Keshan's disease

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Classification according to ICD-10
E59 Alimentary selenium deficiency
Keshan disease
ICD-10 online (WHO version 2019)

The Keshan Disease is a disease of the heart muscle ( cardiomyopathy ), mainly engaged in selenium occurs poor areas. Selenium is an essential trace element that is part of the rare amino acid selenocysteine . Selenocysteine ​​occurs in the enzyme glutathione peroxidase , which is involved in the human body's defense against oxidative stress . Children and young women in particular are affected by the disease. It is endemic to some rural areas of China where the soil is particularly poor in selenium. It was named after the district of Kèshān in the city of Qíqíhāěr in the northeastern Chinese province of Hēilóngjiāng in Manchuria .

There are acute, subacute, chronic and latent courses. Clinically, the disease manifests itself in cardiac symptoms such as heart failure , arrhythmia , EKG changes and, in the worst case, cardiogenic shock . This is based on the development of a cardiomyopathy , the heart hypertrophies and is increasingly remodeled by connective tissue, cellular infiltrates and calcifications occur.

How the disease ultimately develops is unclear. Animal experiments suggest that the human coxsackievirus B3 (CVB3 / 0) is involved in the disease process. The disease only breaks out when there is a selenium deficiency . Therefore, this deficiency was considered the sole trigger for a long time. Little is known about the interaction of the factors (viral infection, deficiency symptoms). However, it has been shown that both selenium and vitamin E deficiencies cause mutations in the virus genome . Selenium also inhibits the replication of the virus genome.

The occurrence of the disease can be contained by prophylactic supply of sodium selenite or organic, selenium-containing fungal cultures in the affected areas.

See also

A selenium deficiency cardiopathy without virus involvement in domestic swine is the mulberry heart disease .

Individual evidence

  1. ↑ G. Löffler u. a .: biochemistry and pathobiochemistry. Springer, 2006, ISBN 3-540-32680-4 , p. 43. (online)
  2. ^ OA Levander, MA Beck: Interacting nutritional and infectious etiologies of Keshan disease. Insights from coxsackie virus B-induced myocarditis in mice deficient in selenium or vitamin E. In: Biol Trace Elem Res. (1997) 56, pp. 5-21. PMID 9152508 .
  3. ↑ C. Cermelli et al. a .: Selenite inhibition of Coxsackie virus B5 replication: implications on the etiology of Keshan disease. In: J Trace Elem Med Biol. (2002) 16, pp. 41-46. PMID 11878751 .
  4. ↑ MA Beck: Selenium deficiency and viral infection. In: J Nutr. 2003 May; 133 (5 Suppl 1), pp. 1463S-1467S, PMID 12730444
  5. ↑ G. Alfthan et al. a .: Selenium supplementation of children in a selenium-deficient area in China: blood selenium levels and glutathione peroxidase activities. In: Biol Trace Elem Res. (2000), 73, pp. 113-125. PMID 11049204 .