Summary
Definition
History and exam
Key diagnostic factors
- prolonged exposure to an endemic area
- constitutional symptoms
- diarrhea
- bloating
- foul-smelling, greasy stools
- glossitis
- numbness of fingers and toes
Other diagnostic factors
- abdominal cramping
- fever
- leg swelling
- hair loss
- cheilitis/angular stomatitis
- pedal edema
- hyperactive bowel sounds/borborygmi
- hyperpigmentation/eczematous rash
- pallor
- dry eyes
- corneal xerosis
- decreased deep tendon reflexes/decreased vibratory sensation
- night blindness
Risk factors
- prolonged exposure to an endemic area
- HLA antigen in the Aw-19 series
Diagnostic tests
1st tests to order
- CBC
- quantitative fecal fat assay
- D-xylose test
- serum folate
- serum vitamin B12
Tests to consider
- stool ova and parasites (O and P)
- stool culture
- upper gastrointestinal endoscopy with biopsy
- folic acid therapeutic trial
Treatment algorithm
tropical sprue symptoms
Contributors
Authors
Daniel Wild, MD
Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
Disclosures
DW declares that he has no competing interests.
Iris L. Vance, MD
Assistant Professor of Medicine
Division of Gastroenterology
Duke University Medical Center
Durham
NC
Disclosures
ILV declares that she has no competing interests.
Acknowledgements
Dr Daniel Wild and Dr Iris L. Vance would like to gratefully acknowledge Dr Moises Guelrud, a previous contributor to this topic. MG declares that he has no competing interests.
Peer reviewers
J. Thomas LaMont, MD
Professor of Medicine
Harvard Medical School
Division of Gastroenterology
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
JTLM declares that he has no competing interests.
Daniel Leffler, MD, MS
Instructor in Medicine
Harvard Medical School
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
Boston
MA
Disclosures
DL declares that he has no competing interests.
Paul Ciclitira, MBBS, MD, PhD
Professor of Gastroenterology
Department of Diabetes and Nutritional Sciences
King's College London
Rayne Institute
St Thomas' Hospital
London
UK
Disclosures
PC declares that he has no competing interests.
References
Key articles
Keele KD, Bound JP. Sprue in India: a clinical survey of 600 cases. BMJ. 1946;1:77-81.
Sheehy TW, Cohen WC, Wallace DK, et al. Tropical sprue in North Americans. JAMA. 1965;194:1069-1076. Abstract
Sheehy TW, Baggs B, Perez-Santiago E, et al. Prognosis of tropical sprue. A study of the effect of folic acid on the intestinal aspects of acute and chronic sprue. Ann Intern Med. 1962;57:892-908. Abstract
Suarez RM, Spies TD, Suarez RM Jr. The use of folic acid in sprue. Ann Intern Med. 1947;26:642-677.
Rickles FR, Klipstein FA, Tomasini J, et al. Long-term follow-up of antibiotic-treated tropical sprue. Ann Intern Med. 1972;76:203-210. Abstract
Guerra R, Wheby MS, Bayless TM. Long term antibiotic in tropical sprue. Ann Intern Med. 1965;63:619-634. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Parasitic infections: Strongyloides, Isosporiasis, Giardia lambia, Entamoeba histolytica, Cyclosporiasis
- Bacterial infections: Shigella, Salmonella, Escherichia coli
- HIV enteropathy
More DifferentialsGuidelines
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
More Guidelines
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