Tropical sprue: Difference between revisions
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==Cause== |
==Cause== |
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The cause of tropical sprue is not known.<ref name="pmid9135537">{{cite journal |author=Cook GC |title= Tropical sprue: some early investigators favoured an infective cause, but was a coccidian protozoan involved? |journal=Gut |volume=40 |issue=3 |pages=428–9 |year=1997 |month=March |pmid=9135537 |pmc=1027098 |doi= |url=http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=9135537}}</ref> |
The cause of tropical sprue is not known.<ref name="pmid9135537">{{cite journal |author=Cook GC |title= Tropical sprue: some early investigators favoured an infective cause, but was a coccidian protozoan involved? |journal=Gut |volume=40 |issue=3 |pages=428–9 |year=1997 |month=March |pmid=9135537 |pmc=1027098 |doi= |url=http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=9135537}}</ref> 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.<ref name="pmid9134437"/> |
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In a condition called [[coeliac disease]] (also known as ''[[coeliac sprue]]''), which has similar symptoms to tropical sprue, the flattening of the [[Intestinal villus|villi]] and [[small intestine inflammation]] is caused by an [[autoimmune disorder]] triggered by ingested gluten. |
In a condition called [[coeliac disease]] (also known as ''[[coeliac sprue]]''), which has similar symptoms to tropical sprue, the flattening of the [[Intestinal villus|villi]] and [[small intestine inflammation]] is caused by an [[autoimmune disorder]] triggered by ingested gluten. |
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==Affected regions== |
==Affected regions== |
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The disease was first described by [[William Hillary]]<ref name="pmid2691344">{{cite journal | author = Bartholomew C | title = William Hillary and sprue in the Caribbean: 230 years later | journal = Gut | volume = 30 | issue = Special issue | pages = 17–21 | year = 1989 | month = November | pmid = 2691344 | pmc = 1440696 | doi = | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1440696/pdf/gut00226-0023.pdf }}</ref> in 1759 in [[Barbados]]. Tropical sprue is endemic to |
The disease was first described by [[William Hillary]]<ref name="pmid2691344">{{cite journal | author = Bartholomew C | title = William Hillary and sprue in the Caribbean: 230 years later | journal = Gut | volume = 30 | issue = Special issue | pages = 17–21 | year = 1989 | month = November | pmid = 2691344 | pmc = 1440696 | doi = | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1440696/pdf/gut00226-0023.pdf }}</ref> in 1759 in [[Barbados]]. Tropical sprue is endemic to the [[Caribbean]], Central and [[South America]], and [[India]] and southeast [[Asia]]. |
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==Treatment== |
==Treatment== |
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Once diagnosed, tropical sprue can be treated by a course of the antibiotic [[tetracycline]](Doxycycline) or [[Sulfamethoxazole]]/Trimethoprim(Co-trimoxazole) for 3 to 6 months, as well as supplementation of vitamins B<sub>12</sub> and folic acid. |
Once diagnosed, tropical sprue can be treated by a course of the antibiotic [[tetracycline]] (Doxycycline) or [[Sulfamethoxazole]]/Trimethoprim (Co-trimoxazole) for 3 to 6 months, as well as supplementation of vitamins B<sub>12</sub> and folic acid. |
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The use of folic acid in the treatment of tropical sprue was promoted in the late 1940s by Dr. [[Tom Spies]] of the [[University of Alabama]], while conducting his research in Cuba and Puerto Rico.<ref>[http://www.uab.edu/nutrition/about/history UAB Department of Nutrition Sciences - History]</ref><ref>[http://jama.jamanetwork.com/article.aspx?articleid=320916 JAMA: DR. SPIES RECEIVES DISTINGUISHED SERVICE MEDAL (1957)]</ref> |
The use of folic acid in the treatment of tropical sprue was promoted in the late 1940s by Dr. [[Tom Spies]] of the [[University of Alabama]], while conducting his research in Cuba and Puerto Rico.<ref>[http://www.uab.edu/nutrition/about/history UAB Department of Nutrition Sciences - History]</ref><ref>[http://jama.jamanetwork.com/article.aspx?articleid=320916 JAMA: DR. SPIES RECEIVES DISTINGUISHED SERVICE MEDAL (1957)]</ref> |
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Revision as of 13:47, 21 October 2013
| Tropical sprue | |
|---|---|
| Specialty | Gastroenterology  |
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.
Symptoms and signs
The illness usually starts with an attack of acute diarrhea, 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 fatty stool (often foul-smelling and whitish in colour)
- 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
Tropical sprue was responsible for one-sixth of all casualties sustained by the Allied forces in India and Southeast Asia during World War II.[1]
Investigations
Diagnosis of tropical sprue can be complicated because many diseases have similar symptoms. The following investigation results are suggestive:
- 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 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.
Cause
The cause of tropical sprue is not known.[2] 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.[3]
In a condition called coeliac disease (also known as coeliac sprue), which has similar symptoms to tropical sprue, the flattening of the villi and small intestine inflammation is caused by an autoimmune disorder triggered by ingested gluten.
Affected regions
The disease was first described by William Hillary[4] in 1759 in Barbados. Tropical sprue is endemic to the Caribbean, Central and South America, and India and southeast Asia.
Treatment
Once diagnosed, tropical sprue can be treated by a course of the antibiotic tetracycline (Doxycycline) or Sulfamethoxazole/Trimethoprim (Co-trimoxazole) for 3 to 6 months, as well as supplementation of vitamins B12 and folic acid.
The use of folic acid in the treatment of tropical sprue was promoted in the late 1940s by Dr. Tom Spies of the University of Alabama, while conducting his research in Cuba and Puerto Rico.[5][6]
Prevention
Preventive measures include using only bottled water for drinking, brushing teeth, and washing food, and avoiding fruits washed with tap water (or consuming only peeled fruits, such as bananas and oranges).
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%.
References
- ^ UAB Department of Nutrition Sciences - History
- ^ Cook GC (1997). "Tropical sprue: some early investigators favoured an infective cause, but was a coccidian protozoan involved?". Gut. 40 (3): 428–9. PMC 1027098. PMID 9135537.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Cite error: The named reference
pmid9134437was invoked but never defined (see the help page). - ^ Bartholomew C (1989). "William Hillary and sprue in the Caribbean: 230 years later" (PDF). Gut. 30 (Special issue): 17–21. PMC 1440696. PMID 2691344.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ UAB Department of Nutrition Sciences - History
- ^ JAMA: DR. SPIES RECEIVES DISTINGUISHED SERVICE MEDAL (1957)