Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. The insufficient protein consumption, but with sufficient calorie intake, distinguishing it from marasmus. Kwashiorkor cases occurs in areas of famine or poor food supply. Cases in the developed world are rare. The defining sign of kwashiorkor in a malnourished child is pedal edema. Other signs include a distended abdomen, an enlarged liver with fatty infiltrates, thinning hair, loss of teeth, skin depigmentation and dermatitis. Children with kwashiorkor often develop irritability and anorexia. Victims of kwashiorkor fail to produce antibodies following vaccination against diseases, including diphtheria and typhoid. The disease can be treated by adding protein to the diet. It can have a long-term impact on a child's physical and mental development, and in severe cases may lead to death.