Tropical Sprue Clinical Presentation

Updated: Dec 15, 2014
  • Author: Rohan C Clarke, MD; Chief Editor: Julian Katz, MD  more...
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Presentation

History

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  • Tropical sprue manifests clinically with a spectrum of signs and symptoms. It may develop in natives or travelers to the tropics, and it may not appear until as long as 10 years after the patient has left there. No definitive marker of tropical sprue exists; hence, these claims remain unsubstantiated. Patients may experience the following:
    • Diarrhea
    • Weight loss
    • Leg swelling
    • Fatigue
    • Fever
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Physical

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  • Examination may reveal the following:
    • Weight loss
    • Dehydration
    • Pallor
    • Oral mucosa changes (glossitis, stomatitis)
    • Edema
  • Consider specific causes of diarrhea and malabsorption.
  • Consider the diagnosis of tropical sprue if the initial history, physical, and laboratory workups are suggestive of mucosal malabsorption.
  • Although tropical sprue can manifest as an acute diarrheal illness, the clinical diagnosis is usually not considered until patients present with chronic symptoms.
  • Diarrhea and fat malabsorption may occasionally be difficult to differentiate. Perform a 24- to 72-hour stool test for fat. Total stool fat less than 6-7 g/d excludes steatorrhea; therefore, consider chronic diarrhea.
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Causes

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  • Environmental
  • Residence or travel in an endemic tropical area
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