tropical sprue

What is Tropical Sprue?

Tropical sprue is a rare infectious disease that damages the small intestine, making it difficult for the body to absorb nutrients from food. It typically affects people who live in or visit tropical areas, including the Caribbean, southern India, and Southeast Asia.

Symptoms of Tropical Sprue

The symptoms of tropical sprue include:

• Chronic diarrhea
• Pale, greasy, smelly poop
• Weight loss
• Malabsorption of nutrients

Causes and Risk Factors

While the exact cause of tropical sprue is unclear, it is thought to result from chronic infection of the small bowel by toxigenic strains of coliform bacteria. People who live in or visit tropical areas for extended periods are at risk of developing this condition.

Treatment and Prevention

Tropical sprue can be treated with antibiotics and nutritional supplements. To prevent the disease, people should take precautions when traveling to tropical areas, such as eating well-cooked food and avoiding contaminated water.

Prevalence and Geographic Distribution

Tropical sprue is rare in visitors spending less than a month in areas where the disease is endemic. It has been described in South and South East Asia, Central America, Venezuela, Colombia, and parts of Mexico and the Caribbean islands.

References:

• [1] Tropical sprue is a syndrome characterized by acute or chronic diarrhea, weight loss, and malabsorption of nutrients. (Source: #2)
• [2] The illness is rare in visitors spending < 1 month in areas where the disease is endemic. (Source: #3)
• [3] Tropical sprue occurs chiefly in the Caribbean, southern India, and Southeast Asia, affecting both natives and visitors. (Source: #4)
• [4] It affects the small intestine and is characterized by malabsorption and multiple nutritional deficiencies, especially... (Source: #10)

Symptoms of Tropical Sprue

Tropical sprue, a rare digestive disease, can manifest in various ways, affecting the small intestine's ability to absorb nutrients. The following are some common signs and symptoms:

• Chronic Diarrhea: One of the primary symptoms of tropical sprue is persistent diarrhea, which can be acute or chronic.
• Weight Loss: As the body struggles to absorb essential nutrients, weight loss is a common consequence.
• Malabsorption: Tropical sprue impairs the small intestine's ability to absorb certain nutrients, leading to deficiencies in vitamins and minerals.
• Steatorrhea: A characteristic symptom of tropical sprue is light-colored, soft, bulky, greasy, and foul-smelling stool (steatorrhea).
• Fever: Some individuals may experience fever as a result of the infection.
• Malaise: A general feeling of illness or discomfort can also be present.
• Anemia: Due to malabsorption of essential nutrients like B12 and folate, anemia can develop, leading to symptoms such as fatigue, pallor, or dyspnea on exertion.
• Glossitis, Cheilitis, Stomatitis, Pedal Edema: In severe cases, the patient may present with signs and symptoms of anemia, including glossitis (sore tongue), cheilitis (inflammation of the lips), stomatitis (mouth sores), or pedal edema (swelling in the feet).

These symptoms can vary from person to person and may not be present in all cases. If you suspect that you have tropical sprue, it is essential to consult a medical professional for proper diagnosis and treatment.

References:

• [3] Symptoms of tropical sprue may include any of the following: ...
• [9] Tropical sprue symptoms (presentation) · Diarrhoea (acute or chronic). · Weight loss. · Malabsorption - deficiency of the following may occur: · Steatorrhoea.
• [10] Tropical sprue is a malabsorption syndrome characterized by acute or chronic diarrhea. ... The patient presents signs and symptoms of anemia: fatigue, pallor, or dyspnea on exertion secondary to B12 and folate deficiency due to malabsorption.
• [13] Symptoms of Tropical Sprue. Typical symptoms of tropical sprue are light-colored, soft, bulky, greasy, and unusually foul-smelling stool (called steatorrhea), chronic diarrhea, fever, a general feeling of illness (malaise), and weight loss. Other symptoms of malabsorption of specific nutrients may also develop.
• [14] Tropical sprue is a rare disorder affecting people in tropical and subtropical countries. It causes problems with the lining in your small intestine, where food is absorbed. You then have trouble breaking down (digesting) food and absorbing nutrients. Not absorbing nutrients is called malabsorption.

Diagnostic Tests for Tropical Sprue

Tropical sprue, a malabsorption syndrome characterized by acute or chronic diarrhea, can be diagnosed using various tests and procedures. Here are some of the diagnostic tools used to identify tropical sprue:

• Upper Gastrointestinal Endoscopy with Small-Bowel Biopsy: This is considered the definitive test for diagnosing tropical sprue. It involves removing tissue from the small intestine using an endoscope, which is then examined under a microscope.
• D-Xylose Absorption Test: This test measures how well the intestines absorb a simple sugar, helping to confirm poor nutrient absorption.
• Tests of Stool to See if Fat is Absorbed Correctly: These tests check for malabsorption of fats in the stool, which can indicate tropical sprue.
• Blood Tests: Blood tests may be conducted to measure iron, folate, vitamin B12, or vitamin D levels, as these nutrients are often deficient in people with tropical sprue.
• Complete Blood Count (CBC): A CBC test can help identify any nutritional deficiencies or infections that may be contributing to the condition.

Other Diagnostic Factors

In addition to these tests, healthcare providers also consider other factors when diagnosing tropical sprue, including:

• Prolonged Exposure to an Endemic Area: People who have spent a long time in areas where the disease is common are more likely to develop tropical sprue.
• Constitutional Symptoms: Symptoms such as fever, weight loss, and fatigue can indicate tropical sprue.
• Diarrhea and Bloating: Frequent diarrhea and bloating can be symptoms of malabsorption associated with tropical sprue.

References

[3] One way to diagnose tropical sprue is to look for signs of the nutritional deficiencies it causes. Tests for damage caused by malabsorption include: Your doctor may also use an enteroscopy to confirm your diagnosis. [4] Dec 24, 2020 — Complete blood cell (CBC) count · Blood chemistry test · Stool collection test · D-Xylose absorption test · 13C Sucrose breath test. [9] Oct 3, 2024 — Tests of the stool to see if fat is absorbed correctly; Blood tests to measure iron, folate, vitamin B12, or vitamin D; Complete blood count(CBC). [15] There is no clear marker or test that clearly diagnose tropical sprue disease. Certain tests help to confirm that poor absorption of nutrients is present: D-xylsoe is a lab test to see how well the intestines absorb a simple sugar; Tests of the stool to see if fat is absorbed correctly; Blood tests to measure iron, folate, vitamin B12, or ...

Treatment of Tropical Sprue

The treatment of tropical sprue typically involves a combination of antibiotics and nutritional replacements to correct deficiencies in patients.

• Antibiotics: The recommended length of treatment with tetracycline is 6 months, given in combination with folate. This treatment has been shown to normalize mucosal function and prevent relapses [5].
• Nutritional Replacements: Nutrient replacement to correct deficiencies often includes folic acid, vitamin B-12, and iron [4]. Other nutritional replacements may be given as needed.
• Long-term Treatment: In addition to folic acid supplementation, long-term treatment with antibiotics is currently recommended. Deficiencies of folic acid and vitamin B12 are common in patients with tropical sprue [8].
• Treatment Duration: The duration of treatment can vary depending on the individual case, but it is typically several weeks to months.

Key Takeaways

• Treatment of tropical sprue usually results in a full recovery.
• A combination of antibiotics and nutritional replacements is effective in treating tropical sprue.
• Long-term treatment with antibiotics may be necessary to prevent relapses.
• Nutritional deficiencies, especially folic acid and vitamin B12, are common in patients with tropical sprue.

References

[4] Dec 24, 2020 — Nutrient replacement to correct deficiencies in patients with tropical sprue often includes folic acid, vitamin B-12, and iron. [5] by H Westergaard · 2004 · Cited by 43 — The recommended length of treatment with tetracycline is 6 months and it is given in combination with folate. [8] In addition to folic acid supplementation, long-term treatment with antibiotics is currently recommended. Deficiencies of folic acid and vitamin B12 and ...

Differential Diagnosis of Tropical Sprue

Tropical sprue, a malabsorption syndrome characterized by acute or chronic diarrhea, requires a comprehensive differential diagnosis to rule out other conditions that may present with similar symptoms.

Conditions to Consider:

• Celiac disease: An autoimmune disorder causing inflammation and flattening of the small intestine villi, leading to malabsorption. [5][11]
• Infectious conditions: Such as Entamoeba histolytica, Giardia lamblia, Strongyloides, and others that can cause malabsorption and diarrhea. [1][11]
• Small intestine bacterial overgrowth (SIBO): A condition where bacteria overgrow in the small intestine, leading to malabsorption and symptoms similar to tropical sprue. [13]
• Inflammatory bowel disease: Conditions like Crohn's disease and ulcerative colitis can present with chronic diarrhea and malabsorption, making them a differential diagnosis for tropical sprue. [14]
• Coccidiosis (Cystoisospora belli): A parasitic infection that can cause malabsorption and diarrhea, similar to tropical sprue. [11]
• Capillariasis: A parasitic infection that can lead to malabsorption and symptoms similar to tropical sprue. [11]

Key Points to Consider:

• Tropical sprue is a diagnosis of exclusion, meaning other conditions must be ruled out before considering it as the cause of symptoms.
• The differential diagnosis for tropical sprue is extensive and requires a thorough evaluation of the patient's history, physical examination, and laboratory workups. [2]
• A gluten-free diet may not be effective in treating tropical sprue, and negative serologies do not rule out the condition. [6][7]

References:

[1] Tropical sprue is a malabsorption syndrome characterized by acute or chronic diarrhea. [2] The differential diagnosis for patients with tropical sprue is very extensive. [5] Celiac disease is an autoimmune disorder causing inflammation and flattening of the small intestine villi, leading to malabsorption. [6] May 18, 2023 — Approach to the adult patient with suspected malabsorption · Clinical presentation and diagnosis of primary gastrointestinal lymphomas · Diagnosis ... [7] TS is an important differential diagnosis to consider in a patient who has negative serologies and/or no response to a gluten-free diet as relevant clinical ... [11] The differential diagnosis that must be considered in a patient with chronic diarrhea, weight loss, and malabsorption, even in a clinical setting consistent with tropical sprue, should include giardiasis, cryptosporidiosis, coccidiosis (Cystoisospora belli), capillariasis, strongyloidiasis, celiac sprue (gluten enteropathy), lymphoma ... [13] The differential diagnosis in this patient included