Scurvy causes severe and persistent deficiency of Vitamin C. It is an uncommon disease that exists in society. Many people consider scurvy a condition of the past when sailors had to go months without fresh vegetables and fruits but scurvy prevailed. Any person with an incomplete diet deprived of Vitamin C is at risk of developing scurvy. Scurvy-like symptoms cannot be seen at a particular time period; it depends on the time taken by a person to diminish Vitamin C stores. The human body is not capable of producing Vitamin C; therefore, a diet deprived of Vitamin C leads to scurvy-like symptoms in four weeks. Vitamin C, whose name is also ascorbic acid, plays an important role in producing collagen in the body; this collagen is a protein present in bones, blood vessels and tissues. Moreover, it helps in haemoglobin formation and deficiency may cause anaemia.

Symptoms

Early symptoms of scurvy include:

Usually, the early symptoms show up as a mild complaints. You may ignore these signs because they resemble flu or other common illnesses.

Some of the symptoms include:

1. Feeling unwell and active


2. Fatigue


3. Appetite loss


4. Nausea


5. Diarrhoea


6. Fever


7. Achy joints and muscles


8. Bleeding around hair follicles on the skin

Late symptoms of scurvy include:

Late scurvy signs and symptoms are more prominent and help in disease diagnosis.

1. Spongy and swollen legs


2. Teeth becoming loose


3. Eyes tending to bulge out


4. Bleeding of skin


5. Easy and severe bruising


6. Brown, dry and scaly skin


7. Dry and curly hair that is easily breakable


8. Slow healing of wounds


9. Slowing of bone growth


10. Swelling over bones and joints

Scurvy in infants:

Scurvy is possible in children who have autism spectrum disorder (ASD). Children may present with the following symptoms:

1. Presence of high fever


2. Diarrhoea


3. Irritability


4. Appetite loss

Causes And Risk Factors

Causes

Scurvy is caused by Vitamin C deficiency due to a diet deprived of Vitamin C content. Vitamin C is present in both fruits and vegetables.

Vitamin C contains collagen that is necessary for connective tissue generation. Connective tissue supports protects, and gives structure to tissues and organs of the body. Moreover, Vitamin C plays a role in bone formation.

Risk Factors

Scurvy was a disease often seen in sailors of the 15th century who travelled on long voyages. Many sailors experienced deaths and died from this disease until they discovered a cure for the illness: Vitamin C, which was present in lemons, oranges and limes.
Scurvy is considered a rare disease in today's society as people have regular access to fresh fruits and vegetables; however, the people at risk are listed below:

People with long-term malnutrition or those who consume fewer fruits/vegetable serving

1. Alcoholics


2. Elderly


3. Bachelor's


4. Children


5. People who undergo aggressive diets


6. Fear of food, people suffering from eating disorders

Other conditions that affect vitamin C absorption are listed below:

Patients undergoing dialysis
Patients suffering from inflammatory bowel disease
Hyperacidity

Prevention

Regular intake of required Vitamin C is recommended to prevent scurvy. Diet rich in Vitamin C is helpful for preventing scurvy.
Vitamin C helps in building the bones and maintaining muscular health. Eating a diet rich in fresh vegetables and fruits is confirmed to be effective. With an adequately balanced diet, you can easily avoid scurvy.

Diagnosis

The primary parameters for diagnosing scurvy are listed below:

1. History of Vitamin C deficiency


2. Symptoms that resemble scurvy

Laboratory parameters demonstrate a low level of Vitamin C in the blood and a low urinary excretion rate

The presentation of scurvy differs in adults and children because of bones being in the growing stage in the children's case. Compared to adults, bleeding or blood loss is at a low rate in children.

The biochemical evaluation of Vitamin C levels in the blood is performed by a blood test that measures the ascorbic acid levels in the blood. The levels of ascorbic acid depend on Vitamin C intake. Scurvy is detected when the ascorbic acid ranges below < 11 µmol/L.

Treatment

Treating scurvy involves treating Vitamin C deficiency. It is simply managed by providing Vitamin C supplements that are orally provided. Usually, adults are prescribed 800–1000 mg/ day for 1 week, and then 400 mg/day until the Vitamin C stores are replenished. Children are prescribed 150–300 mg/day for a month.

Improvements in the patient’s condition are seen as early as 1 day after the initiation of treatment. There is no permanent damage that the disease causes except the fallout of teeth because of dental issues.

You can easily prevent scurvy by considering the recommended amount of dose of Vitamin C, which is 30–60 mg/day. Moreover, you must include any five servings of fruits and vegetables per day through which your Vitamin C stores will be maintained, in addition to getting the right amount of Vitamin C every day for producing bones and muscles.

Similar to usual pills, vitamin C tablets are supposed to be taken in a particular manner, which is chewing them and not swallowing them with a glass of water . Ensure you know what type of a formulation you are consuming by reading the information leaflet or consulting with your physician.

Lifestyle/management

Ascorbic acid, known as Vitamin C, to the general public, has the following essential functions:

1. Protecting the cells and keeping them healthy.


2. Maintaining the skin, blood vessels, and bones to be healthy.


3. Helping in the wound-healing process.

The lack of Vitamin C causes scurvy.
You can include Vitamin C in your balanced diet with the intake of fruits and vegetables.

Good sources of Vitamin C are listed below:

1. Oranges and citrus fruits


2. Strawberry


3. Black currant


4. Broccoli


5. Potatoes


6. Pepper


7. Brussels sprouts


8. Berries

Usually, you require ~40 mg of Vitamin C daily. It should be incorporated into your diet daily as the body cannot store it.
Moreover, it would be best if you watched for taking large amounts of Vitamin C daily as it may lead to stomach ache, diarrhoea or constipation. Vitamin C intake of <1000 mg does not cause any harm to the body.
Overdosing of Vitamin C can cause other complications; before deciding on the dose of daily Vitamin C supplements, you must be consulting a registered general physician or your family doctor.

Prognosis And Complications

Prognosis

Vitamin C deficiency is a long-standing cause of scurvy. It occurs after 2–3 months with a diet lacking vitamin C. Early scurvy signs are weakness and disturbing behaviour, which are vague. Therefore, it is challenging to diagnose scurvy in the early stages; usually, it leads to bleeding, swollen joints, and bleeding gums. Scurvy causes impaired immunity towards infection.
The cases of scurvy reflect public health problems and make it necessary to measure the population's nutritional assessment. Vitamin C is a factor responsible for iron absorption,; hence such a population requires to be checked for anaemia.
There is no protocol or solution to treat scurvy; the leading solution to prevent it is by improving the population's diet and improving the knowledge of it. There are no long-term effects of scurvy except teeth loss.

Complications

When scurvy is diagnosed in young children and infants, it seems to affect the growth of arms and legs; scurvy causes the stunting of limbs. This happens because of the lack of Vitamin C, which makes it difficult for bones to properly grow and build. Moreover, scurvy causes the softening of bones in adults, making them more prone to fractures. People with neglected scurvy are at risk for complications such as anaemia, heart attack and death.

References

1. Better Health. Living Healthy- Scurvy [Internet] [Updated July 31, 2012]. Available at: https://www.betterhealth.vic.gov.au/health/healthyliving/scurvy. Accessed on March 23, 2021. (https://www.betterhealth.vic.gov.au/health/healthyliving/scurvy)


2. Apollo Hospitals. Health and Lifestyle- Diseases and Conditions- Scurvy [Internet] [Updated Sep, 2019]. Available at: https://www.apollohospitals.com/patient-care/health-and-lifestyle/diseases-and-conditions/scurvy. Accessed on March 23, 2021. (https://www.apollohospitals.com/patient-care/health-and-lifestyle/diseases-and-conditions/scurvy)


3. Winchester Hospital. Health Library- Scurvy [Internet] [Updated February 04, 2021]. Available at: https://www.winchesterhospital.org/health-library/article?id=200831 Accessed on March 23, 2021. (https://www.winchesterhospital.org/health-library/article?id=200831)
   Derm Netz. Scurvy [Internet] [Updated March 28, 2020]. Available at: https://dermnetnz.org/topics/scurvy/. Accessed on March 23, 2020. (https://dermnetnz.org/topics/scurvy/)


4. World Health Organization. Scurvy [Internet]. Available at https://www.unhcr.org/4cbef0599.pdf. Accessed on March 23, 2021.


5. National Health Services- United Kingdoms. Scurvy [Internet] [Updated August 3, 2020]. Available at : https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-c/. Accessed on March 23, 2021. (https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-c/)