|Year : 1981 | Volume
| Issue : 4 | Page : 485-488
Hypovitaminosis A associated with Helminth infestations
IS Roy, E Ahmed
Institute of Ophthalmology, Medical College, Calcutta, India
I S Roy
Institute of Ophthalmology, Medical College, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy I S, Ahmed E. Hypovitaminosis A associated with Helminth infestations. Indian J Ophthalmol 1981;29:485-8
Vitamin A or Retinol plays possibly a vital role in the metabolism of all human cells. In man, the conversion of precursor-carotene into retinol occurs chiefly in the walls of the small intestine. The relationship between retinol and protein is rather complex ; retinol is transported to the liver by retinolbinding protein and wrapped by serum pre-albumen.
GOPALAN et al have recently suggested the following daily requirements of Vit. A for the Indians, which are a little different from those suggested earlier by joint F.A.O./W.H.O. group of nutritional experts (1967)
Infants : 300-400 micrograms.
Children : 250-600 micrograms.
Adolescents-men : 750 micrograms and women
Women during se- : 1150 micrograms.
cond half of pregnancy and during first year of lactation.
So it appears that the normal need of vitamin A is variable according to the age, state of health, and demand of the body. The clinical features of hypovitaminosis A appear when the average daily allowance is less than half the daily suggested requirements.
The W.H.O. survey of the incidence of xerophthalmia in the world revealed that malnutrition is one of the major causes of blindness in Africa, Asia and South America. In India the whole of South India, Orissa, Bihar, Bengal, Madhya Pradesh and Utter Pradesh have been shown as endemic areas. Surveys of malnutritional blindness in India have been undertaken in course of various recordsW.H.O./I.C.M.R.. T.C.P.P., Ophthalmic Out Patients records, School health surveys,, It appears that the incidence varied between 1.5 to 10 percent in population.
In India there are about one million economically blind people due to malnutrition which is clinically evident in 35.6 percent or more cases. The commonest cause of Paediatric blindness is keratomatacia.
Literature is replete with various aspects of hypovitaminosis A,,,,.
| Clinical features of hypovitaminosis a|| |
The signs and symptoms can be grouped under two broad headings according to W.H.O,
A. Primary signs
- (X1 A ) Conjunctival xerosis.
- (XI B ) Bitot's spot with conjunctival xerosis
- (X 2 ) Corneal xerosis.
- (X3 A ) Corneal ulceration with xerosis. 5. (X3B) Keratomalacia.
B. Secondary signs
- (X N ) Night blindness.
- (X N ) Xerophthalmia fundus.
- (Xs) Corneal scars following keratomalacia.
Poor vitamin A status of an individual is evidenced by xerophthalmia, night blindness associated with protein-calorie malnutrition (PCM) and infections. Conjunctival pigmentation appears to be an early sign of xerophthalmia.
We fully agree with Chandra AND Venkatachalan who emphasized that "the diagnosis is easy provided that the practitioner makes it a point to examine the conjunctiva and cornea in every child that attends the clinic irrespective of the complaint."
| Helminth infestation and hypovitaminosis a|| |
The causative factors of hypovitaminosis A are well khown. Of the in, defective absorption appears to be more important and in our view, it needs a greater emphasis.
The role of intestinal parasites in different ocular disorders including keratomalacia; 95 percent of his 1500 cases of kemtomalacia showed presence of worms deserve emphasis., Severe diarrhoea in cases of keratomalacia has beer reported,,.
In our previous communications (1969197.5), we reported the association of helminths with hypovitaminosis A showing ocular signs. In a previous study of sixty cases selected solely on the history of diarrhoea or dysentery, ova, cysts or parasites were found to be present in 50 percent cases.
| Materials and methods|| |
One hundred cases of xerophthalmia from different age-groups were selected at random from the Eye Outpatients' of Medical College Hospital, Calcuttaduring last one year or so.
Ocular findings were documented. Evidence of under nutrition and/or malnutrition, if any, was noted.
A. single specimen of stool in each case was examined by clinical pathologist attached to the Eye Infirmary.
| Observations|| |
The Age-incidence (Shown in [Table - 1])
80 percent of the cases were below the age of 10 years, of which maximum number of cases were infants.
Children often showed evidence of under nutrition and/or malnutrition, but there was practically no such evidence in adults.
Evidence of xerophthalmia [Table - 2]
Most of them showed pigmentation at equatorial portion of bulbar conjunctiva on the outer side and Bitot's spots. Only a few presented wish keratomalacia and they were all in infants. Rarely some cases presented with general opacity in one or both eyes but still with presence of Bitot's spot.
Ova, parasites or cysts
Infants and children below 10 years showed maximum number of positive cases. Ascaris ova and giardia cysts were particularly common in 0-10 years age-group. E. histolytica was universally present in all age-groups, while a few patients above the age of 10 years show ed- hook worm ova. About 30 percent cases did not reveal any ova, parasites or cysts [Table - 3].
In addition to vitamin A injections, anthelminthics were prescribed in all cases showing helminth infestation.
| Discussion|| |
Since there is no control study comparing xerophthalmia cases showing helminths and helminths in general population, it is difficult to pinpoint helminth infestation alone to be cause of hypovitaminosis A, but the association is certainly very common. Better therapeutic response when vitamin A administration is coupled with proper anthelminthic is also very suggestive.
A single microscopic examination of faecal specimen reveals ova, parasites or cysts in about one-sixth to one-third cases and many of them are voided at varying intervals. So such examinations at intermittant intervals would detect more cases of helminths.
| Summary|| |
One hundred cases of xerophthalmia showing evidence of helminth infestation have been documented.
| References|| |
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[Table - 1], [Table - 2], [Table - 3]