Tropical sprue natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Tropical sprue has an acute and a chronic phase and usually follows an episode of infectious diarrhea. The patients present with chronic non bloody diarrhea with malabsorption. The chronic phase can result in malabsorption and the patients will develop symptoms of vitamin B12 and vitamin A deficiency. The prognosis is excellent with treatment.

Tropical sprue is a diagnosis of exclusion, patients present with chronic non-bloody diarrhea, abdominal bloating and flatulence following an episode of infectious diarrhea. Patients with chronic form of tropical sprue presents with features of vitamin B12 and vitamin A deficiencies. If left untreated it is associated with significant morbidity and mortality, therefore suspicion of tropical sprue must be high if histology of the duodenal biopsy demonstrates villous atrophy and if the patient is unresponsive to a gluten free diet.^[1]

The complications of tropical sprue include:^[2]

• Vitamin B12 deficiency causes sub acute combined degeneration of the spinal cord resulting in neurological symptoms.
• Vitamin A deficiency causes visual disturbances and night blindness.
• Hypokalemia can occur due to chronic diarrhea.

All the patients with tropical sprue have excellent prognosis with tetracycline treatment. Treatment is continued for a period of 6 months but the symptoms resolve within 2 to 3 weeks from initiation of therapy.^[3]

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