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🌴 Tropical Sprue is a malabsorption syndrome endemic to tropical regions.
Its cause remains unclear but is thought to involve chronic infection + environmental factors.
💡 Key clue: It may develop even months or years after leaving an endemic area.
📖 About
- Malabsorptive disorder of the small intestine found in tropical/subtropical regions (SE Asia, Caribbean, Central America, India).
- Distinguished from coeliac disease: no gluten sensitivity, but similar villous atrophy.
- Responds dramatically to antibiotics + folate, suggesting an infectious trigger.
🧬 Aetiology
- Exact cause unknown → likely chronic infection or bacterial overgrowth due to poor sanitation + high enteric pathogen load.
- Environmental and immune factors → impaired mucosal absorption.
- Strong response to tetracyclines supports an infective role, but no single pathogen proven.
🩺 Clinical Features
- 💩 Chronic diarrhoea → watery, sometimes steatorrhoeic.
- ⚖️ Weight loss & failure to thrive in prolonged cases.
- 🍳 Steatorrhoea from fat malabsorption.
- 🩸 Vitamin deficiencies: Folate & B12 (macrocytic anaemia), fat-soluble vitamins A/D/E/K.
- 🤒 Other: Fatigue, oedema (hypoalbuminaemia), abdominal distension.
- May mimic: coeliac disease, giardiasis, or tropical infections.
🧪 Investigations
- 📊 Bloods:
- FBC: Macrocytosis (folate/B12 deficiency), or microcytosis (iron deficiency).
- ↓ Albumin → protein malabsorption.
- 💩 Stool studies: Fat quantification → confirms steatorrhoea; rule out Giardia.
- 🔬 Small bowel biopsy: Villous atrophy + crypt hyperplasia (less severe than coeliac).
- 🥛 Lactose tolerance test: Often abnormal → secondary lactose intolerance.
📌 Differential Diagnosis
- Coeliac disease (anti-tTG, EMA antibodies).
- Giardiasis (stool microscopy, antigen testing).
- Whipple’s disease.
- Chronic pancreatitis (enzyme deficiency rather than mucosal disease).
💊 Management
- 💊 Antibiotics:
- Tetracycline 250 mg QDS for 3–6 months (standard).
- Doxycycline or Metronidazole → alternatives if tetracycline not tolerated.
- 🍃 Folate 5 mg/day → rapid haematological & symptomatic improvement.
- 💉 Vitamin B12: IM/oral replacement if low.
- 🩸 Iron supplementation for deficiency anaemia.
- 🍗 Diet: High-protein, low-fat, lactose-restricted if intolerance present.
- 📈 Monitoring: Weight, bloods, and resolution of diarrhoea/nutritional deficits.
🔮 Prognosis
- Excellent with appropriate antibiotics + supplementation.
- Relapse possible, especially on return to endemic regions.
- Untreated → severe malnutrition, vitamin deficiency complications, growth failure.
📚 References
🌟 Teaching Pearl:
If you see a patient from or recently returned from the tropics with chronic diarrhoea, weight loss, and megaloblastic anaemia → think Tropical Sprue.
Dramatic improvement with tetracycline + folate is both diagnostic & therapeutic.
