptoms in Children:

In children, scurvy can cause additional complications, such as:

• Delayed wound healing
• Swollen joints
• Bone deformities and stunted growth
• Extreme irritability and loss of appetite

Diagnosis of Scurvy:

The diagnosis of scurvy is often clinical, based on presenting symptoms, dietary history, and laboratory findings. Early recognition and treatment are crucial to prevent complications.

Clinical Presentation:

Patients with scurvy typically present with a combination of the following signs and symptoms:

• Fatigue and Weakness: Often among the earliest symptoms, caused by impaired collagen synthesis.
• Gingival Changes: Swollen, bleeding gums and loose teeth are hallmark signs of advanced scurvy.
• Skin Manifestations: Perifollicular hemorrhages (bleeding around hair follicles), petechiae (small red or purple spots), and bruising.
• Joint Pain and Swelling: Due to bleeding into joints or subperiosteal hemorrhage.
• Poor Wound Healing: Impaired tissue repair leads to chronic ulcers and delayed recovery from injuries.
• Corkscrew Hair: Abnormally twisted hair shafts may be observed.

In severe cases, scurvy can lead to anemia, cardiac complications, and even death if untreated.

Diagnostic Approach:

★ Detailed Medical and Dietary History:

• Identifying risk factors is essential. Patients with limited fruit and vegetable intake or specific diets (e.g., restrictive diets, alcoholism, or mental health disorders) are at higher risk.
• Symptoms' duration and severity help distinguish scurvy from other conditions.

★ Physical Examination:

• Focus on characteristic signs such as gingival bleeding, perifollicular hemorrhage, and musculoskeletal pain.

Although scurvy can often be diagnosed clinically, laboratory investigations confirm the diagnosis:

• Vitamin C Levels: A serum vitamin C level below 11 µmol/L is diagnostic of vitamin C deficiency.
• Complete Blood Count (CBC): May reveal anemia, particularly if bleeding is significant.
• Inflammatory Markers: Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may indicate systemic inflammation.

In advanced cases, imaging may reveal skeletal abnormalities, particularly in children:

• Subperiosteal hemorrhages
• Metaphyseal fractures (scorbutic rosary)
• Ground-glass appearance of bones

Differential Diagnosis:

Scurvy can mimic several other conditions, making differential diagnosis crucial:

• Hemophilia
• Idiopathic thrombocytopenic purpura (ITP)
• Leukemia
• Rheumatoid arthritis
• Iron or folate deficiency

Clinicians must rule out these conditions before confirming scurvy.

The diagnosis of scurvy relies on recognizing the classic clinical features, dietary history, and biochemical tests. Since the disease is rare in modern times, it can often be overlooked, leading to delays in treatment. Timely diagnosis and vitamin C supplementation result in rapid symptom resolution and full recovery in most patients.

Treatment of Scurvy:

The treatment for scurvy is straightforward and highly effective with early diagnosis. It primarily involves restoring vitamin C levels in the body through diet and supplementation.

► Vitamin C Supplementation:

The most effective way to treat scurvy is by taking vitamin C supplements.

• Dosage: An initial high dose of 1–2 grams of vitamin C daily for the first 2–3 days, followed by a maintenance dose of 100–500 mg per day for several weeks.
• Symptoms such as fatigue and pain usually improve within 24 to 48 hours. More severe symptoms, like skin changes and gum issues, may take longer to resolve.

► Dietary Changes:

Foods high in vitamin C:

• Citrus fruits (oranges, lemons, limes)
• Strawberries and kiwi
• Bell peppers
• Tomatoes
• Green leafy vegetables (spinach, kale)
• Broccoli and Brussels sprouts
  Fresh, raw fruits and vegetables are preferable, as cooking can destroy some of the vitamin C content.

► Addressing Underlying Causes:

In some cases, scurvy may result from poor absorption of nutrients due to underlying health conditions. Treating the root cause, such as gastrointestinal disorders or alcohol dependence, is essential to prevent recurrence.

Prevention of Scurvy:

Preventing scurvy is simple and achievable through proper dietary choices and awareness.

Steps to Prevent Scurvy:

The most effective way to prevent scurvy is by maintaining a diet rich in vitamin C. Fresh fruits and vegetables are the best sources. Some of the most vitamin C-rich foods include:

• Citrus fruits (oranges, lemons, limes)
• Berries (strawberries, blackberries)
• Kiwi
• Bell peppers
• Broccoli
• Tomatoes
• Spinach and other leafy greens

A well-rounded diet with a variety of fruits, vegetables, whole grains, and lean proteins ensures that your body receives essential nutrients for overall health. Balanced nutrition reduces the risk of vitamin deficiencies and helps keep the immune system strong.

Vitamin C is sensitive to heat, light, and oxygen. Overcooking fruits and vegetables can significantly reduce their vitamin C content. To preserve nutrients, consume these foods raw when possible or use cooking methods like steaming or stir-frying.

In cases where dietary intake is insufficient—such as during long sea voyages, extreme climates, or limited access to fresh produce—vitamin C supplements may be necessary. Always consult a healthcare professional before starting supplements.

Awareness about the importance of vitamin C can help prevent scurvy, especially in vulnerable populations such as the elderly, individuals with restrictive diets, or those living in food-insecure areas. Health education and public awareness campaigns can play a vital role in reducing the incidence of this preventable condition.

Scurvy is a preventable disease that can have serious consequences if left untreated. By incorporating vitamin C-rich foods into your daily diet and being mindful of nutrition, you can avoid this condition entirely. Maintaining a balanced diet not only prevents scurvy but also promotes overall health and well-being. Regular consumption of fresh fruits and vegetables is the key to a scurvy-free, healthy life.

Conclusion:

Though rare in developed countries, scurvy serves as a reminder of the importance of proper nutrition. Ensuring adequate intake of vitamin C is essential for overall health and well-being. Early recognition and treatment of scurvy can prevent serious complications and lead to a full recovery.