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tropical sprue
Etiology:
1) Klebsiella
2) E. coli
Epidemiology:
- travel to India, Thailand, Puerto Rico
Pathology:
- duodenal villous atrophy & intraepithelial lymphocytosis [3]
Clinical manifestations:
1) diarrhea 2-3 months after travelling to the topics
2) weight loss
3) megaloblastic anemia develops after 6 months due to folate deficiency & possible co-existing vitamin B12 deficiency
4) glossitis may develop due to iron deficiency [3]
Laboratory:
1) stool studies (rule out parasites)
2) complete blood count (check for megaloblastic anemia)
3) serum folate
4) serum vitamin B12
5) serum iron
Special laboratory:
- upper GI endoscopy with small intestine biopsy
Management:
1) tetracycline 250 mg QID or sulfonamide for 3-6 months [2]
2) folate
3) vitamin B12
General
intestinal disease
bacterial infection
malabsorption
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 298
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006
- NEJM Knowledge+ Gastroenterology
- Nath SK.
Tropical sprue.
Curr Gastroenterol Rep. 2005 Oct;7(5):343-9.
PMID: 16168231 Review.