A Family Doctor's Tale - TROPICAL SPRUE

DOC I HAVE  TROPICAL SPRUE

Tropical Sprue is a malabsoption disease of unknown etiology associated with temporary or permanent stay in the tropics and characterized by abnormalities in the lining of the small intestine.

The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes, plasma cells and eosinophils

Who is affected by Tropical Sprue?
---------------------------------------------------

Tropical Sprue cause is unknown but some possible causes are:
1.Nutritional deficiency
2.intestinal infection

There is a possibility of enzyme deficiency and abnormal immunological response.

Tropical Sprue can be found in all ages but are more common in the 10-30 years age group.

What are the Symptoms and signs of Tropical Sprue?
-----------------------------------------------------------

Symptoms varies from mild to severe:
Early symptoms are:

1.fatigue

2.bulky stools

3.Weight loss despite good appetite and intake

After some months malnutrition is noted with evidence of malnutrition syndrome:
1.weight loss

2.glossitis

3.stomatitis

4.pigmentation

5.edema

5.diarrhea and steatorrhea

6.megaloblastic anemia

7.iron,folic acid and vitamin b12 deficiency

The Diagnosis of Tropical Sprue is confirmed by:
------------------------------------------------------------

1.A history of abdominal pain , diarrhea and weight loss

2.small bowels radiology
a.thickening and coarsening of mucosal folds
b.dilatation of smaa intestinal lumen
c.flocculation and segmentation of barium

3.tests for malabsorption syndrome

4.fecal fat assessment

5.Jejunal biopsy

What are the complications of Tropical Sprue?
---------------------------------------------------

1.weight loss

2.Nutrition: malabsorption and vitamin deficiency

What is the treatment of Tropical Sprue?
---------------------------------------------------

Treatment is :
Control of Diet
1.Folic acid is given for at least 6 months

2.Vitamin B12 injection is given

3.food containing iron, folic acid and vitamin B12 are are given

4,Enough protein supplement

5.lots of fluids

Medication

1.Antispasmotic medication for abdominal pain

2.lomotil or imodium to suppress diarrhea

3.Tetracycline is given daily for at least 6 months
Start with high doses at first, followed by reduction of dosage.

4.Correction of anemia and nutritional deficiencies is important to enhance the immune system

What is the prognosis of Tropical Sprue?
-----------------------------------------

The prognosis is usually very good

Treatment is very effective in producing weight gain and correcting nutritional deficiency.

Abnormal morphology and bowel function may persist despite treatment

There may be spontaneous remission especially leaving the tropics.

What are preventive measures in Tropical Sprue?
-----------------------------------------------------

A nutritious diet with vitamin supplements can strengthen the body resistance against illness.

Avoid the tropics.