Estudio clínico y epidemiológico de un brote de beriberi húmedo en Cartagena de Indias, Colombia, 1992-1993

The main goal of this paper has been to understand the etiology of a clinical picture characterized by an edema of the legs and dysesthesia with motor dysfunction of the legs. In two cases the clinical picture ended up in a cardiopathy that lead to an irreversible cardiac failure. This outbreak occurred between July 1991 and June 1993 and affected selectively marines from the Escuela Naval Almirante Padilla in Cartagena the Indias. Our methodology was to carry out a case and control study as follows: ask the patients and their controls to fully answer a questionnaire; to perform clinical exams; to test for heavy metals in blood and 24 hour urine sample and to analyze the levels of thiamine in serum samples. We analyzed four sural nerve biopsies. In the two postmortem examinations we paid special attention to the myocardial changes. In enviromental and biological samples we searched for mercury, lead, arsenic and thalium. The final outcome of the study was a very uniform picture of the manifestations of a nutritional peripheral neuropathy in a group of 22 marines.This fact plus the two fatal cardiopathies that were studied both by light and electron microscopy showed changes that are compatible with those observed in beriberi. Thus, we concluded that the problem had al1 the characteristics of wet beriberi. After we concluded that the source of the problem was a nutritional dificiency, mainly of thiamine, we made the appropiate recommendations and adjustments of the diet indicated in such cases. The response was immediate and entirely satisfactory.