Tropical sprue

Aetiology:

Unknown

Likely to be infective because the disease occurs in epidemics and pts improve on antibiotics

Clinical features:

Vary in intensity but include the following:

Diarrhoea

Anorexia

Abdominal distension

Weight loss

The onset can sometimes be acute (occurring within a few days) or may occur several years after being in the tropics.

The disease can also be insidious, with chronic diarrhoea and evidence of nutritional deficiency.

Diagnosis:

Acute infective causes of diarrhoea must be excluded (particularly Giardia)

Malabsorption should be demonstrated (particularly of fat and B₁₂)

Treatment and prognosis:

Many pts improve when they leave the sprue area and take folic acid (5mg daily)

Most pts also require an antibiotic (usually tetracycline 1g daily) to ensure a complete recovery – may be required for up to 6 months

The severely ill pt requires resuscitation with fluids and electrolytes for dehydration

Any nutritional deficiencies should be corrected

Vitamin B₁₂ (1000μg) is also given to all acute cases

Prognosis is excellent