Tropical sprue is a chronic disease that affects the small intestine. It is characterized by malabsorption of nutrients due to damage to the lining of the intestine. The exact cause of tropical sprue is not known, but it is thought to be an autoimmune disorder.

Tropical sprue is endemic in many tropical islands, including most of Asia, some Caribbean islands, Puerto Rico, and parts of South America. The disease is more common in residents of these areas, but visitors can also be affected.

Aetiology

• Unknown, likely to be infective because the disease occurs in epidemics and patients improve on antibiotics
• Different infective agents could be responsible in different parts of the world

PC

• Symptoms of tropical sprue include diarrhea, weight loss, abdominal pain, and malnutrition.
• These symptoms can vary in severity and can be difficult to diagnose.

Investigations

• The diagnosis of tropical sprue involves a combination of blood tests, endoscopy, and biopsy of the small intestine.
• acute infective causes of diarrhoea must be excluded - especially Giardia (very similar presentation)
• malabsorption must be demonstrated- particulary of fat and vitamin B12

Management

• Many patients improve when they leave the sprue area and take folic acid (5mg daily).
• Most patients also require an antibiotic to ensure a complete recovery (usually tetracycline 1g daily for up to 6 months).
• Severely ill patients require resuscitation with fluids and electrolytes for dehydration, and nutritional deficiencies should be corrected.