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Tropical sprue

Definition

Tropical sprue is a condition that occurs in people who live in or visit tropical areas for extended periods of time. It impairs nutrients from being absorbed from the intestines.

Tropical sprue (TS) is a syndrome characterized by acute or chronic diarrhea, weight loss, and of nutrients.

Causes

This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines.

Risk factors are:

  • Living in the tropics
  • Long periods of travel to tropical destinations

    • Symptoms

    Symptoms include:

  • Diarrhea, worse on a high-fat diet
  • Fatigue
  • Fever
  • Leg swelling

    • Symptoms may not appear for up to 10 years after leaving the tropics.

    Exams and Tests

    There is no clear marker or test that clearly diagnoses this problem.

    Certain tests help to confirm that poor absorption of nutrients is present:

  • D-xylose test to see how well the intestines absorb a simple sugar
  • Tests of the stool to see if fat is absorbed correctly
  • Blood tests to measure iron, folate, , or vitamin D
  • (CBC)

    • Tests that examine the small intestine may include:

  • Biopsy of the small intestine

    • Treatment

    Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or trimethoprim with sulfamethoxazole is typically given for 3 to 6 months.

    In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.

    Outlook (Prognosis)

    The outcome is good with treatment.

    Possible Complications

    Vitamin and mineral deficiencies are common.

    In children, sprue leads to:

  • Delay in the maturing of bones (skeletal maturation)

    • When to Contact a Medical Professional

    Contact your health care provider if:

  • Tropical sprue symptoms get worse or do not improve with treatment.
  • You develop new symptoms.
  • You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics.

    • Prevention

    Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

    References

    Ramakrishna BS. Tropical diarrhea and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 108.

    Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 126.

    Schedule An Appointment

    Contact Atlanta Obsetrics and Gynaecology at The Womens Center Millennium Hospital - 404-ATL-BABY

    GO

    Review Date: 12/31/2023

    Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.