Tropical sprue – Definition, Symptoms, Causes and Treatment

Tropical sprue (TS) is a common digestive disorder noticed in visitors to or residents of tropical regions. Find out about the causes, symptoms, diagnosis and treatment of this disease.

Tropical Sprue Definition

This is a contagious digestive disorder that results in malabsorption in patients. It is primarily restricted to the tropical and subtropical regions.

The disease was described for the first time in 1759 by Dr. William Hillary in Barbados.

Tropical Sprue Meaning

People suffering from TS are not able to absorb food nutrients properly. They are especially found to have problems in absorbing folic acid and vitamin B12. In healthy individuals, small intestines consist of finger-like projections known as villi which provide additional surface area for absorption of nutrients. In TS patients, the villi are flattened, which makes absorption of nutrients difficult. TS also causes inflammation of the small intestinal lining.

Tropical Sprue Symptoms

The condition normally begins with a bout of acute diarrhea, malaise and fever. This is followed by chronic diarrhea, malaise, anorexia, steatorrhoea, weight loss and various other nutritional deficiencies.

Some of the common symptoms of TS are:

  • Diarrhea
  • Sore tongue
  • Indigestion
  • Steatorrhoea
  • Abdominal Cramps
  • Muscle Cramps
  • Nausea
  • Fatigue
  • Paleness
  • Anemia
  • Loss of appetite
  • Indigestion and gas
  • Malnutrition and weight loss

If left untreated, deficiency of vitamin and other nutrients can cause several other serious health problems which are associated with TS. Such deficiency can result in problems like:

  • Skin scales or Hyperkeratosis
  • Megaloblastic¬†Anemia
  • Muscular Spasms
  • Osteomalacia
  • Bone pain
  • Numbness
  • Tingling sensation
  • Bruises
  • Inflammation of the nerves or Peripheral neuritis
  • Edematous swelling of extremities
  • Blood and bruising in urine

Tropical Sprue Diagnosis

While diagnosing TS, doctors first try to determine if the patient is a resident of the tropical regions or has visited the tropics in the recent past. They might also conduct a series of medical examinations and tests, as many of the symptoms of TS are similar to that of various other health conditions. Doctors try to ascertain whether there are any other causes responsible for diarrhea by obtaining the blood and stool samples of the patient. A biopsy is the most prevalent way to test this disease. The process involves removing small pieces of tissues from the bowel of patients and observing under a microscope. This technique is conducted by using an endoscope, which is a flexible cord carrying a small camera. The camera is mounted on the cord and inserted through the mouth and esophagus.

Some blood tests can also be carried out to determine whether or not a patient has TS. As the disease prohibits the absorption of certain minerals and vitamins, the patient can display lower levels of calcium, albumin or vitamins A, D, E and K. A deficiency of B12 and Folic acid can also lead to anemia. Apart from this, the stool samples of patients may display excess amounts of fats. A list of various tests and examinations carried out for diagnosing TS is given below:

  • Bone density test
  • Comprehensive metabolic panel
  • Complete blood count (CBC)
  • Enteroscopy
  • Iron level (serum)
  • Folate level (serum)
  • Examination of stool samples for parasites and bacteria
  • Upper GI series
  • Upper endoscopy
  • Vitamin D level
  • Vitamin B12 level (serum)

Tropical Sprue Causes

The exact causes for this disorder are unknown. However, it is widely believed to be caused by viral, amoebal, bacterial or parasitic infection. Rancid fat and folic acid deficiency are also supposed to be among the possible causes. Living in or near the tropics is also a major factor responsible for TS. TS commonly affects the tropical and subtropical regions of the world, including India, Southeast Asia, Africa, the Caribbean Islands, Cuba, Puerto Rico, Central and South America. However, cases of Tropical sprue have also been reported in people from all across the world.

Tropical Sprue Prevention

There are no known preventive measures against this condition. One can choose to stay away from tropical climates in order to maintain a distance from this disease. However, if an individual has to stay in tropical areas, he or she should follow certain regulations in order to prevent being affected by this disease. These include:

  • Drinking soda and bottled water from trusted sources
  • Using bottled water while brushing teeth
  • Washing fruits well with bottled water before consuming them. A person may also choose to limit their diet of fruits to the ones that can be peeled, such as bananas and oranges.
  • Avoiding ice made from frozen tap water
  • Washing salads and vegetables with bottled water
  • Avoiding food stuffs sold and distributed by street vendors
  • Avoiding tap water under any circumstance

Tropical Sprue Treatment

Patients suffering from Tropical sprue are treated for three to six months with supplements of tetracycline and folic acid. Cyanocobalamin can be given as a Vitamin B12 supplement. Persistent signs of anemia can be cured by intravenous transfusions and anemia caused by iron deficiency or megaloblastic anemia can be healed by administering iron. Sulfamethoxazole or Trimethoprim is also administered along with other antibiotics. Children still having deciduous teeth are normally not prescribed with oral tetracycline as it can cause permanent discoloration of the growing teeth.

Tropical Sprue Prognosis

The prognosis for this disease is usually very good. Proper treatment can totally cure one of TS. The rate of recurrence of this disease is only about 20%.

Tropical Sprue Complications

In children, TS may lead to delays in skeletal maturation or failure in overall growth.

Tropical sprue is a serious digestive disorder that can cause significant health damage. With proper and timely treatment however, one can completely recover from the disease and lead a healthy life.



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