Which disease used to be known as "the disease of the three D's": diarrhea, dermatitis and dementia?

UPRVUNL - 2021

Applied Nutrition & Dietetics

Easy

Appeared in: UPRVUNL - 2021

Explanation

Pellagra is a systemic disease caused by a severe deficiency of niacin (vitamin B3) or its precursor, tryptophan.
It is classically identified by a triad of symptoms known as the "three D's": Dermatitis, Diarrhea, and Dementia.
The dermatitis is a characteristic photosensitive rash, often appearing symmetrically on sun-exposed skin (e.g., Casal's necklace).
The diarrhea is due to inflammation of the gastrointestinal tract.
The dementia manifests as cognitive decline, confusion, and depression due to neuronal dysfunction.
If untreated, the disease is fatal, leading to a fourth 'D': Death.

Option B: Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency. Its main sign is severe wasting of muscle and fat, not the specific triad of dermatitis, diarrhea, and dementia.
Option C: Meningitis is the inflammation of the meninges, the membranes covering the brain and spinal cord. It is typically caused by an infection and presents with fever, headache, and neck stiffness (nuchal rigidity).
Option D: Scurvy is caused by a deficiency of vitamin C (ascorbic acid). It leads to impaired collagen synthesis, resulting in symptoms like bleeding gums, poor wound healing, petechiae (small skin hemorrhages), and joint pain.

Clinical Relevance

Nursing practice connection: Knowing Vitamin Deficiency Disorders helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must be able to recognize the signs of pellagra, especially in at-risk populations such as individuals with alcohol use disorder, malabsorption syndromes (e.g., Crohn's disease), or those on highly restrictive diets.
A key nursing assessment is to examine sun-exposed areas of the skin for the characteristic rash (Casal's necklace), while also assessing for gastrointestinal issues and changes in mental status.
Patient education is crucial, focusing on a balanced diet rich in niacin and tryptophan, including sources like meat, fish, eggs, and fortified cereals.

How to Approach the Question

This is a factual recall question that tests your knowledge of classic disease presentations.
Identify the key phrase in the question stem: "the disease of the three D's": diarrhea, dermatitis and dementia.
This mnemonic is strongly associated with a specific nutritional deficiency.
Systematically evaluate each option. Recall or deduce the primary characteristics of Marasmus (wasting), Meningitis (infection with neck stiffness), and Scurvy (Vitamin C deficiency with bleeding).
Recognize that Pellagra, caused by niacin (B3) deficiency, is the disease that matches the classic "3 D's" triad.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 734-736

E6 textbook of Applied Biochemistry and Nutrition & DieteticsHarbans Lal (pp 26-464 of 479) p. 367-369

E6 Medicine Harrison 22e Part 2 p. 512-514