Scurvy Outbreak Among Male Inmates in a Large Penitentiary in Ceará State, Northeast of Brazil, 2019-2020

Background:
A large male penitentiary in Ceará, Brazil, reported cases of an unknown disease. The main diagnostic hypotheses were deep vein thrombosis (DVT), filariasis, leptospirosis, and scurvy. Although rare, scurvy still occurs in vulnerable people on restrictive diets. This study aimed at confirming the existence of an outbreak and its cause, describing the patients’ characteristics and contributing to the adoption of control and prevention measures.

Methods:
We conducted a descriptive study and interviewed patients using a questionnaire. Based on clinical records, suspected case was “male inmate who presented lower limb swelling”, and any of the following signs/symptoms: lower limb pain, hematoma/ecchymosis or stiffness/hardening, difficulty in walking, gingival bleeding or fever, between October 1st, 2019 and March 18th, 2020. Criteria for confirming or discarding cases were serology, biopsy, tomography tests and/or positive therapeutic response to ascorbic acid supplementation. We used descriptive statistics measures, absolute/relative frequency, and central/dispersion tendency measures.

Results:
The penitentiary had 2,179 inmates, and we interviewed 62/64 patients who met the case definition. Mean age was 40.6 years (SD 10.8), and mean prison time was 2.0 years (SD 1.0). The main signs/symptoms were lower limb swelling and pain (100.0%), difficulty in walking (91.9%), lower limb hematoma/ecchymosis (90.3%), fever (88.7%), and 66.1% (n=41) had been hospitalized. We discarded DVT, filariasis and leptospirosis. All patients reported absence of fresh fruits and juices at meals. Ascorbic acid and other vitamins supplementation was administered for 100.0% of inmates. Patients (n=58; 93.6%) reported improvement of symptoms within 2-10 days of treatment. There were no deaths.

Conclusions:
We confirmed a scurvy outbreak. Diagnosis was based on clinical manifestations, dietary history and positive therapeutic response to ascorbic acid. After interventions, the penitentiary did not report new cases. We recommended regular offer of balanced and vitamin C-rich diet to all inmates, and clinical monitoring of patients’ evolution.

Please abstracts [at] tephinet [dot] org (email us) if you have any corrections.

If this abstract has been converted into a full article, please abstracts [at] tephinet [dot] org (email us) the link. We would love to help promote your work.