Introduction
Tropical sprue (TS) is known to be a syndrome that is characterized by diarrhea that can be acute or chronic, loss of weight, and malabsorption of nutrients. It is more commonly seen to occur in people in tropical and subtropical areas. William Hillary was the first to observe it in 1759 as chronic diarrhea while he was in Barbados. Subsequently, tropical sprue became a known disease that occurs in tropical climates throughout the world.
The definition has been modified as malabsorption of at least two different substances after the exclusion of other causes was also included. It is also known as hill diarrhea or tropical diarrhea.
What Signs And Symptoms Does Tropical Sprue Cause?
Symptoms of tropical sprue can be varied and may comprise any of the following-:
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Cramps in the abdomen.
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Diarrhea that worsens after taking a high-fat diet.
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Indigestion.
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Too much gas.
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Irritation.
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Numbness.
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Cramps in the muscles.
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Loss of weight.
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Pale skin and mucous membranes.
What Is the Epidemiological Distribution of Tropical Sprue?
Frequency of the Syndrome
Tropical sprue can occur both as an epidemic and endemic and commonly involve Southeast Asia and the Caribbean. It is difficult to estimate the actual prevalence rate of the endemic form, but studies have shown that it rates at 8 % in Puerto Rico.
Also, it is interesting to note that this syndrome may limit itself to certain areas in the tropical region itself.
Race
Though it is confined geographically to certain regions, reports show that it can affect any race and depends on the individual visiting that place rather than the race.
Sex
Reports and studies show that the distribution of this syndrome within the gender is equal with no predominance in particular sex.
Age
It is more commonly seen involving adults, but children may also get affected by it.
Mortality or Morbidity
One of the reported complications of this syndrome is an acute illness that gets complicated by deficits in fluid and electrolyte levels. It is fatal rarely. Another complication includes chronic illness that can lead to severe malabsorption, anemia, and death.
What Are The Causes Of Tropical Sprue?
The occurrence of tropical sprue is rare and it develops in an individual only after visiting tropical sprue-prone geographical locations. The following are commonly known to be the causative geographical locations:
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The Caribbean.
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Southeast Asia.
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India.
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South Africa.
What Is the Pathophysiology of Tropical Sprue?
Research has put forward the fact that one of the possible reasons could be bacterial overgrowth in the intestines but the exact causative microorganisms are still not known. In addition, how these bacterias lead to the initiation and spread of this infection is also not very clearly known.
One theory that can help understanding it says that an acute infection in the intestine can lead to injury in the jejunal and ileal mucosa, which can lead to overgrowth of intestinal bacteria and an increase in plasma enteroglucagon which can ultimately result in small-intestinal transit retardation. Folate deficiency can also contribute to an increase in the injury to the mucosa.
There is an elevation in the hormone enteroglucagon and motilin levels in patients suffering from tropical sprue. The proposed reason for this could be the injury of the enterocyte. Enteroglucagon plays a role in intestinal stasis. The role of motilin in this condition is not well understood.
The locations in the body that can be affected include the upper small intestine, which is the most common location, followed by the involvement of the distal small intestine up to the terminal ileum as this syndrome is contagious as well as progressive.
The pathological changes in the stomach and colon have not been reported much. Studies have reported that Coliform bacteria, like Klebsiella, Escherichia coli, and Enterobacter species are the usual organisms that can be associated with tropical sprue.
How Can Tropical Sprue Be Diagnosed?
Various conditions or diseases may show similar presentation to tropical sprue and they are as follows:
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Giardiasis.
Some other rarely reported conditions are primary sclerosing cholangitis and chronic erosive gastritis.
When you visit your physician, certain questions will be asked to you, especially about your geographical living or visited areas and also the symptoms you are facing. Various tests may be done later but if the tests are not conclusive for anything, then the physician can diagnose it as tropical sprue depending on the area that you visited.
Nutritional deficiencies can be used as a diagnostic factor for this syndrome. Various tests can be used to assess the damage caused in the body due to malabsorption and they can be as follows:
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Folate level.
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Complete blood count.
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Vitamin D level.
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Vitamin B12 level.
An enteroscopy can also be used to confirm the diagnosis. In this, a biopsy will be done after entering your intestine in which small tissue of the intestine will be removed and studied for pathological changes. If you have tropical sprue, there will be swelling of the intestinal lining or cells.
How to Treat Tropical Sprue?
1. Antibiotics
This helps in killing the bacteria. Antibiotics can be prescribed for a period of two weeks and in some cases up to a year. Tetracycline is the most commonly used antibiotic followed by Sulfamethoxazole and Trimethoprim (Bactrim), Oxytetracycline, and Ampicillin.
Tetracycline is usually not prescribed for children, at least till they have their permanent teeth erupted into their oral cavity as this can cause discoloration of teeth. Hence, a different antibiotic is prescribed in children with a different dosage.
2. Malabsorption Management
It is important to bring the levels of vitamins, nutrients, and electrolytes back to normal along with the usage of antibiotics. Hence, various supplements may be prescribed which are as follows:
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Fluids and electrolytes.
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Folic acid.
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Vitamin B12.
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Iron.
Folic acid is advised for at least three months. Vitamin B12 may also be given and if required, antidiarrheal medication can also be given.
Are There Any Complications Related To Tropical Sprue?
The most commonly observed complications of tropical sprue include deficiencies of vitamins and minerals. This can lead to failure of growth and bone maturation problems in children.
Studies have shown that the prognosis is really good after the treatment. People have shown very good improvement within three to six months of initiation of treatment.
Conclusion
Tropical sprue is a syndrome that can affect the overall health of the body. If it is not managed early, it can lead to certain complications. Early diagnosis and treatment can help in getting a better prognosis. Online medical platforms have made consultations easy for patients. Hence, consult a physician or specialist to get more details on the same.
