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Tropical sprue
Last reviewed: 12.07.2025
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Tropical sprue is an acquired disease of the gastrointestinal tract, probably of infectious etiology, characterized by malabsorption and megaloblastic anemia. The diagnosis is established clinically and by small intestinal biopsy. Treatment of tropical sprue involves the use of tetracycline and folic acid for 6 months.
What causes tropical sprue?
Tropical sprue occurs primarily in the Caribbean, southern India, and Southeast Asia, affecting both natives and tourists. It is rare in travelers who spend less than 1 month in an endemic area. Although the cause is not fully understood, it is thought to result from chronic infection of the small intestine by toxigenic strains of coliform bacteria. Folate malabsorption and vitamin B deficiency result in megaloblastic anemia. The incidence of tropical sprue is decreasing, possibly due to the increasing use of antibiotics to treat and prevent acute traveler's diarrhea.
Symptoms of tropical sprue
Patients typically develop acute diarrhea with fever and malaise. This is followed by a chronic phase of mild diarrhea, nausea, anorexia, abdominal cramps, and fatigue. Steatorrhea is common. Malnutrition, especially folate and vitamin B12 deficiency, develops over a period of months to years. The patient may experience weight loss, glossitis, stomatitis, and peripheral edema.
Diagnosis of tropical sprue
Tropical sprue is suspected in people permanently residing in endemic areas or tourists visiting these areas with symptoms of megaloblastic anemia and malabsorption. The final diagnosis is established by upper gastrointestinal endoscopy with small bowel biopsy. Characteristic histological changes usually involve the entire small intestine and consist of villous smoothing with chronic infiltration of inflammatory cells of the epithelium and lamina propria. Celiac disease and parasitic infection should be excluded.
Additional laboratory tests (eg, complete blood count; albumin; calcium; prothrombin time;iron, folate, and B12 levels ) help evaluate the status of digestive processes. Barium small bowel movement may show barium segmentation, lumen dilation, and thickening of mucosal folds. D-xylose absorption is impaired in more than 90 % of cases. However, these tests are not specific or helpful in making the diagnosis.
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Treatment of tropical sprue
Treatment of tropical sprue includes oral tetracycline 250 mg 4 times a day for 1 to 2 months, then 2 times a day for up to 6 months depending on the severity of the disease and the effectiveness of treatment. Folic acid is prescribed at 5-10 mg, orally once a day during the first month, along with vitamin B 12 intramuscularly at 1 mg weekly for several weeks. The course of megaloblastic anemia improves rapidly, and the clinical effect occurs quickly. Other dietary supplements are carried out as needed. Relapse of tropical sprue can occur in 20% of cases. Ineffectiveness of treatment for 4 weeks suggests another pathology.