Tropical Sprue

Tropical Sprue is a disease that only affects the people who live in the tropics and those visiting these regions. This article deals with the definition, possible causes, preventive methods and treatment options of this contagious disease.

What is Tropical Sprue?

Tropical Sprue (TS), a mal-absorption disease, is mainly seen in people who live in the tropical regions and those who travel in these areas. This disorder is characterized by abnormal destruction of the villi and mild to severe inflammation of the small intestine lining. Individuals suffering from TS are unable to properly absorb various nutrients, especially Folic acid and vitamin B12.

TS is also known by several other names, including:

• Tropical Enteropathy
• Postinfective Tropical Malabsorption
• Idiopathic Tropical Malabsorption Syndrome
• Aphthae Tropical
• Cochin China Diarrhea
• Ceylon Sore Mouth

Tropical Sprue Incidence

The exact prevalence rate of this disorder is not known. It can occur in people of all ages who either live in or are visiting the tropical regions. The disease affects males and females alike. However, it is not generally seen in children.

Tropical Sprue Causes

The exact causes for TS are still not known. However, scientists believe that some bacteria, virus, amoeba or parasite is responsible for triggering the infection. Rancid fat and folic acid deficiency are also considered to be responsible for it.

Some other causes include:

Pancreatic insufficiency

It generally occurs as a secondary condition to various intestinal disorders, may also cause TS and mal-absorption.

Nutritional Deficiency

The small intestine in human body is bordered with villi. These tiny, finger-like projections increase the small intestine’s surface area. The villi help the small intestine to absorb various nutrients. In a TS patient, the villi become flattened which significantly reduces the surface of the small intestine. The reduced surface automatically leads to the absorption of fewer nutrients than normal.

The condition may also be caused by a combination of poor nutrition and some infectious microbial organism.

Tropical Sprue Signs and Symptoms

The symptoms of this contagious malabsorption syndrome resemble those of many other similar conditions. Its primary symptoms are diarrhea, sore tongue and weight loss. Other symptoms include:

• Nausea
• Abdominal cramping
• Gas/flatulence
• Fatigue
• Irritability
• Muscle cramps
• Indigestion
• Pale skin
• Fever
• Steatorrhea (fatty stool )
• Anorexia
• Mouth pain
• Vomiting
• Reduced white blood cell count
• Low levels of prothrombin in blood
• Low blood platelet count
• Reduced acidity of the stomach fluids
• Low blood cholesterol
• Low blood protein level
• Increased level of bilirubin in blood
• Smooth tongue
• Cheilosis
• Dry hair
• Mouth ulcer
• Mouth inflammation
• Macrocytic anemia

Tropical Sprue Vs Non Tropical Sprue (Celiac Disease)

This condition is similar to the autoimmune disorder Celiac Disease or Non Tropical Sprue, another disorder with the symptoms of small intestine inflammation and flattening of villi. The causes and effects of these two conditions are quite similar. However, there are a few differences between them. TS do not affect people who never visit tropical regions while Non Tropical Sprue can affect people from all over the world. Celiac Disease can be present from the birth of an individual; however, in many cases the person does not develop the symptoms until they reach adulthood. The treatment processes of these two diseases are fairly different as well.

Tropical Sprue Diagnosis

It is diagnosed with a number of tests as there are various other conditions that have the similar symptoms. The doctor performs a stool test and a blood test to determine whether there are any other causes of diarrhea. If there are no other factors present that can be responsible for the symptoms and if the individual have lived in the tropical regions for a long time, then he or she may have Tropical Sprue. Doing a biopsy is the commonest way of confirming this disease. In this test, the physician removes a small portion of tissue from the small bowel and examines it under microscope. To carry out this procedure, the physician has to examine the stomach and the small intestines of the patient using an endoscope (a small camera attached to a flexible cord) which is passed through the patient’s mouth and esophagus.

Some blood tests are also helpful for finding out whether a person has this infection. Tropical Sprue prevents the absorption of certain nutrients. Blood tests help to confirm the presence of the condition by showing low levels of calcium, albumin and/or the vitamins A, D, E and K. The folate and vitamin B12 deficiencies may also lead to anemia or low red blood cell count in the patients. Stool tests also help to diagnose the infection by demonstrating excessive fat in stool specimen.

Other diagnostic tests commonly used for detecting the presence of Tropical Sprue include:

• Bone density test
• Enteroscopy
• Comprehensive metabolic panel
• Upper endoscopy
• Iron level (serum)
• Upper GI series

Tropical Sprue Differential Diagnosis

Other disorders characterized by the similar symptoms like this infective condition include:

• Giardiasis
• Isosporiasis
• Celiac Disease (Gluten Enteropathy)
• Scleroderma
• Whipple’s Disease
• Crohn’s Disease
• Strongyloidosis
• Intestinal Capillariasis
• Chronic Pancreatitis
• Intestinal Tuberculosis
• Intestinal Amyloidosis
• The Blind-Loop Syndrome
• Small-intestinal bacterial overgrowth
• Diverticula
• Jejunocolic Fistulae

Tropical Sprue Treatment

It is important to begin the treatment immediately after an individual is diagnosed with Tropical Enteropathy. Early treatment helps to speed up the recovery process. The duration of the treatment varies from one individual to another depending on the symptoms. However, in most cases a prolonged treatment is required.

Folic Acid Supplementation

Large doses of folic acid are given to the TS patients as an initial treatment. The ideal folic acid dose to administer is five milligram per day; however, dosages ranging from one to ten milligram have also been studied. The clinical response of the treatment should be prompt. Improvements in pathological villous blunting and megaloblastic anemia can be seen within two days to one week of starting this treatment.

Antibiotic Treatment

Antibiotic treatments are given to individuals suffering from this disease. Studies show that antibiotic treatment can be helpful for curing this bacterial infection that affects the small bowel. Various antibiotic medications have been proved to be successful and are currently used as one of the main treatment options for TS. Besides their effectiveness, the widespread availability and low cost are the other advantages of antibiotic medicines. The most common antibiotic used for this purpose is Tetracycline (Doxycycline). Other similar medicines such as Chloramphenicol have also been used, but many studies show them to be less effective.

There are no antibiotic alternatives that have been proved to be effective for treating Tropical Sprue. Rifaxamin is believed to be reasonably effective; however, there is not enough evidence to prove this.

Vitamin B12 Supplementation

Vitamin B12 supplements are also used for treating this disease. But the effectiveness of this treatment option is not clear yet. In most cases, the folic acid supplements are sufficient for reducing the severity of the symptoms and curing the condition. Only the patients who have vitamin B12 deficiency are treated with these supplements.

Tropical Sprue Alternative Remedies

Various homeopathic medicines and home remedies are also used for treating Tropical Enteropathy. The natural treatment options are quite effective in keeping the TS symptoms in check, especially in the mild cases of the disease.

Tropical Sprue Complications

The complications of TS include:

• Vitamin deficiency
• Anemia
• Malnutrition
• Malabsorption syndrome
• Dehydration
• Diarrhea
• Delay in skeletal maturation

Tropical Sprue Prognosis

The outcome is excellent in travelers. Early diagnosis and proper treatment contributes to a better prognosis. People who live in the tropical regions also have a positive outcome with proper treatment.

Tropical Sprue Prevention

There are no known ways to prevent Tropical Enteropathy due to the fact that the reasons causing this disease are still unidentified. Avoiding travelling to the tropical region can help to one to keep away from the condition. People in the tropical area can take the following preventive measures to avoid it:

• Drinking only bottled mineral water
• Brushing teeth regularly with bottled water
• Consuming fruits, vegetables and other food items only after washing them properly with clean water
• Avoiding cut fruits washed with tap water
• Avoiding foods sold by street vendors

Tropical Sprue Recurrence Risks

Travelers who develop TS while visiting the tropics have almost no risks of developing this condition again once they leave the area. However, individuals living in the tropical regions have greater recurrence risks.

Tropical Sprue Pictures

Here are some images displaying how this infectious condition affects the external appearance of the patients.

Picture 1 – Tropical Sprue

Picture 2 – Tropical Sprue Image

Tropical Sprue is a contagious but curable disease that can cause various severe symptoms if left untreated. But with suitable treatment, patients can completely recover from the condition within a short time.