Follow-up
Further Inpatient Care
- Patients with TS are not usually admitted as inpatients unless they present with at diagnosis of chronic diarrhea or malabsorption with dehydration and weight loss (see Medical Care).
- Patients admitted with suspected TS should undergo workup and evaluation as previously described (see Workup).
Further Outpatient Care
- Observe patients regularly to ensure that they respond to treatment and that the correct diagnosis is made. The patient should be observed at least once a month with careful monitoring of lab studies to make sure that any signs or symptoms of malabsorption have been corrected.
- Monitor weight gain.
- Monitor the CBC count and electrolytes at least monthly.
- Correct folate, vitamin B-12, and any other deficiencies.
Inpatient & Outpatient Medications
- The same medications are used in both outpatient and inpatient settings (see Medication).
Deterrence/Prevention
- No direct evidence indicates that antibiotic prophylaxis can prevent TS.
Complications
- Anemia
- Malnutrition
- Vitamin deficiency
Prognosis
- Prognosis of this condition is generally good.
Patient Education
- Travelers to the tropics should be aware of this syndrome and take steps to limit exposure to enteric pathogens. If protracted diarrhea occurs, early presentation to medical personnel is helpful.
- For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article Traveler's Diarrhea.
Miscellaneous
Medicolegal Pitfalls
- As with any medical illness, physicians should make sure that the patient responds to the appropriate therapy after the diagnosis is made. If no response occurs, reevaluate the patients to make sure other mucosal causes of malabsorption or infectious causes (eg, protozoan illnesses) are not missed.
- TS may recur in patients living in endemic areas; therefore, retreatment may be necessary.
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| Differential Diagnoses & Workup: Sprue, Tropical |
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References
Cook GC. Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue). Lancet. Mar 31 1984;1(8379):721-3. [Medline].
Farthing MJ. Tropical malabsorption and tropical diarrhea. In: Feldman M, ed. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, Pa: WB Saunders Co; 1998:1574-1584.
Floch MH, Ozick L. Tropical sprue. In: Hurst JW, ed. Medicine for the Practicing Physician. 3rd ed. Boston, Mass: Butterworth;1992:1547-1549.
French AB. Tropical sprue--specific disease or extreme of a spectrum?. Ann Intern Med. Jun 1968;68(6):1362-5. [Medline].
Gilman AG, ed. The Pharmacological Basis of Therapeutics. 8th ed. New York, NY:. Pergamon Press Inc;1990.
Greeberger NJ, Isselbacher KJ. Disorders of absorption. In: Fauci AS, ed. Harrison's Principle of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;1998:1626.
Klipstein FA, Baker SJ. Regarding the definition of tropical sprue. Gastroenterology. May 1970;58(5):717-21. [Medline].
Klipstein FA. Tropical sprue--an iceberg disease?. Ann Intern Med. Mar 1967;66(3):622-3. [Medline].
Klipstein FA. Tropical sprue in travelers and expatriates living abroad. Gastroenterology. Mar 1981;80(3):590-600. [Medline].
Nath SK. Tropical sprue. Curr Gastroenterol Rep. Oct 2005;7(5):343-9. [Medline].
Thielman NM, Guerrant RL. Persistent diarrhea in the returned traveler. Infect Dis Clin North Am. Jun 1998;12(2):489-501. [Medline].
Toskes P. Malabsorption. In: Bennet JC, Plum F, eds. Cecil Textbook of Medicine. Philadelphia, Pa:. WB Saunders Co;1996:705-706.
Further Reading
Keywords
tropical sprue, aphthoids chronica, diarrhea, cachectic diarrhea, psilosis, postinfective tropical malabsorption, TS, intestinal stasis, mucosal injury, ileal mucosa injury, mucosal malabsorption, intestinal malabsorption, malabsorption of nutrients, villous atrophy, enterocyte injury, intestinal stasis, jejunal mucosa injury, tropical diarrhea
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