Wet athlete's foot

Introduction Wet beriberi (wet beriberi), caused by vitamin B1 deficiency, mostly edema and heart symptoms. Due to cardiovascular system disorders, edema, the right ventricle can be enlarged, palpitations, shortness of breath, tachycardia, such as treatment is not timely, often cause heart failure. Mixed beriberi (dry and wet) is characterized by both neuritis and heart failure and edema.

Cause

Thiamine is phosphorylated into thiamine pyrophosphate in the body. The latter acts as a coenzyme involved in the oxidative decarboxylation of pyruvate and alpha ketoglutarate in sugar metabolism, and is also involved in the keto group transfer of pentose phosphate bypass. The lack of thiamine not only affects glucose metabolism, but also involves fatty acid and energy metabolism, causing the accumulation of pyruvic acid and lactic acid in tissues. In addition, excessive production of alanine in brain cells and reduction in the production of aspartic acid, glutamic acid, and -aminobutyric acid are the biochemical basis for dysfunction in various systems.

Pathological lesions showed multiple peripheral neuritis, segmental degeneration and loss of myelin. The longest nerve in the lower extremities, such as the sciatic nerve, is the first to be affected. There are Schwann s cell edema, vacuolar degeneration and even collapse. Cranial nerves (pairs III and VI) and vagus nerves (recurrent laryngeal nerves) also have degeneration. The pia mater is congested and there is a needle-like hemorrhage around the small artery. There are nerve cells disappearing in the diencephalon and cerebral ventricles, and glial cells and vascular endothelial cells proliferate. The heart is enlarged due to cardiac insufficiency, especially in the right ventricle. Myocardial fibroblasts and interstitial edema were seen under the microscope, and degeneration and necrosis were observed in severe cases. Pulmonary arteries, peripheral blood cells and small arteries are also seen to expand.

In the absence of thiamine, increased pyruvate inhibits the activity of choline acetylase and reduces acetylcholine synthesis. Moreover, due to the reduced production of thiamine pyrophosphate, the activity of cholinesterase is enhanced, and the hydrolysis of acetylcholine is also accelerated, which affects nerve conduction. Therefore, gastrointestinal fatigue and peristalsis slow down, and digestive juice secretion is reduced. The disorder of glucose metabolism causes cell function to decline, and various gastrointestinal symptoms appear. Pathological findings showed intestinal inflation, mucosal hemorrhage, follicular swelling, and mesenteric lymphadenopathy. In addition, the liver and kidneys have blood stasis and steatosis.

an examination

Related inspection

Urine routine blood fungi examination

It is characterized by enlarged heart, dilated blood vessels, tachycardia at rest, shortness of breath, chest pain, and edema. If not treated in time, it can cause acute heart failure, often sudden, sudden illness, extremely difficult breathing, rapid heart rate, heart dullness to the two sides, heart sounds are pendulum, systolic murmur in the anterior region, pulmonary artery second Heart sounds. The arterial pressure is slightly lower, the pulse pressure difference is large, the venous pressure is significantly increased, and the neck and femoral artery pulsation is enhanced. The liver is swollen, the whole body is swollen, and there is oliguria. ECG shows tachycardia, PR interval is shortened, T wave is biphasic or inverted, low voltage, QT interval is prolonged. Infants and young children are mainly affected by the heart, manifested as loss of appetite, vomiting, irritability, insomnia, rapid development can cause angulation, convulsions, heart failure, can cause death. The mother of the child is often a recessive or clinical manifestation of beriberi patients.

Differential diagnosis

The beriberi disease is divided into dry beriberi and wet beriberi.

The nervous system center and the peripheral nervous system are damaged, called dry beriberi. Peripheral nervous system lesions caused by vitamin B1 deficiency typically show a feeling of rising symmetry, impaired motor and reflex function. The onset starts from the distal end of the limb, and the lower extremity is more common in the upper limb. It may have burning or abnormal feeling. It is distributed in the sock type and gradually develops to the proximal end of the limb. It turns out that the allergic area is gradually dull, even painful, warm and vibrating. The feeling disappears in turn. With muscle strength decline, muscle soreness, with gastrocnemius muscles, difficult to get up and down stairs. Then the feet, the toes droop, the muscles contract, and bedridden. The reflex function of the ankle, knee, etc. is initially hyperactive, but generally decreases or disappears later, and some patients still cannot recover completely after healing. Central nervous system damage can involve the vagus nerve, optic nerve, oculomotor nerve, abductor nerve, auditory nerve, recurrent laryngeal nerve, and phrenic nerve. Expressed as Wenicke-Korsakoff syndrome. Symptoms include vomiting, nystagmus (more than vertical tremor), ophthalmoplegia, fever, ataxia, changes in consciousness, and coma, accompanied by memory loss, decreased learning ability, and fiction.

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