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Tropical Sprue

Tropical Sprue is a topic covered in the 5-Minute Clinical Consult.

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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 B12) possibly further disrupts structural integrity of the small intestine.

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Citation

Stephens, Mark B., et al., editors. "Tropical Sprue." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816183/all/Tropical_Sprue.
Tropical Sprue. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816183/all/Tropical_Sprue. Accessed April 24, 2019.
Tropical Sprue. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816183/all/Tropical_Sprue
Tropical Sprue [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816183/all/Tropical_Sprue.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tropical Sprue ID - 816183 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816183/all/Tropical_Sprue PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -