TROPICAL SPRUE

Question 1

Overview (3)

Answer 1

• Progressive small intestinal disorder (damage more severe in jejunum & ileum), presenting with diarrhea, steatorrhea, megaloblastic anemia (folate +/- B12)
• Affects residents or visitors or endemic areas in the tropics (Asia, some Caribbean islands, Puerto Rico, parts of South Africa)
• Etiology: unknown, but likely to be infective (esp. Giardia intestinalis)

Question 2

Diagnosis (3)

Answer 2

1- Evidence of malabsorption (particularly of fat and vitamin B12) together with steatorrhea
2- Small bowel mucosal biopsy showing features similar (not identical) to those with untreated celiac (villous atrophy)
3- Infective causes of diarrhea should be excluded e.g. parasitic (giardia intestinalis)

Question 3

Treatment (2)

Answer 3

1- Folic acid and Tetracycline for 3-6 months
2- Correction of nutritional deficiencies