Under a tropical sprue is meant a rare acquired disease, which is characterized by a malabsorption and megaloblastic anemia. Its etiology is probably infectious. The diagnosis is made clinically and by means of a small bowel biopsy. The therapy consists of the administration of tetracycline and folic acid for 6 months.

Tropical sprue is a malabsorption syndrome.

Under a tropical sprue is meant a rare acquired disease, which is characterized by a malabsorption and megaloblastic anemia. Its etiology is probably infectious. The diagnosis is made clinically and by means of a small bowel biopsy. The therapy consists of the administration of tetracycline and folic acid for 6 months. Tropical sprue is a malabsorption syndrome. Etiology The tropical sprue occurs mainly in the Caribbean, southern India and Southeast Asia on, it attacks both locals and tourists. The disease is rare in people choosing to spend <1 month in regions where the disease is endemic. Although the etiology is unclear, it is believed that the disease is a result of chronic infection of the small intestine with toxigenic strains of coliform bacteria. Malabsorption of folic acid and vitamin B12 leads to megaloblastic anemia. Tropical sprue occurs in the US rare, and the incidence has declined in recent decades the world, possibly due to the increasing use of antibiotics for acute traveler's diarrhea. Symptoms and signs Patients usually suffer from acute diarrhea with fever and malaise. Then a chronic phase of lighter diarrhea, nausea, anorexia, abdominal cramps and fatigue follows. Steatorrhea occurs frequently. A lack of nutrients, v. a. of folic acid and vitamin B12, develops months or years after. In the patients also weight loss, glossitis, stomatitis, and peripheral edema may occur. Diagnostic endoscopy with small bowel biopsy Blood tests to study the consequences of malabsorption You have in individuals who live in areas where the disease is endemic or have lived and megaloblastic anemia and symptoms of malabsorption have to think of the tropical sprue. The crucial test is an endoscopy in the upper GIT with small bowel biopsy. The characteristic histological changes (see Table: Histology of the intestinal mucosa for certain Malabsorptionskrankheiten) are extended over the entire small intestine, and consisting in flattening of the crypts and infiltration of a chronic cell infiltrate in the epithelium and in the lamina propria. Celiac disease and parasite infection must be excluded. Unlike celiac disease, anti-tissue transglutaminase antibodies (tTG) and anti-endomysial antibody (EMA) is negative in patients with celiac sprue. Other laboratory tests (z. B. blood count, albumin, calcium, PT, iron, folic acid and vitamin B12) are necessary for the assessment of nutritional status. Bariumkonstrastaufnahmen of the small intestine can show a segmentation of barium, a dilation of the lumen and a thickening of the mucosal folds. The d-xylose -Rebsorptionstest is pathological in> 90% of cases. However, these tests are not specific or essential for the diagnosis of tropical sprue. Long-term therapy Tetracyclingabe The treatment of tropical sprue Tetracyclingaben consists of 250 mg p.o. 4 times daily for 1-2 months, then. 2 times daily for up to 6 months, depending on the severity of the disease and the success of the treatment Doxycycline 100 mg p.o. can be used in place of tetracycline 2 times a day. In the first month of folic acid should be 5-10 mg p.o. be given once a day, along with vitamin B12 1 mg i.m. once a week for several weeks. The megaloblastic anemia sounds immediately, and improvement of the clinical condition is profound. The further replacement of nutrients is demand-oriented. A relapse can occur in 20% of cases. Failure to respond after 4 weeks of therapy must be thinking of other diseases.

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