What to know about Keshan disease

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The first known case of Keshan disease was in 1935 in Keshan, which is in the Heilongjiang province of China. Since then, people have reported it in 14 provinces across the country. Most of the known cases of the condition have occurred in rural, mountainous areas, where much of the population faces socioeconomic hardships or has limited access to basic needs, such as education, health services, housing, and income.

Keshan disease can affect anyone, but it is most prevalent in boys and in women of childbearing age. Overall, 13.6% of all cases involve people under the age of 30 years, which indicates that the condition is still prevalent today.

On average, Keshan disease affects at least 10 out of 100,000 people each year. However, the condition hit the hardest in Yunnan, China, in the 1960s. At that time, there was an average of 100 cases per 100,000 people, with the condition having a mortality rate of 98%.

Keshan disease is a significant public health issue. Research suggests that the condition is the result of environmental and biological factors. Despite this, there is still insufficient information on the disease and its national and global impact.

There are several suspected causes of Keshan disease, including:

• selenium deficiency
• viral or fungal infection
• malnutrition
• environmental toxins
• seasonal changes

Although research is still inconclusive, the most likely cause of the condition is a deficiency of the trace mineral selenium.

Several studies have linked the lack of selenium in the soil to endemic conditions, including Keshan disease. The fact that the condition is most common in regions with low amounts of selenium in the soil and, thus, in the food that grows in it, further supports this theory.

A selenium deficiency alone may not be enough to cause Keshan disease. It could, however, contribute to the presence and mutation of the coxsackievirus B3 (CVB3). CVB3 is a human pathogen or virus that researchers have linked to acute heart failure and cardiac arrhythmia, especially in the absence of selenium.

One study concluded that 80% of people with chronic Keshan disease and 83% of those with acute Keshan disease also had a mutated form of CVB3. This indicates that people with the virus and a selenium deficiency were more likely to develop the condition.

There are four main types of Keshan disease: acute, subacute, chronic, and latent. The symptoms vary among individuals, depending on the type.

Acute

In acute Keshan disease, people may experience cardiogenic shock, severe arrhythmia, and heart failure. Early symptoms include nausea, dizziness, chills, shortness of breath, and loss of appetite.

Subacute

The symptoms of subacute Keshan disease include congestive heart failure, cardiogenic shock, and heart expansion. This type is most common in children aged 2–5 years.

Chronic

Chronic Keshan disease usually progresses slowly. Acute or subacute Keshan disease may develop into a chronic variant. Symptoms vary among individuals and may include dilated heart chambers or congestive or chronic heart failure. Some people experience shortness of breath, fainting spells, or hemoptysis, which is the term for coughing up blood.

Latent

Individuals with latent Keshan disease may not even realize that they have it until a routine autopsy after their death reveals its presence. However, those who do have symptoms may experience dizziness, heart palpitations, and fatigue. The condition may also cause abnormal changes in an electrocardiogram (EKG) exam.

Common symptoms

Other symptoms that are common across all types of Keshan disease include:

• body aches and pains
• fever
• nausea or vomiting
• fatigue
• inflammation
• hair loss
• blood clotting
• hypertension
• stroke
• cardiovascular disease
• enlarged heart

Although all four types of the condition still exist today, there are few reported cases of acute or subacute Keshan disease. Instead, the chronic and latent variants are the most prominent.

With proper treatment, Keshan disease is usually manageable. In some cases, it may even be reversible.

For individuals with a selenium deficiency, one of the best ways to treat the condition is with an inorganic selenium compound called sodium selenite. Long-term oral intake of sodium selenite may reverse the effects of the disease or make the symptoms more manageable.

A balanced diet of essential vitamins and minerals may also help individuals manage the condition. Selenium-rich foods include:

• eggs
• tuna
• cod
• chicken breast
• oatmeal
• brown or white rice
• onions
• garlic

There is circumstantial evidence that adding astragalus root to the soil could also be helpful in areas with a selenium deficiency. This strategy may work because the root can accumulate selenium from the surrounding soil. This may increase the availability of the mineral to other edible plants.

Besides taking dietary supplements or eating plants from enriched soil, a person with Keshan disease may need to undergo cardiac surgery in the form of a stent, implant, or heart transplant. This requirement, however, is rare.

Currently, there is no fixed treatment for Keshan disease. Anyone who suspects that they have the condition should consult a doctor to discuss their concerns and the next steps.

The exact cause of Keshan disease is still unknown, so there are no foolproof preventive measures yet. However, people can reduce their likelihood of developing the condition by:

• consuming a lot of selenium-rich foods
• taking a daily selenium supplement or an inorganic selenium compound, such as sodium selenite
• testing the soil in food growing and harvesting sites to determine the concentration of selenium
• eating a well-balanced diet and, if necessary, working with a doctor or dietitian to create a custom diet
• consulting a doctor at the first sign of any related symptoms

Greater involvement in improving the socioeconomic status of those in high risk areas may also help with prevention.

Learn more about foods rich in selenium here.

Keshan disease is a potentially fatal condition, but mortality rates have dropped from more than 80% to about 30% since its discovery 8 decades ago. With continued research and current treatment options, most people with the condition live a normal, well-adjusted life.

Researchers do predict that there will be lower amounts of selenium in the soil in the coming decades due to climate change. This could increase the risk of cardiovascular disease, cognitive decline, and other disorders, including Keshan disease.

Keshan disease is an endemic cardiomyopathy with high mortality rates. It is most prevalent in low income, rural regions of China and in areas with selenium-deficient soil.

The condition can cause acute or congestive heart failure, a thinning heart wall, and cardiac arrhythmia, among other health issues. The initial symptoms may include low blood pressure, nausea, fever or chills, body aches, and fatigue.

Although the exact cause or causes of Keshan disease are not fully known, the condition is commonly associated with low selenium intake. It may also be linked to the existence of the coxsackievirus B3 in the body.

This condition can affect anyone, but it is most common in women of childbearing age and boys. With early treatment, people with Keshan disease can have a good quality of life.