Beriberi classification

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

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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.

	Affected Site	Course	Population	Presentation
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 nerve systems. It first affects the sensory system (parasthesia), then the motor system (loss of tendon reflexes, followed by foot and wrist drop)
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. - Pure Cardiologic: 1 to 3 months of 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) or 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.

• Wet beriberi usually affects the cardiovascular system, which may cause heart failure. Moreover, it weakens the capillary walls in peripheral tissues, causing tissue water leakage and edema; hence the nomenclature "Wet".
• Dry beriberi (or endemic neuritis) usually affects the nervous system, particularly the peripheral nerves, causing partial paralysis.

Based on the disease course, wet beriberi can be further classified into two forms:

• Acute fulminant/pernicious form (Shoshin beriberi): This form is characterized by rapid onset, progressive disease course, and poor prognosis (often fatal). The heart is the main site affected and it usually leads to cardiovascular collapse.
• Chronic wet beriberi: This form has a subtle onset and a gradual course and usually ends in high-output heart failure in three stages: Initial peripheral vasodilatation, followed by activation of the kidney renin-angiotensin system, leading to fluid overload, peripheral edema, and pulmonary effusion.

There are two forms of beriberi that occur in special populations due to their nature of risk factor exposure. "Infantile beriberi" occurs in children nursed by women deficient in thiamine and usually occurs between one and four months of age. Another form of the disease occurs mainly in chronic alcoholics "Wernicke-Korsakoff syndrome" in which the brain is the main target (cerebral beriberi). This form may have either acute (Wernicke's encephalopathy) or chronic presentations (Korsakoff psychosis).

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