Tropical Sprue Differential Diagnoses

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

Diagnostic Considerations

Brown et al compared the histologic changes found in tropical sprue with those occurring in gluten-sensitive enteropathy, a condition for which tropical sprue is often mistaken. The study, which involved 12 patients with tropical sprue and 150 cases of gluten-sensitive enteropathy, identified no complete villous blunting in the duodenal mucosa of the tropical sprue patients, although partial blunting occurred in 75% of them. In contrast, complete villous blunting was identified in 25% of gluten-sensitive enteropathy patients. The investigators also found that in the appropriate clinical context, tropical sprue is indicated by involvement of the terminal ileum, with greater inflammation and villous blunting than in the duodenum, and by the presence, in the lamina propria, of a conspicuous eosinophil infiltrate. [5]

A study of Indian adults by Ghoshal et al indicated that, in comparison with patients with tropical sprue, those with celiac disease tended to be younger (< 35 years), have a longer duration of diarrhea and a higher platelet count, and more often demonstrate villous atrophy (subtotal or partial). [6]

Diseases of general fat malabsorption to consider include the following:

  • Bacterial overgrowth
  • Ileal diseases
  • Pancreatic disorders

Mucosal diseases leading to malabsorption to consider include the following:

  • AIDS enteropathy
  • Celiac sprue
  • Cryptosporidia
  • Giardiasis
  • Infectious causes
  • Nonspecific enteropathy
  • Norwalk virus
  • Radiation enteropathy
  • Intestinal lymphoma

Differential Diagnoses