Tropical sprue

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Tropical sprue
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Diarrhea, weight loss, fatigue, anemia
Complications	Malabsorption, nutritional deficiencies
Onset	Gradual
Duration	Long-term
Types	N/A
Causes	Unknown, possibly infectious
Risks	Living in or traveling to tropical regions
Diagnosis	Endoscopy, biopsy, blood tests
Differential diagnosis	Celiac disease, Whipple's disease, Giardiasis
Prevention	N/A
Treatment	Antibiotics, folic acid supplementation
Medication	Tetracycline, Folic acid
Prognosis	Good with treatment
Frequency	Rare outside tropical regions
Deaths	N/A

Other Names: Tropical enteropathy; Idiopathic tropical malabsorption syndrome Tropical sprue is a condition that occurs in people who live in or visit tropical areas for extended periods of time. It impairs nutrients from being absorbed from the intestines. Tropical sprue (TS) is a syndrome characterized by acute or chronic diarrhea, weight loss, and malabsorption of nutrients.

Causes

This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines. Risk factors are:

• Living in the tropics
• Long periods of travel to tropical destinations

Symptoms

Symptoms include:

• Abdominal cramps
• Diarrhea, worse on a high-fat diet
• Excess gas (flatus)
• Fatigue
• Fever
• Leg swelling
• Weight loss

Symptoms may not appear for up to 10 years after leaving the tropics.

Diagnosis

There is no clear marker or test that clearly diagnoses this problem. Certain tests help to confirm that poor absorption of nutrients is present:

• D-xylose 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 vitamin D
• Complete blood count (CBC)

Tests that examine the small intestine may include:

• Enteroscopy
• Upper endoscopy
• Biopsy of the small intestine
• Upper GI series

Treatment

Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or Bactrim is typically given for 3 to 6 months. In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.

Prognosis

The outcome is good with treatment. Possible Complications

• Vitamin and mineral deficiencies are common.

In children, sprue leads to:

• Delay in the maturing of bones (skeletal maturation)
• Growth failure

Prevention

Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

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.

NIH genetic and rare disease info

• NIH info on Tropical sprue

Tropical sprue is a rare disease.

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