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Linked between major medical complications and malnutrition

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Anonymous 9639

Nutrition supervisor

Normal user

3 Jul 2017, 11:19

Respected sir, there is a difficulty to understand and I searched many time for a better answer but couldn't find a suitable answer. My question is: what is the link between malnutrition and lymph nodes? Why do we check it during admission at health centre? I mean that when we enrol a patient in severe acute malnourished condition, why do we check the lymph nodes, skin changes (like scabies, peeling, ulcers/abscesses), candida? What are the reasons? Can you elaborate please. It will be my pleasure to receive your quick answer. Looking for your quick and prompt response in this regards. Thanks

Anonymous 2367

Normal user

5 Jul 2017, 07:33

Just to see whether the child is having secondary infection due to malnutrition and vice versa. Most of the time malnutrition is associated with other conditions so better to identify them for treatment purpose.

DIALLO

Management de Projet Nutrition santé

Normal user

5 Jul 2017, 12:29

Hello,
Malnutrition is a gateway to several germs because the body becomes immunodeficient.
Infectious diseases and malnutrition form a vicious circle.

So at admission we must look for all the avenues which can also be complications of the disease.

Paul

Technical expert

5 Jul 2017, 13:16

Dear Anonymous,
Malnutrition causes pathophysiological changes that affect every organ and system in the body including skin. Children that have been identified with Severe Acute Malnutrition for example will undergo a general medical examination (for example using the IMCI framework). Typically the examination will identify illnesses that may have contributed to or may be a consequence of malnutrition. The assessment record (OTP card) that is/was used by NGO's would typically identify specific features such as 'scabies' or 'lymph nodes' depending on context.

Scabies is context specific, meaning that in some contexts many children with SAM coincidentally have scabies. Scabies is identified and treated as a public health intervention rather than being specific to SAM.

Ulceration of the skin may occur in SAM resulting in open wounds of the limbs, particularly in cases of severe oedema. In some contexts there may be a high prevalence of bacterial skin infections that will need attention in addition to the other treatment protocols.

Lymph node checks are a normal part of a medical examination. Swollen lymph nodes in isolation may be due to a local infection in one or more limbs. Generalised swelling of lymph nodes may be indicative of generalised infection (e.g. Influenza) but may also sometimes be related to illnesses such as TB, HIV or malignant disease. While checking lymph nodes is a normal part of any examination it may be that in some contexts the check (on OTP cards) may be emphasised due to a high prevalence of HIV/TB, for example.

Candida may be the result of immunosuppression (which may be a direct consequence of SAM) or may be indicative of generalised illness such as TB / HIV. Checking the mouth should be a standard part of any medical examination since the clinician may also detect problems (e.g. cleft palate or dysphagia) that may be a barrier to eating RUTF for example for children with SAM.

A quick internet search came up with this briefing by Save the Children that gives a brief overview of some of the physiological consequences of malnutrition.

http://www.knowledgemeridian.com/wwv/MalnutritionBriefingForDoctorsAndNurses.pdf

If you would like to investigate the pathophysiology further I would recommend researching the work of Professor Michael Golden.

I hope this helps
Paul

Dr. Tajkera Noor

Program Manager/ Action Against Hunger

Normal user

6 Jul 2017, 07:51

Dear Paul,

Thank you for your detailed answer . In some cases when there is infection lymph nodes are involved or swollen. As we all know in Severe acute malnutrition due to Reductive adaptation patient does not produce sign- symptoms of infection/ fever but lymph nodes can be involved. This malnourished child can also suffer from tuberculosis which also cause swelling of the lymph node. In hospitals examination/ palpation of lymph nodes of different site of the body is mandatory.

As this children mostly come from a lower socio economic condition lack of proper hygiene and living in a crowded place which can causes scabies in some cases but that is not a diagnostic feature for SAM cases. Rather than different stages of dermatosis is common in SAM cases.

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