Tropical sprue is a type of malabsorption condition that causes acute or persistent diarrhea. In the lack of a specific etiology of malabsorption, it is seen in tropical people.
It is assumed to be infectious in origin, with environmental variables playing a role. It involves the small intestine and is characterized by malabsorption and nutritional deficiencies, including vitamin B12 and folic acid.
Epidemiology
Tropical sprue geographic spread is not entirely understood. It is prevalent between the latitudes of 30°N and 30°S and is observed in tropical countries. All of the nations in this region are not impacted. In the Western Hemisphere, it is common in Puerto Rico, Haiti, and Cuba, with zero or very few cases in the Bahamas and Jamaica.
In India and Pakistan in the Eastern Hemisphere, it is widespread. The condition typically affects indigenous people and tourists who visit endemic areas for more than a month. It is rarely found in travelers who stay in these places for less than two weeks.
In India and Pakistan, the prevalence is decreasing, most likely due to improved hygiene and widespread antibiotic use. This illness affects both men and women equally. Although it is most common in adults, it has been reported in children.
Anatomy
Pathophysiology
Injuries to the jejunal and ileal mucosa from an acute intestinal infection are followed by intestinal bacterial overgrowth and an increase in plasma enteroglucagon, which slows down small intestinal transit. Folate insufficiency, which likely contributes to additional mucosal damage, is essential to this process.
There are higher levels of the hormones enteroglucagon and motilin in individuals with tropical sprue. These elevations may be brought on by enterocyte damage. The role of motilin is unclear; however, enteroglucagon induces intestinal stasis.
Although the distal small intestine up to the terminal ileum may be damaged, the upper small intestine is predominately impacted since it is a progressive and contiguous disease. The stomach and colon rarely exhibit pathological abnormalities. Coliform bacteria, isolated and frequently linked to tropical sprue, include E. coli, Enterobacter species, and Klebsiella.
Etiology
It has been proposed that the condition is caused by a vitamin or mineral deficiency. However, research has revealed that it is not the primary event that causes it. The remission of symptoms with anti-bacterial medications indicates that bacterial infections may be the cause.
In contrast, stool cultures taken from patients to investigate for bacterial infections have yielded no positive results. Viral infections cause enterocyte damage. They typically induce acute, self-limiting diarrhea rather than persistent diarrhea that might last for months, as observed in tropical sprue.
When viruses like Reovirus were inoculated in monkeys, they caused diarrhea that may persist for weeks. Although evidence suggests that viral illness is the causative agent, techniques for isolating these agents are needed.
Genetics
Prognostic Factors
Tropical sprue usually has a good prognosis. The treatment response has been great in individuals infected while traveling to endemic areas, with little to no recurrence.
The recurrence rate in endemic places is estimated to be over 20%, with recurrent relapses. However, new studies demonstrate that the patterns are improving.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
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Future Trends
Media Gallary
References
https://www.ncbi.nlm.nih.gov/books/NBK567742/
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Tropical sprue is a type of malabsorption condition that causes acute or persistent diarrhea. In the lack of a specific etiology of malabsorption, it is seen in tropical people.
It is assumed to be infectious in origin, with environmental variables playing a role. It involves the small intestine and is characterized by malabsorption and nutritional deficiencies, including vitamin B12 and folic acid.
Tropical sprue geographic spread is not entirely understood. It is prevalent between the latitudes of 30°N and 30°S and is observed in tropical countries. All of the nations in this region are not impacted. In the Western Hemisphere, it is common in Puerto Rico, Haiti, and Cuba, with zero or very few cases in the Bahamas and Jamaica.
In India and Pakistan in the Eastern Hemisphere, it is widespread. The condition typically affects indigenous people and tourists who visit endemic areas for more than a month. It is rarely found in travelers who stay in these places for less than two weeks.
In India and Pakistan, the prevalence is decreasing, most likely due to improved hygiene and widespread antibiotic use. This illness affects both men and women equally. Although it is most common in adults, it has been reported in children.
Injuries to the jejunal and ileal mucosa from an acute intestinal infection are followed by intestinal bacterial overgrowth and an increase in plasma enteroglucagon, which slows down small intestinal transit. Folate insufficiency, which likely contributes to additional mucosal damage, is essential to this process.
There are higher levels of the hormones enteroglucagon and motilin in individuals with tropical sprue. These elevations may be brought on by enterocyte damage. The role of motilin is unclear; however, enteroglucagon induces intestinal stasis.
Although the distal small intestine up to the terminal ileum may be damaged, the upper small intestine is predominately impacted since it is a progressive and contiguous disease. The stomach and colon rarely exhibit pathological abnormalities. Coliform bacteria, isolated and frequently linked to tropical sprue, include E. coli, Enterobacter species, and Klebsiella.
It has been proposed that the condition is caused by a vitamin or mineral deficiency. However, research has revealed that it is not the primary event that causes it. The remission of symptoms with anti-bacterial medications indicates that bacterial infections may be the cause.
In contrast, stool cultures taken from patients to investigate for bacterial infections have yielded no positive results. Viral infections cause enterocyte damage. They typically induce acute, self-limiting diarrhea rather than persistent diarrhea that might last for months, as observed in tropical sprue.
When viruses like Reovirus were inoculated in monkeys, they caused diarrhea that may persist for weeks. Although evidence suggests that viral illness is the causative agent, techniques for isolating these agents are needed.
Tropical sprue usually has a good prognosis. The treatment response has been great in individuals infected while traveling to endemic areas, with little to no recurrence.
The recurrence rate in endemic places is estimated to be over 20%, with recurrent relapses. However, new studies demonstrate that the patterns are improving.
https://www.ncbi.nlm.nih.gov/books/NBK567742/
medtigo
Tropical Sprue
Updated :
August 30, 2023
Tropical sprue is a type of malabsorption condition that causes acute or persistent diarrhea. In the lack of a specific etiology of malabsorption, it is seen in tropical people.
It is assumed to be infectious in origin, with environmental variables playing a role. It involves the small intestine and is characterized by malabsorption and nutritional deficiencies, including vitamin B12 and folic acid.
Tropical sprue geographic spread is not entirely understood. It is prevalent between the latitudes of 30°N and 30°S and is observed in tropical countries. All of the nations in this region are not impacted. In the Western Hemisphere, it is common in Puerto Rico, Haiti, and Cuba, with zero or very few cases in the Bahamas and Jamaica.
In India and Pakistan in the Eastern Hemisphere, it is widespread. The condition typically affects indigenous people and tourists who visit endemic areas for more than a month. It is rarely found in travelers who stay in these places for less than two weeks.
In India and Pakistan, the prevalence is decreasing, most likely due to improved hygiene and widespread antibiotic use. This illness affects both men and women equally. Although it is most common in adults, it has been reported in children.
Injuries to the jejunal and ileal mucosa from an acute intestinal infection are followed by intestinal bacterial overgrowth and an increase in plasma enteroglucagon, which slows down small intestinal transit. Folate insufficiency, which likely contributes to additional mucosal damage, is essential to this process.
There are higher levels of the hormones enteroglucagon and motilin in individuals with tropical sprue. These elevations may be brought on by enterocyte damage. The role of motilin is unclear; however, enteroglucagon induces intestinal stasis.
Although the distal small intestine up to the terminal ileum may be damaged, the upper small intestine is predominately impacted since it is a progressive and contiguous disease. The stomach and colon rarely exhibit pathological abnormalities. Coliform bacteria, isolated and frequently linked to tropical sprue, include E. coli, Enterobacter species, and Klebsiella.
It has been proposed that the condition is caused by a vitamin or mineral deficiency. However, research has revealed that it is not the primary event that causes it. The remission of symptoms with anti-bacterial medications indicates that bacterial infections may be the cause.
In contrast, stool cultures taken from patients to investigate for bacterial infections have yielded no positive results. Viral infections cause enterocyte damage. They typically induce acute, self-limiting diarrhea rather than persistent diarrhea that might last for months, as observed in tropical sprue.
When viruses like Reovirus were inoculated in monkeys, they caused diarrhea that may persist for weeks. Although evidence suggests that viral illness is the causative agent, techniques for isolating these agents are needed.
Tropical sprue usually has a good prognosis. The treatment response has been great in individuals infected while traveling to endemic areas, with little to no recurrence.
The recurrence rate in endemic places is estimated to be over 20%, with recurrent relapses. However, new studies demonstrate that the patterns are improving.
https://www.ncbi.nlm.nih.gov/books/NBK567742/
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