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home - Small Bowel - Small Bowel Infections - Tropical Sprue Written by Dr Sebastian Zeki

Tropical Sprue

Written by Dr Sebastian Zeki Endoscopic and radiological features These are the same as coeliac disease. Small bowel biopsy histology: Chronic inflammatory infiltrate in lamina propria. Lymphocytes in epithelium. Decreased epithelial cell surface height. Loss of height. Crypt hyperplasia. Epidemiology Can develop an acute diarrhoea during or after tropical visit Consider if have lived for > 1month in an area where tropical sprue exists. Tropical Sprue TreatmentReplacement of folate is the most important consideration and patients will clinically improve within weeks- almost diagnostic of the disease.Despite folate replacement 50% have symptom persistence therefore also need tetracycline (250 mg PO four times daily).20% will relapse even after antibiotics.Replacement of other malabsorbed nutrients is necessary. Reasons to consider it as an infection:Household epidemics occur.It is associated with overgrowth of toxi-genic coliform bacteria (Klebsiella, E.coli and Enterobacter) in the proximal small intestine.Treatment with broad spectrum antibiot-ics is usually curative.Bacterial overgrowth doesn’t have the same effect probably as the bacterial spectrum is different- the bacteria gene-ate folic acid, and serum [concentration] are increased. Aetiology Signs consistent with mal-absorption- in particular:Most patients have steator-rhea with an abnormal D-xylose absorption test.Megaloblastic anemia due to folate deficiency 3-4 months after disease onset. Progressively affects entire small bowel from duodenum Affects:Indigenous peopleVisitors staying >1 month India and to a lesser degree in Burma, Indone-sia, Borneo, Malaysia, Singapore and Vietnam, but is virtually absent in Africa. Haiti, the Dominican Repub-lic, Puerto Rico, and Cuba, but is rare or absent in Jamaica and the Bahamas.

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