Tropical sprue

This diagnosis should be considered in any patient with diarrhoea and signs and/or symptoms of malabsorption who has spent more than 2 weeks in a tropical region where the disease is endemic.

Improvement after folate replacement is prompt and dramatic. Failure to do so should elicit doubt about the diagnosis.

No causative microbe has been found, but the condition is likely to result from bacterial infection.

In addition to folic acid supplementation, long-term treatment with antibiotics is currently recommended.

Deficiencies of folic acid and vitamin B12 and resultant megaloblastic anaemia are the defining characteristics of the disease.

Tropical sprue (TS) is an acquired malabsorptive condition of probable infectious aetiology. Features include altered small bowel mucosa, chronic diarrhoea, and signs and symptoms of multiple vitamin and nutrient deficiencies. It is seen in both natives of, and long-term visitors to, specific endemic areas in the tropics. [Figure caption and citation for the preceding image starts]: Tropical sprue; ridged and foveolar patterns, duodenumFrom the collection of Dr M. Guelrud; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Endoscopy, normal and tropical sprue (TS) villi changes, duodenumFrom the collection of Dr M. Guelrud; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Normal duodenum, standard endoscopyFrom the collection of Dr M. Guelrud; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Tropical sprue; scalloping, mosaic appearance, and mucosal grooves; duodenumFrom the collection of Dr M. Guelrud; used with permission [Citation ends].