Tropical sprue
From Wikipedia, the free encyclopedia
| Tropical sprue | |
| Classification and external resources | |
| ICD-9 | 579.1 |
|---|---|
Tropical sprue is a malabsorption disease commonly found in the tropical regions, marked with abnormal flattening of the villi and inflammation of the lining of the small intestine. It differs significantly from coeliac sprue.
Contents |
[edit] Symptoms
The illness usually starts with an attack of acute diarrhoea, fever and malaise following which, after a variable period, the patient settles into the chronic phase of diarrhoea, steatorrhoea, weight loss, anorexia, malaise and nutritional deficiencies. The symptoms of tropical sprue are:
- Diarrhea
- Steatorrhea or foul-smelling faeces
- Indigestion
- Cramps
- Weight loss and malnutrition
- Fatigue
Left untreated, nutrient and vitamin deficiencies may develop in patients with tropical sprue. These deficiencies may have the following symptoms:
- Vitamin A deficiency: hyperkeratosis or skin scales
- Vitamin B12 and folic acid deficiencies: anaemia
- Vitamin D and calcium deficiencies: spasm, bone pain, numbness and tingling sensation
- Vitamin K deficiency: bruises
[edit] Signs
Diagnosis of tropical sprue can be complicated because many diseases have similar symptoms. The following signs are suggestive:
- Abnormal flattening of villi and inflammation of the lining of the small intestine, observed during an endoscopic procedure.
- Presence of inflammatory cells 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 feces (steatorrhoea).
- Thickened small bowel folds seen on barium swallow
Tropical sprue is largely limited to within about 30 degrees north and south of the equator. Therefore, if one resides outside of that geographical region, recent travel to the region is a key factor in diagnosing this disease.
[edit] Cause
The cause of tropical sprue is not known.[1] It has been suggested that it is caused by bacterial, viral, amoebal, or parasitic infection. Folic acid deficiency and rancid fat have also been suggested as possible causes. In a condition called coeliac (also: celiac) disease (also known as coeliac sprue), which has similar symptoms to non tropical sprue, the flattening of the villi and small intestine inflammation is caused by an autoimmune disorder.
[edit] Affected Regions
The disease was first described by William Hillary[2] in 1759 in Barbados. Tropical sprue is endemic to India and southeast Asia, Central and South America, and the Caribbean.
[edit] Treatment
Once diagnosed, tropical sprue can be treated by a course of the antibiotic tetracycline(Doxycycline) or Sulfamethoxazole/Trimethoprim(Co-trimoxazole) and vitamins B12 and folic acid for at least 6 months.
[edit] Prevention
Preventive measures include drinking only bottled water, brushing teeth, washing food, avoiding fruits washed with tap water (or consuming only peeled fruits, such as bananas and oranges), and altogether avoidance of travel to the affected regions.
[edit] Prognosis
The prognosis for tropical sprue is excellent. It usually does not recur in patients who get it during travel to affected regions. The recurrence rate for natives is about 20%.
[edit] References
- ^ Cook GC (March 1997). "'Tropical sprue': some early investigators favoured an infective cause, but was a coccidian protozoan involved?". Gut 40 (3): 428–9. PMID 9135537. PMC: 1027098. http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=9135537.
- ^ Bartholomew C (November 1989). "William Hillary and sprue in the Caribbean: 230 years later". Gut 30 Spec No: 17–21. PMID 2691344. PMC: 1440696. http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=2691344.
[edit] External links
- InteliHealth - Tropical Sprue
- Health In Plain English - Tropical Sprue
- Malabsorption Syndromes: Tropical Sprue at Merck Manual
