Tropical Sprue
Basics
Description
- Malabsorption syndrome (MAS) of unknown/infectious etiology occurring primarily in patients in the tropics and subtropics: diagnosis likely if (1):
- Typical clinical presentation
- Deficiency of two nutrients
- Abnormal small intestinal mucosal histology
- Exclusion of other specific causes for MAS
- Persistent response to treatment with antibiotics
- Symptoms may appear years after leaving an endemic area and may be relapsing without treatment.
- Endemic areas: tropic regions only—India, Southeast Asia, and Caribbean. Distribution is sporadic.
- System(s) affected: gastrointestinal, hematologic, lymphatic, immunologic
Epidemiology
Incidence
- Predominant sex: male = female
- Rarely fatal but can be unremitting
Risk Factors
- Infectious source likely (viruses, parasites, or bacteria)
- Indigenous populations in endemic tropical countries
- Travelers spending at least 1 month in high-risk endemic areas; symptoms may develop years after returning.
Etiology and Pathophysiology
- Multifactorial-possible infectious agent, including persistent overgrowth of the small intestine by enteric pathogens after a bout of traveler’s diarrhea
- Invasive pathogens cause enterocyte damage in the small intestine, which leads to an increase in enteroglucagon and other intestinal hormones, leading to increase in small intestinal stasis and further bacterial colonization. Villous atrophy results in impaired absorption of carbohydrates, fat, folate, iron, and vitamin B12.
- Dietary deficiency (folate and vitamin B12) possibly further disrupts structural integrity of the small intestine.
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Citation
Domino, Frank J., et al., editors. "Tropical Sprue." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688786/all/Tropical_Sprue.
Tropical Sprue. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688786/all/Tropical_Sprue. Accessed October 6, 2024.
Tropical Sprue. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688786/all/Tropical_Sprue
Tropical Sprue [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 06]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688786/all/Tropical_Sprue.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Tropical Sprue
ID - 1688786
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688786/all/Tropical_Sprue
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -