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At least 19 recordsLinked to original sources
PubMed2004

Tropical Sprue.

Tropical sprue is a disease that causes progressive villus atrophy in the small intestine, similar to nontropical (celiac) sprue. The loss of intestinal villi profoundly affects intestinal absorptive function, and patients with tropical or nontropical sprue present with malabsorption. Whereas the etiology of celiac sprue has been elucidated in considerable detail, the etiology of tropical sprue remains obscure. The favored hypothesis is that the disease is either initiated or sustained by a still-undefined infection. Patients with tropical sprue typically present with macrocytic anemia due to malabsorption of folate and/or vitamin B(12). Treatment of tropical sprue with folic acid replacement was introduced more than 50 years ago and has become standard medical treatment. Vitamin B(12) replacement is usually added if there is evidence of B(12) deficiency or malabsorption. Treatment of tropical sprue with folate and B(12) cures the macrocytic anemia and the accompanying glossitis, and often results in increased appetite and weight gain. However, even prolonged treatment with these vitamins fails to restore villus atrophy, and malabsorption usually persists. The benefit of antibiotic treatment of tropical sprue was first documented during World War II, when sulfonamides were used to treat epidemics of tropical sprue in British and Italian troops in India. Antibiotic treatment has since become the standard treatment, and tetracycline has replaced sulfonamides. The recommended length of treatment with tetracycline is 6 months and it is given in combination with folate. The treatment has been shown to normalize mucosal structure in the small intestine and resolve malabsorption in most patients with tropical sprue. However, there is a substantial relapse rate in treated patients who return to, or remain in, endemic areas in the tropics.

Journal Article↗
PubMedDate not supplied

[Chronic diarrhea since returning from Black Africa. "Think of tropical sprue"!].

Tropical sprue is a diagnosis about which we have to think when we are confronted to a patient back from overseas. We examined a young man back from Central African Republic where he got diarrhoea which keeps going on in France, with alteration of his general condition and stigmata of malabsorption. Taking advantage of such observation, the authors report on the present knowledge about that disease peculiar to tropical zone. Biological elements of malabsorption are associated to partial emaciation of villi of small intestine. As a matter of fact, diagnosis is made by elimination. Its pathogenesis remains unknown and is linked to some troubles of intestinal microbism of which exact causes has not been yet put into evidence. An easy treatment by tetracycline and folic acid is a true diagnosis test, as general condition is set up again, as well as villi intestinalis.

Adult↗
PubMed1984

Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue).

Postinfective tropical malabsorption (TM; tropical sprue) starts with an acute intestinal infection (bacterial, viral, or parasitic) which can affect predominantly the small or the large intestine. Miscellaneous invasive pathogens cause subsequent enterocyte damage affecting the entire small intestine and, to a lesser extent, the colon. Enteroglucagon, a tropic hormone, is then liberated and reaches a high plasma concentration. Small-intestinal stasis results. Further bacterial colonisation (in the lumen and also at the enterocyte surface) is encouraged. Continuing enterocyte damage is worsened by coexistent folate depletion, which is initiated at the onset of disease; body stores of folate reach a low concentration by 3 or 4 months. The cycle continues until the bacterial overgrowth is eliminated with an antibiotic (eg, tetracycline), or mucosal integrity recovers (hastened by oral folic-acid supplements), or both.

Chronic Disease↗
PubMedDate not supplied

[Tropical sprue (author's transl)].

Tropical sprue is a disease of the small intestine characterized by a malabsorption syndrome with a subtotal or partial mucosal atrophy. It is observed in Asia and Central America. It appears to be rare in Africa but its real frequency is unknown as small bowel biopsys are not routinely done. Bacterial overgrowth as well as giardiasis may be trigger factors of the disease the pathogenesis of which is still incompletely understood. The disease beginning as chronic diarrhea is later on characterized by an aphtoïd stomatitis and a macrocytic anemia. Treatment with antibiotics and folic acid is efficient and has a diagnostic value. If treatment is started lately, vitamin B 12 is then also necessary. In any intestinal syndrome observed in tropical areas without an ascertained etiologic diagnosis, peroral biopsie of the small intestine is requested. However, with the use of pediatric endoscope it will be possible to appreciate the respective incidence of tropical sprue and asymptomatic tropical sprue in Africa South of the Sahara.

Anti-Bacterial Agents↗
PubMed1969

Tropical sprue in expatriates from the tropics living in the continental United States.

The results of clinical, laboratory and therapeutic observations conducted over a seven year period in 40 expatriates from the tropics who presented in New York City with overt tropical sprue have been described. The majority of subjects presented with symptoms referable to the gastrointestinal tract, weight loss and weakness. Only nine were symptomatic at the time of arrival; the remainder developed symptoms within several months to 14 years after arrival. Thirty-five subjects had a megaloblastic anemia; this was a secondary to a combined deficiency of folate and vitamin B12 in 25 and to deficiency of only one of these vitamins in the other ten. Serum concentrations of albumin, calcium, and cholesterol were subnormal in approximately one-half and the serum carotene concentrations were low in all but two subjects. Serum values of one or more immunoglobulin were reduced in 19. All 40 subjects had malabsorption of xylose; 12 of 19 tested had malabsorption of a pharmacologic dose of folic acid; 27 of 28 tested had malabsorption of vitamin B12; and 23 of 27 persons tested had steatorrhea. Jejunal morphology was abnormal in 34 of 35 subjects biopsied prior to treatment; villi were completely absent in four and showed changes of moderate severity in 30. Treatment with pharmacologic doses of folic acid or vitamin B12 produced a clinical remission in 18 of 21 patients. This remission was sustained in all 14 subjects who were followed for periods of from one to four years and reevaluation of intestinal morphology and function in nine showed improvement in all, but return to normal in less than one-half. Treatment with oral tetracycline for three weeks resulted in clinical improvement in 11 of 12 subjects, a hematologic response in nine of the ten cases who had a megaloblastic anemia, increased absorption of xylose and cessation of steatorrhea in all, and improved jejunal morphology in 11. Vitamin B12 absorption remained subnormal in nine. Continued antibiotic therapy for six months in eight patients was associated with additional weight gain, further improvement in jejunal morphology and xylose absorption in all, and return of vitamin B12 absorption to normal in all except one. Fifty asymptomatic expatriates from the West Indies were surveyed for abnormalities of intestinal function. The absorption of xylose was reduced in six (24%) of 25 subjects who had been resident in a temperate climate for less than one year but in only one (4%) of 25 persons who had been away from the tropics for more than a year.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2001

A perspective on tropical sprue.

A diagnosis of tropical sprue, an infrequent affliction of inhabitants and travelers in tropical regions, should be considered in patients with a compatible history, malabsorption, and chronic diarrhea. It can occur in either endemic or epidemic form and can be preceded by acute gastroenteritis. The cause of tropical sprue is still unknown, although most data support an infectious etiology. Therapeutic experience is greatest with folic acid and tetracycline. Most patients can be expected to recover with proper nutritional support, although relapses and slow responses occur.

Folic Acid↗
PubMed1988

Tropical sprue in southern India.

Tropical sprue, a primary malabsorption syndrome affecting residents and visitors to several tropical regions, occurs in southern India in endemic and epidemic forms. The stomach, the small intestine and colon are affected and malabsorption results in nutrient deficiency. Enterocyte damage, the primary lesion in southern Indian tropical sprue, is the result of a persistent lesion of the stem cell compartment. This lesion occurs on a background of tropical enteropathy and the available evidence suggests that an immunity conferring agent may be responsible for initiating the damage.

Gastric Mucosa↗
PubMed1976

Endemic tropical sprue in Rhodesia.

The existence of tropical sprue in Africa is controversial. In this paper we present 31 cases seen in Rhodesia over a 15 month period. They have the clinical features, small intestinal morphology, malabsorption pattern, and treatment response of tropical sprue. Other causes of malabsorption, and primary malnutrition, have been excluded. The severity of the clinical state and intestinal malabsorption distinguish these patients from those we have described with tropical enteropathy. The previous work on tropical sprue in Africa is reviewed and it is apparent that, when it has been adequately looked for, it has been found. It is clear that the question of tropical sprue in Africa must be re-examined and that it existence may have hitherto been concealed by the assumption that primary malnutrition is responsible for the high prevalence of deficiency states.

Adolescent↗
PubMed2000

Tropical sprue after travel to Tanzania.

Tropical sprue (TS) is a diagnosis to consider in travelers with prolonged diarrhea and a malabsorption syndrome after return from tropical countries, particularly India and Southeast Asia. TS is an unusual condition in tropical Africa. Textbooks of tropical medicine indicate a low endemicity in Nigeria and a limited number of cases in South Africa and Zimbabwe. A Medline search from 1979 to mid 1998 using "Tanzania and tropical sprue" as key words disclosed no hits. We report herein a case of TS in a European traveler, who lived in Tanzania for 8 months.

Adult↗
PubMed1981

Plasma lipids in tropical sprue.

Previous studies indicated that many patients with tropical sprue in southern India have triglyceride accumulation within the cells of the intestinal mucosa. This could be due to essential fatty acid deficiency as a result of steatorrhea in subjects on a diet normally low in linoleic acid. Plasma lipids have, therefore, been studied in patients with tropical sprue and the results compared to values observed in healthy controls. The low intake of linoleic acid was found to be adequate to maintain normal levels of arachidonic acid and to repress the formation of 5,8,11-eicosatrienoic acid in rural controls. Patients with tropical sprue had decreased levels of plasma linoleic acid, raised monoenoic fatty acids and the appearance of 5,8,11-eicosatrienoic acid in the lecithin fraction. All of these observations indicate essential fatty acid depletion although unequivocal evidence of essential fatty acid deficiency was not present in any of the patients. The degree of essential fatty acid depletion observed is unlikely to be the cause of the mucosal accumulation of triglyceride in tropical sprue.

Cholesterol↗
PubMed1982

Pancreatic function tests in tropical sprue is pancreas involved?

Pancreatic functions were studied in 15 patients with tropical sprue. The diagnosis of tropical sprue was made on accepted criteria of demonstrating malabsorption of at least two unrelated food substances in the absence of any other cause for malabsorption in patients residing in a tropical zone. Exogenous secretion (Boots) in a dose of one clinical unit per kg was employed for direct stimulation of exocrine pancreatic secretion. Of the 15 patients, 12 showed normal pancreatic functions. In two patients, volume output was marginally low i.e. 1.6 and 1.6 ml/kg/hr respectively (Normal value greater than 1.8 ml/kg/hr). In the third patient, volume output was normal but maximum bicarbonate concentration in pancreatic juice was 61.6 mEq/litre (Normal value greater than 80 mEq/litre). None of these three patients, however, had abnormalities in both the parameters of exocrine pancreatic function. Although pancreatic hyposecretion has been reported in patient with tropical sprue when indirect stimulation with Lundh meal was applied to pancreas, yet on direct stimulation with secretin, we found pancreatic functions to be normal. It is therefore concluded that the pancreas is not primarily involved in tropical sprue.

Adolescent↗