TROPICAL SPRUE
 
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TROPICAL SPRUE

 

DEFINITION:

A syndrome of unknown etiology affecting the small intestine resulting in chronic malabsorption, severe malnutrition, and macrocytic anemia.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • ?
  • risk factors:
    • geographic
      • endemic regions confined to the Tropics
        • Caribbean (except Jamaica)
        • North Africa
        • parts of Asia

PATHOGENESIS:

1. Etiology

  • an unknown pathogen (? infectious) causes non-specific changes in the mucosa of the small intestine -> malabsorption especially of vitamin B12 and folate -> severe macrocytic anemia
  • as this disease often responds to antibiotics, this suggests an infectious etiology

CLINICAL FEATURES:

1. Prodrome

  • fever and malaise

2. Diarrhea

1. Acute

  • watery diarrhea

2. Chronic

  • intermittent diarrhea
  • malabsorption & steatorrhea
  • anorexia with malnutrition
    • night blindness, cheilosis, glossitis, stomatitis, cutaneous and mucosal pigmentation, edema, muscle wasting

INVESTIGATIONS:

1. For Malabsorption

  • see file on "Malabsorptive Disorders"
  • especially of vitamin B12, folate, fats, and carbohydrates
  • serum - severe macrocytic anemia

2. Biopsy

  • non-specific changes in the mucosa of the small intestine:
    • villus shortening
    • increased crypt depth
    • round cell infiltration of the lamina propria
    • irregular and shortened surface epithelial cells

MANAGEMENT:

1. Supportive

  • oral rehydration fluid (ORF) or intravenous rehydration
  • nutrient supplementation:
    • folic acid and Vit B12

2. Antibiotics

  • Tetracycline


 

 

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