Tropical sprue is a poorly understand syndrome that affects both expatriates and natives in certain but not all tropical areas and is manifested by chronic diarrhoea ,steatorrhoea,weight loss and nutritional deficiencies, including those of both folate and cobalamin.

 

Causes:

• The cause of this disease is unknown, but it may be caused by an infection.
• The condition affects residents of or visitors to the tropics.

 

The disease affects 5- 10% of the population in some tropical areas.

 

Symptoms:

• Abdominal cramps
• Diarrhea, worse on high-fat diet
• Excessive gas (flatus)
• Indigestion
• Irritability
• Muscle cramps
• Numbness
• Paleness
• Weight loss

Regional variation in clinical pattern:

India:

• Individuals in India usually report the occurence of acute enteritis before development of steatorrhoea and malabsorption.

Puerto rico:

• Individuals from puerto rico shows most  insidious onset of symptoms and more dramatic response to antibiotics.

 

In children, sprue leads to:

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

Diagnostic Tests :  

• Small intestinal mucosal biopsy:

                     -Mononuclear cell infiltration(more prominent)

                     -Villus architechtural alteration (less prominent)

 

• CHEM 20
• Complete blood count (CBC)
• Enteroscopy
• Stool  examination
• Upper endoscopy
• Upper GI series

Treatment :

• Plenty of fluids and electrolytes.
• Replacement of folate, iron, vitamin B12, and other nutrients may also be needed.
• Folic acid alone will induce a hematologic remission as well as improvement in appetite, weight gain and some morphological changes in small intestinal biopsy.
• Antibiotic therapy with tetracycline is given at the beginning of treatment.
• Tetraycline should be used for upto 6 months and may be associted with improvement within 1- 2weeks.
• Oral tetracycline is usually not prescribed for children until after all permanent teeth have appeared.It can permanently discolor teeth that are still forming.

Complications :

• Vitamin and mineral deficiencies are common complications.

 Prognosis:

• The outcome is expected to be good with treatment.

Risk factors are:

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