Tropical sprue

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For other uses, see Sprue.
Tropical sprue
Other namesPostinfectious tropical malabsorption[1]
SpecialtyGastroenterology Edit this on Wikidata
SymptomsDiarrhoea, abdominal pain, weight loss
ComplicationsMalabsorption, anaemia
Diagnostic methodIntestinal histology
Differential diagnosisCoeliac disease, environmental enteropathy
TreatmentAntibiotics, folate replacement

Tropical sprue is a

coeliac sprue. It appears to be a more severe form of environmental enteropathy.[3][4]

Signs and symptoms

The illness usually starts with an attack of acute

steatorrhoea, weight loss, anorexia, malaise, and nutritional deficiencies.[1][2][3]
The symptoms of tropical sprue are:

Left untreated, nutrient and vitamin deficiencies may develop in patients with tropical sprue.[1][2] These deficiencies may have these symptoms:

Cause

The cause of tropical sprue is not known.

intestinal motility, and persistent small intestinal bacterial overgrowth may combine to cause the disorder.[6] A link between small intestinal bacterial overgrowth and tropical sprue has been proposed to be involved in the aetiology of post-infectious irritable bowel syndrome (IBS).[7] Intestinal immunologic dysfunction, including deficiencies in secretory immunoglobulin A (IgA), may predispose people to malabsorption and bacterial colonization, so tropical sprue may be triggered in susceptible individuals following an acute enteric infection.[1]

Diagnosis

Diagnosis of tropical sprue can be complicated because many diseases have similar symptoms. The following investigation results are suggestive:[1]

  • Abnormal flattening of villi and inflammation of the lining of the small intestine, observed during an endoscopic procedure.
  • Presence of inflammatory cells (most often lymphocytes) in the biopsy of small intestine tissue.
  • Low levels of vitamins A, B12, E, D, and K, as well as serum albumin, calcium, and folate, revealed by a blood test.
  • Excess fat in the
    steatorrhoea
    ).
  • Thickened small bowel folds seen on imaging.

Tropical sprue is largely limited to within about 30 degrees north and south of the equator. Recent travel to this region is a key factor in diagnosing this disease in residents of countries outside of that geographical region.[2]

Other conditions which can resemble tropical sprue need to be differentiated.

protozoan infections, tuberculosis, HIV/AIDS, immunodeficiency, chronic pancreatitis and inflammatory bowel disease.[2] Environmental enteropathy is a less severe, subclinical condition similar to tropical sprue.[2]

Prevention

Preventive measures for visitors to tropical areas where the condition exists include steps to reduce the likelihood of

bananas and oranges). Basic sanitation is necessary to reduce fecal-oral contamination and the impact of environmental enteropathy in the developing world.[2]

Treatment

Once diagnosed, tropical sprue can be treated by a course of the antibiotic

sulphamethoxazole/trimethoprim (co-trimoxazole) for 3 to 6 months.[2][8]
Supplementation of vitamins B12 and folic acid improves appetite and leads to a gain in weight.[4][9]

Prognosis

The prognosis for tropical sprue may be excellent after treatment. It usually does not recur in people who get it during travel to affected regions. The recurrence rate for natives is about 20%,[2] but another study showed changes can persist for several years.[10]

Epidemiology

Tropical sprue is common in the Caribbean, Central and South America, and India and southeast Asia. In the Caribbean, it appeared to be more common in Puerto Rico and Haiti. Epidemics in southern India have occurred.[2]

History

The disease was first described by

Tom Spies of the University of Alabama, while conducting his research in Cuba and Puerto Rico.[13][14][15]

References

  1. ^
    PMC 7151975
    .
  2. ^
    PMID 17148698
    .
  3. ^
    PMID 22633998
    .
  4. ^
    PMID 24781741
    .
  5. PMID 9135537
    .
  6. S2CID 41146323
    .
  7. S2CID 33660302
    .
  8. PMID 20805939
    .
  9. PMID 910746
    .
  10. PMID 5009590
    .
  11. PMID 2691344
    .
  12. ^ Hillary, William (1759). Observations on the Changes of the Air and the Concomitant Epidemical Diseases in the Island of Barbados: To which is Added a Treatise on the Putrid Bilious Fever, Commonly Called the Yellow Fever. pp. 277–281.
  13. PMID 17769104
    .
  14. PMID 18139385
    .
  15. doi:10.1001/jama.1957.02980080048013
    .
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