Beriberi classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Abdelrahman Ibrahim Abushouk, MD[2]

Overview

Beriberi is usually classified into two types based on the main system affected (Wet and dry). The two forms may appear in the same patient, but one form dominates the disease phenotype. Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.

Classification

• Beriberi is usually classified into two types based on the main system affected (Wet and dry).
• The two forms may appear in the same patient, but one form dominates the disease phenotype.
• Other forms as infantile beriberi or Wernicke-Korsakoff syndrome occur in special populations.

		Affected Site	Course	Population	Presentation
Classification based on main organ-system affected	Wet beriberi	Cardiovascular System	Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal). Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure.	Individuals with chronic thiamine deficiency.	Heart failure (acute or chronic). Peripheral edema: Due to weakened capillary beds in peripheral tissues leading to fluid leakage.
	Dry beriberi	Peripheral nervous system	Usually follows a chronic disease course.	Individuals with chronic thiamine deficiency.	Polyneuritis and symmetric, ascending paralysis of the peripheral nervous system. It first affects the sensory system (parasthesia), then the motor system (loss of tendon reflexes, followed by foot and wrist drop).
Based on patient risk factor exposure	Infantile beriberi	Cardiovascular or nervous system	Usually follows a progressive disease course and has three distinct forms: Cardiac or pernicious: Rapid onset, progressive course, and poor prognosis. Aphonic form: Subtle onset and a mild course. Pseudomeningitic form: Progressive course.	Infants nursed by thiamine-deficient mothers. Cardiac: 1 to 3 months old. Aphonic:4 to 6 months old. Pseudomeningitic: 7 to 9 months old.	Early signs include restlessness, constipation, and vomiting. Cardiac form: Acute cardiac failure (edema and cyanosis). Once heart failure develops, the infant may die in two to four hours. Aphonic form: hoarseness, weak cry, and even loss of voice due to vocal cord paralysis. Pseudomeningitic form: The classic presentation of meningitis (nystagmus, vomiting and seizures); however, CSF analysis reveals no infectious organisms.
	Wenicke-Korsakoff Syndrome	Brain	Two conditions: Acute (Wernicke's encephalopathy). Chronic (Korsakoff psychosis).	Chronic alcoholics (precipitated by high carbohydrate consumption that exacerbates subclinical thiamine deficiency).	Wernicke's encephalopathy: Confusion, ataxia, ptosis, and double vision. Korsakoff psychosis: Hallucinations, confabulation, and amnesia.
	Bariatric beriberi	Nervous system	The condition may lead to: Dry beriberi Wernicke-Korsakoff syndrome	Bariatric surgeries Common: Roux-en Y gastric bypass Less common: post-adjustable gastric banding	Within the first 6 months of surgery, patients may present with the manifestations of dry beriberi or more acutely, Wernicke-Korsakoff syndrome.

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