Tropical sprue is a rare disorder of unknown cause affecting people living in tropical and subtropical areas who develop abnormalities of the lining of the small intestine, leading to malabsorption and deficiencies of many nutrients.

• This disorder might be caused by an infection, but the real cause is not known.
• Typical symptoms include anemia, light-colored stools, chronic diarrhea, and weight loss.
• A doctor bases the diagnosis on symptoms in a person who lives in or has recently visited one of the areas in which the disorder commonly occurs.
• The antibiotic tetracycline treats the disorder.

Tropical sprue occurs chiefly in the Caribbean, southern India, and Southeast Asia. Both natives and visitors (who spend at least 1 month in the area) may develop the disease, but children are rarely affected. This disorder has rarely been reported in the United States. Worldwide, its occurrence has been declining in recent decades. The cause is unknown, but available evidence suggests an infectious cause.

Symptoms and Diagnosis

Light-colored stools, chronic diarrhea, fever, a general feeling of illness (malaise), and weight loss are typical symptoms of tropical sprue. Other symptoms of malabsorption of specific nutrients may also develop. A sore tongue develops from vitamin B₂ deficiency. Anemia usually develops as a result of iron, vitamin B₁₂, or folate (folic acid) deficiency, causing fatigue and weakness.

A doctor considers the diagnosis of tropical sprue in a person with anemia and symptoms of malabsorption who lives in or has recently visited one of the areas in which the disorder commonly occurs. By removing tissue (biopsy) from the small intestine using an endoscope (a flexible viewing tube equipped with a light source and a camera through which a small clipper can be inserted) and examining the tissue under a microscope, doctors can identify some characteristic but not specific abnormalities. A stool sample is usually analyzed to exclude parasites or bacteria as a cause.

Treatment

A person suspected of having tropical sprue is treated with an antibiotic. Tetracycline is given over several months. Nutritional supplements, especially folate and vitamin B₁₂, are given as needed. Treatment usually results in a full recovery.

Last full review/revision January 2013 by Atenodoro R. Ruiz, Jr., MD