Tropical sprue in southern India

Abstract

Tropical sprue, a primary malabsorption syndrome affecting residents and visitors to several tropical regions, occurs in southern India in endemic and epidemic forms. The stomach, the small intestine and colon are affected and malabsorption results in nutrient deficiency. Enterocyte damage, the primary lesion in southern Indian tropical sprue, is the result of a persistent lesion of the stem cell compartment. This lesion occurs on a background of tropical enteropathy and the available evidence suggests that an immunity conferring agent may be responsible for initiating the damage.

M.C.V. should not be the only criteria to order vitamin B12 for anemia under evaluation

“…In particular a strict vegetarian diet has been associated with increased risk of Cobalamin deficiency [7,8]. Malnutrition is common in India [9] and tropical sprue, gastrointestinal infections, and other nutrient deficiencies frequently result in a malabsorptive state [10,11]. Therefore, one would expect a high prevalence of Cobalamin deficiency in India.…”

Tropical sprue

“…Patients in the Caribbean area respond well to treatment with tetracycline and folate, but have a high rate of relapse [24]. Patients in southern India fail to respond to antibiotic treatment, and the natural history of tropical sprue is similar in untreated and treated patients [8].…”

“…The treatment of tropical sprue before the war consisted of bedrest, a high-protein diet, and liver extract, which induced remission in close to 90% of patients treated in the United Kingdom after a return from the tropics [18]. The natural history of untreated tropical sprue in the indigenous population of endemic areas at that time was characterized by relapses and remissions and a high fatality rate [8]. The first systematic studies of folate replacement and the use of antibiotics were conducted in the Caribbean and India, respectively.…”

“…The prevalence of tropical sprue in these same populations is unknown, but estimates have ranged from 11% in Puerto Rico to 43% in Haiti [6]. Of note, several large epidemics of tropical sprue have been described in India affecting both expatriates (foreign troops) and the indigenous population [7,8]. The epidemics were characterized by a slow spread among family members and in villages, contrary to the rapid spread of acute infectious diarrhea.…”

Sprue tropicale

“…En une semaine, les symptômes régressent et une constipation apparaît ; des épiso-des successifs de rechutes et de rémission surviennent [19]. À la phase d'état, la diarrhée chronique est associée à une malabsorption sévère [20]. Cette diarrhée n'est pas très abondante, < 500 g/j avec parfois une stéatorrhée [21].…”