Tropical sprue

A malabsorption disease commonly found in tropical regions, marked with abnormal flattening of the villi and inflammation of the lining of the small intestine.

It differs from celiac sprue.

It is a severe form of environmental enteropathy.

Thought to be due to an uncharacterized intestinal infection that leads to persistent small bowel mucosal damage.

It is largely limited to within about 30 degrees north and south of the equator.

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.

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 diarrhea, steatorrhoea, weight loss, anorexia, malaise, and nutritional deficiencies.

Symptoms of tropical sprue are:


Steatorrhoea or fatty stool, which is often foul-smelling and whitish in color.



Weight loss and malnutrition


Nutrient and vitamin deficiencies may develop :

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

May be associated with severe hypoalbuminemia as well as bowel wall edema on imaging studies.

Patient may have megaloblastic anemia, as a result of both folate and vitamin B 12 deficiency.

Its cause is not known, but may be caused by persistent bacterial, viral, amoebal, or parasitic infections.

Folic acid deficiency, malabsorbed fat effect on intestinal motility, and persistent small intestinal bacterial overgrowth may combine to cause the disorder.

There is a link between small intestinal bacterial overgrowth and tropical sprue.

Endoscopically abnormal flattening of villi and inflammation of the lining of the small intestine is observed.

Inflammatory cells are noted on small bowel biopsy, thickening of the small bowel walls may be seen on imaging.

Low levels of vitamins A, B12, E, D, and K, serum albumin, calcium, and folate, may be present.

Steatorrhoea may be present.

Diagnosis: travel history is a key factor in diagnosing this disease.

Differential diagnosis: celiac disease, malabsorption can also be caused by protozoan infections, tuberculosis, HIV/AIDS, immunodeficiency, chronic pancreatitis, inflammatory bowel disease and environmental enteropathy.

Preventive measures for visitors to tropical areas where the condition exists, 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, sanitation to reduce fecal-oral contamination.

Treatment is by a course of the antibiotic tetracycline or sulphamethoxazole/trimethoprim (co-trimoxazole) for 3 to 6 months.

Supplementation of vitamins B12 and folic acid improves well-being.

The prognosis is excellent after treatment.

It usually does not recur in people who acquire the infection during travel to affected regions.

The recurrence rate for natives is about 20%.

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