“This is not negligible for a disease that we thought had disappeared” – Libération

He was a little boy, around five years old, who came to Nîmes University Hospital limping, with significant bone pain. In Professor Tu-Anh Tran’s pediatrics department, we explored different avenues: an inflammatory bone or joint disease? Negative results. A blood pathology? Always negative. It was then that the team noticed a curious habit in their little patient: “He only ate yogurt and boudoir”, traces the pediatrician. So the doctors decide to do a nutritional assessment and examine possible deficiencies. His vitamin C levels, in particular, are plummeting. The diagnosis is finally found: scurvy, this old disease best known for having caused the loss of teeth and even killed sailors in the 16th or 18th century. This is what has been affecting the young child for weeks. Vitamin C supplementation, and he’s back on his feet in a few days.

This case of a pathology that was thought to have disappeared in France, or only rarely encountered in very isolated people, could seem exceptional. It is only the second scurvy diagnosed by the Nîmes team in two years. But other pediatricians, elsewhere in France and even in the United Kingdom or Switzerland, have reported similar cases in recent years. And many even have the feeling of seeing more. So much so that pediatricians at the Robert-Debré hospital (Paris) decided to quantify the phenomenon. By relying on the “Program for medicalization of information systems” (PMSI) database, which brings together all data on hospitalizations in France, they counted 888 children hospitalized for scurvy (depending on their vitamin C levels) between January 2015 and November 2023. The trend is even accelerating, with a cumulative increase of 34.5% after March 2020 – going from a increase from 0.01% per month before this date to almost 2%. The sharpest increase (200% between March 2020 and November 2023) is found in 5 to 10 year olds. Severe malnutrition increased by 20% over this same post-Covid period.

“This data is worrying”

Their study, carried out with researchers from Inserm and the universities of Paris Cité and Guyana, was published in early December in the British journal of medicine The Lancet. “These data are worrying, undoubtedly underestimated since we only count hospitalizations, but they correspond to what we see in the hospital, breathes Ulrich Meinzer, head of department at Robert-Debré and who coordinated this work. Precariousness has worsened since the pandemic: nurses are reporting to us more and more often about families who have not eaten due to lack of means.” However, scurvy is often linked to socio-economic difficulties. Since the body cannot produce vitamin C, essential for the proper functioning of the body, it must be supplied from outside, normally through food. It is found in citrus fruits, potatoes, spinach, cabbage… For the first signs of scurvy to appear, you must ingest less than 10 mg of vitamin C per day for one to three months – an orange contains 80 mg. to 100. Children in an advanced state have therefore not absorbed it for months, or even years.

This is what Serge Ganga observed at the Roubaix hospital (North), in 2020: a 16-month-old baby, very tired, limping, had a very low weight and bleeding in the mouth. He had anemia, an iron deficiency… and vitamin C. “The parents were socially settled but bought few fruits and vegetables, they could not afford them,” describes the pediatrician. Hence the hypothesis followed by Ulrich Meinzer’s team: questioning the link between the increase in scurvy and the explosion of precariousness since the pandemic, particularly due to the economic crisis and the inflation of these recent years. Among children hospitalized for scurvy after March 2020, 22.6% suffered from severe malnutrition. Nearly 6% had an autistic disorder and 5% had anorexia, pathologies which can also explain poor nutrition. But if the study notes correlations, it remains cautious about the precise explanations of the phenomenon.

“Pasta and Danettes”

Doctors interviewed by Libé agree that the price of food certainly determines the quality of meals among the most precarious families, but they also cite the abnormal eating habits that they find among their little patients, whatever their income. At Montpellier University Hospital, Eric Jeziorski, head of the general pediatrics department, remembers this “extreme case”: a teenager suffering from scurvy so advanced that he could no longer bend his knees and had been using a wheelchair for months. He didn’t eat “only pasta and Danettes”. Like all the others, he was able to walk again in a few days once the diagnosis was found and the vitamin was ingested. Without after-effects.

“The recovery is quite spectacular, but it is alarming to have to take daily vitamin C tablets – not reimbursed – that a normal diet provides,” regrets Julie Barthelet. As part of her thesis devoted to scurvy during her internship, she identified 68 cases at the Montpellier University Hospital between 2014 and 2021. Among them, certain profiles were “expected” because they presented eating disorders, digestive diseases. But seven children did not present any pathology that could explain it. “This is not negligible for a disease that we thought had disappeared, remarque Eric Jeziorski. Children who only want to eat pasta is nothing new, but there may be less education about nutrition [en raison de] the possibility of eating processed products while avoiding fruits and vegetables.”

“You have to think about it”

The pediatrician also insists on raising awareness among caregivers: “To diagnose scurvy, all you need is a vitamin C dosage. It’s easy to do, but you have to think about it.” It must be said that the signs are not specific and rarely go as far as tooth loss: doctors therefore often consider other conditions first. “For an infant with fractures, we even thought about domestic violence,” remembers Julie Barthelet. “Thinking about scurvy can also save unnecessary invasive tests, such as biopsies,” notes Tu-Anh Tran, their colleague from Nîmes.

This is the whole meaning of the alert that Ulrich Meinzer and his collaborators intend to raise with their study: “It is not an explosion of cases like a bronchiolitis epidemicbut if we do nothing, the phenomenon will continue and even increase, insists the Parisian professor. We need a rapid response: promoting access to quality products, better food education, more training for caregivers in the prevention and detection of deficiencies…” Especially since scurvy is only the extreme presentation of an unbalanced diet. Which also exposes children to other diseases, including obesity, diabetes, stunted growth and even a weakened immune system.