Tropical Sprue - Symptoms, Causes, Treatment | NORD (2023)

Disease Overview

Tropical Sprue is a rare digestive disease in which the small intestine’s ability to absorb nutrients is impaired (malabsorption). Consequently, nutritional deficiencies and abnormalities in the mucous lining of the small intestine may be present. The exact cause of this disorder is not known, however it may be related to environmental and nutritional conditions in the tropical regions where it is most prevalent.

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Signs & Symptoms

The symptoms of Tropical Sprue may include fatigue and diarrhea with stools that are abundant, pale and foul-smelling. People with this disorder may also experience a profound loss of appetite (anorexia), a sore tongue, night blindness, weight loss, a loss of strength and energy (asthenia) and general weakness.

The onset of Tropical Sprue may be sudden. Individuals may have an abnormally high fever, inflammation of the mouth and tongue, experience dry skin, a scaly appearance on the lips and at the angles of the mouth. Sometimes mental depression may occur.

For some people with Tropical Sprue, symptoms cease as suddenly as they may have begun (spontaneous remission). Treatment of the disorder in its early stages may result in rapid and complete recovery. The return to normal intestinal structure and function may be slower if treatment is begun later in the course of the disease. In some cases, Tropical Sprue may become chronic with frequent relapses.

People with this disorder may develop anemia characterized by the presence of abnormally enlarged blood cells (megaloblastic) in the bone marrow. (For more information on this disorder, choose “Megaloblastic Anemia” as your search term in the Rare Disease Database.)

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The exact cause of Tropical Sprue is not known. It is an acquired disorder that may be related to environmental and nutritional factors, or Tropical Sprue may be related to an infectious organism (either viral or bacterial), dietary toxin, parasitic infestation, or a nutritional deficiency such as folic acid. Tropical Sprue causes damage to the mucosal lining of the intestine resulting the impaired absorption of food, minerals, and water.

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Affected populations

Tropical Sprue is a rare disorder in temperate regions. It occurs mainly in the tropical regions of the Caribbean, India, South Africa, and Southeast Asia. Transients, tourists and visitors to these areas can be affected.

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Disorders with Similar Symptoms

Symptoms of the following disorders can be similar to those of Tropical Sprue. Comparisons may be useful for a differential diagnosis:

Malabsorption syndromes refer to a group of digestive disorders which are characterized by the impairment of absorption of nutrients and the excessive loss of nonabsorbed substances in the stool. There are many underlying diseases that are associated with these syndromes. Symptoms vary directly with the severity of the disease. Diarrhea and large volumes of fatty stools are consistent symptoms in people with malabsorption syndromes.

Giardiasis is a rare infectious disease of the small intestine caused by the single-celled organism Giardia lamblia. Like Tropical Sprue, this disease is characterized by the impaired absorption of a variety of nutrients by the small intestine. Symptoms may include abdominal cramps, stomach pain, watery diarrhea, excessive gas and fould-smelling stools. Later in the course of the disease, other symptoms such as weight loss and a profound loss of appetite (anorexia) may be encountered. (For more information on this disorder, choose “Giardiasis” as your search term in the Rare Disease Database.)

(Video) Tropical Sprue | Causes, Pathogenesis, Signs & Symptoms, Diagnosis, Treatment

Crohn’s disease is an inflammatory bowel disease characterized by severe, chronic inflammation of the intestinal wall or other portion of the gastrointestinal tract. Symptoms that may develop over time include nausea, vomiting, fever, night sweats, a general feeling of weakness and waves of abdominal pain and discomfort. Diarrhea and bleeding from the rectum are often present. Crohn’s disease can be difficult to recognize and manage. Diagnosis is often delayed. (For more information on this disorder, choose “Crohn” as your search term in the Rare Disease Database.)

Ulcerative colitis is an acute inflammatory bowel disease characterized by diarrhea and blood in the stools because of multiple, irregular ulcerations of the bowel. Initial symptoms may include a general feeling of weakness (malaise) and fatigue. There amy be abdominal discomfort accompanying a change in frequency and consistency of stools. Weight loss and and a decrease in appetite are also met with. Abdominal pain, cramping and urgency (tenesmus) are also often present. (For more information on this disorder, choose “Ulcerative Colitis” as your search term in the Rare Disease Database.)

Primary sclerosing cholangitis is a rare collagen disorder involving inflammation and blockage of the bile duct, liver ducts, and gallbladder. Later, yellow skin color (jaundice), fever, chills, and/or itching of the skin may appear. Bacterial infections resulting from ulcerative colitis, Crohn’s disease, and/or vasculitis may be associated with the cause of bile duct blockages in this disorder. (For more information on this disorder, choose “Primary Sclerosing Cholangitis as your search term in the Rare Disease Database.)

Chronic erosive gastritis is an inflammatory disorder characterized by multiple lesions in the mucosal lining of the stomach. Symptoms of this disorder may include burning or a heavy feeling in the stomach, mild nausea, vomiting, loss of appetite and/or weight loss. In severe cases, bleeding from the stomach may be so extensive that anemia results. (For more information on this disorder, choose “Chronic Erosive Gastritis” as your search term in the Rare Disease Database.)

Irritable bowel syndrome, also known as spastic colon, is a common digestive disorder that involves both the small intestine and the large bowel. Patients with irritable bowel syndrome who have “painless diarrhea” may experience an urgent need to defecate upon arising. (For more information on this disorder, choose “Irritable Bowel Syndrome” as your search term in the Rare Disease Database.)

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Standard Therapies

Treatment for Tropical Sprue includes the use of folic acid, cobalamin, and antibiotics such as tetracycline, oxytetracycline, or ampicillin. The dosage of these medications depends on the severity of the disorder as well as how the patient responds to the therapy. Combined therapy with folic acid and tetracycline seems to rapidly reduce the severity of the symptoms and also heal unhealthy tissue in the small intestine. Other nutrients may be given as needed (i.e., iron, vitamin B12). Diarrhea associated with this disorder may be controlled with anti-diarrhea agents.

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Clinical Trials and Studies

Information on current clinical trials is posted on the Internet at All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: [emailprotected]

For information about clinical trials sponsored by private sources, contact:

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Cecil Textbook of Medicine, 20th Ed.: J. C. Bennett & F. Plum, Editors; W.B. Saunders Co., 1996. Pp. 705-06.

The Merck Manual, 17th Ed.: Mark H. Beers and Robert Berkow , Eds.; Merck Research Laboratories, 1999. Pp. 300-01.

Mayo Clinic Family Health Book, 2nd Ed., David E. Larson, Ed. William Morrow and Company, Inc., 1996, P. 971.


Persistent Diarrhea in the Returned Traveler. N. M. Thielman et al., Infect Dis Clin North Am. (Jun 1998, 12 (2)), Pp. 489-501.

Tropical Sprue and Subclinical Enteropathy: A Vision for the Nineties.

P Haghighi et al., Crit Rev Clin Lab Sci. (Aug1997, 34 (4)), Pp. 313-41.


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What is the treatment for tropical sprue? ›

Tropical sprue is treated with antibiotics. This kills the bacteria overgrowth that results in this condition. Antibiotics may be given for a period of two weeks or one year. Tetracycline is the most commonly used antibiotic for treating tropical sprue.

What is the medical treatment for sprue? ›

Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or Bactrim is typically given for 3 to 6 months.

What causes tropical sprue? ›

The exact causative factor of tropical sprue is unknown, but an intestinal microbial infection is believed to be the initiating insult. The infection results in enterocyte injury, intestinal stasis, and possible bacteria overgrowth. Villous destruction and demonstrable nutrient malabsorption occur in varying degrees.

What vitamin deficiency causes tropical sprue? ›

Tropical sprue is a chronic diarrheal disease, possibly of infectious origin, that involves the small intestine and is characterized by malabsorption of nutrients, especially folic acid and vitamin B12.

What causes sprue disease? ›

Cause. The cause of tropical sprue is not known. It may be caused by persistent bacterial, viral, amoebal, or parasitic infections. Folic acid deficiency, effects of malabsorbed fat on intestinal motility, and persistent small intestinal bacterial overgrowth may combine to cause the disorder.

How do you diagnose tropical sprue? ›

Diagnosis of Tropical Sprue
  1. Endoscopy with small-bowel biopsy.
  2. Blood tests to screen for consequences of malabsorption.

What is the diagnosis and treatment of tropical sprue? ›

Tropical sprue is a rare acquired disease, probably of infectious etiology, characterized by malabsorption and megaloblastic anemia. Diagnosis is clinical and by small-bowel biopsy. Treatment is with tetracycline and folate for 6 months. Tropical sprue is a malabsorption syndrome.

How do you know if your body is not absorbing vitamins? ›

The most common signs of the disease are weight loss and diarrhea. Malabsorption can lead to weight loss, because the body cannot absorb nutrients through the bloodstream.
Other symptoms include:
  • stomach pain.
  • weakness.
  • fatigue.
  • anemia.
  • a darkening or graying of skin exposed to the sun.

Is sprue the same as celiac disease? ›

Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye. If you have celiac disease, eating gluten triggers an immune response in your small intestine.

How do you get tropical diseases? ›

In addition, many diseases are spread by contaminated water and food sources, since clean water and sanitary conditions are often a luxury in developing countries. Alternatively, some tropical disease agents are transmitted by an intermediate carrier or vector.

What causes tropical issues? ›

Some tropical diseases began to spread into temperate climates as a result of increased human travel and climate-driven migration of vectors. The impact of a large number of tropical diseases was influenced by factors such as poverty, lack of clean water, and lack of medical care.

What foods should be avoided in tropical sprue? ›

Breads, cakes, desserts, alcoholic beverages (except wine), cereals, and pastas may all contain gluten. Eating a gluten-free diet heals the intestines and prevents further damage.

What are 3 diseases caused by deficiencies of vitamins? ›

These include, but are not limited to, Protein Energy Malnutrition, Scurvy, Rickets, Beriberi, Hypocalcemia, Osteomalacia, Vitamin K Deficiency, Pellagra, Xerophthalmia, and Iron Deficiency.

What vitamins are in tropical sprue? ›

Vitamin B12 was found therapeutically as effective as folic acid in the treatment and management of patients with tropical sprue.

What type of anemia is tropical sprue? ›

The anemia of tropical sprue is most often macrocytic and related to vitamin B12 and folate malabsorption. Iron deficiency may also occur, related to malabsorption, and may turn a macrocytic anemia into a normocytic anemia.

What suddenly causes celiac disease? ›

Coeliac disease is caused by an abnormal immune system reaction to the protein gluten, which is found in foods such as bread, pasta, cereals and biscuits.

What triggers celiac disease? ›

Gluten. Consuming gluten triggers the abnormal immune system response that causes celiac disease.

What causes short gut syndrome? ›

Causes of short bowel syndrome include having parts of your small intestine removed during surgery, or being born with some of the small intestine missing or damaged. Conditions that may require surgical removal of portions of the small intestine include Crohn's disease, cancer, injuries and blood clots.

What is the best test for sprue? ›

Antibody testing, especially immunoglobulin A anti-tissue transglutaminase antibody (IgA TTG), is the best first test, although biopsies are needed for confirmation; in children younger than 2 years, the IgA TTG test should be combined with testing for IgG-deamidated gliadin peptides.

Is there a blood test for celiac sprue? ›

Two blood tests can help diagnose it: Serology testing looks for antibodies in your blood. Elevated levels of certain antibody proteins indicate an immune reaction to gluten. Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to rule out celiac disease.

What are the signs and symptoms of tropical diseases? ›

Typical symptoms of many tropical diseases share common traits to ,disease found at home and include Fevers, Muscle Ache and Headaches. Other common signs to look for include diarrhoea, nausea, vomiting, lethargy, chronic fatigue, or skin rashes.

What does poop look like with malabsorption? ›

Fat malabsorption

Fatty stools are greasy and runny and particularly smelly. They may be light-colored and float. Fat malabsorption also leads to the malabsorption of fat-soluble vitamins (A, D, E and K).

Can blood test detect malabsorption? ›

The Malabsorption Blood Test (MBT), consisting of pentadecanoic acid (PA), a free fatty acid and triheptadecanoic acid (THA), a triglyceride that requires pancreatic lipase for absorption of the heptadecanoic acid (HA), was developed to assess fat malabsorption in patients with cystic fibrosis (CF) and pancreatic ...

What vitamin is deficient in celiac sprue? ›

Vitamin B12, absorbed in the lower part of the small intestine, is a common deficiency seen in celiac disease. Carefully following a balanced, gluten-free diet can help fix low vitamin and mineral levels. It may also be necessary to take gluten-free vitamin and mineral supplements.

What are 4 symptoms of celiac disease? ›

In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.

Can celiac turn into Crohn's? ›

Though Crohn's and celiac disease may be related, having one condition doesn't mean you'll develop the other. But no matter which condition you have, a gluten-free diet may make your life a whole lot easier.

Is Lyme disease a tropical disease? ›

Spirochetal diseases in the Tropical Zone include syphilis, leptospirosis, Lyme borreliosis, relapsing fever borreliosis, and the endemic treponematoses (yaws, pinta, and bejel).

How can we prevent tropical diseases? ›

Clean water, sanitary food handling, and good hygiene can prevent diseases such as guinea-worm disease, schistosomiasis, soil-transmitted helminthiasis, and trachoma. Vector-borne NTDs—those that are spread by worms, flies, mosquitoes, or other hosts—can be prevented through control of the vectors themselves.

What are the most common tropical infections? ›

Some viral tropical infections include dengue, yellow fever, rotavirus, AIDS, Ebola and Lassa fever. Some examples of bacterial tropical infections include cholera, Escherichia coli, tuberculosis and Hansen's disease (leprosy). Parasitic single-celled protozoa and worms are another source of tropical infections.

What are three major threats to tropical? ›

Deforestation and fragmentation, over-exploitation, invasive species and climate change are the main drivers of tropical forest biodiversity loss.

What are the four conditions for a tropical? ›

Development of tropical cyclones
  • High sea temperatures of at least 27°C.
  • Converging winds near the ocean surface forcing air to rise and form storm clouds.
  • Winds that do not vary greatly with height - known as low wind shear. ...
  • Sufficient distance from the equator for a spin such as the Coriolis force to take effect.

What causes most serious damage from tropical depressions? ›

Wind and water are the parts of a tropical storm that are likely to cause the most damage, leading to property damage, mudslides, heavy rain, flying debris, and large waves and swells. Tropical storms have caused billions of dollars in damage in the Southeastern United States over the past 50 years.

What are 3 grain based foods that you should avoid if you have a disease where you need to avoid gluten? ›

Grains not allowed
  • Wheat.
  • Barley.
  • Rye.
  • Triticale — a cross between wheat and rye.
  • Oats, in some cases.

What are 3 foods high in vitamin A that the chw can recommend to families to include in their daily diet? ›

Animal products like meat, fish, dairy, and eggs are good sources of vitamin A. Many fruits and vegetables are also rich in provitamin A and can help you meet your needs.
However, a few types of fruit provide good amounts, as shown below.
  • Mango. ...
  • Cantaloupe. ...
  • Grapefruit. ...
  • Watermelon. ...
  • Papaya. ...
  • Apricot. ...
  • Tangerine. ...
  • Nectarine.
Dec 23, 2022

What is the prognosis of tropical sprue? ›

The patients present with chronic non bloody diarrhea with malabsorption. The chronic phase can result in malabsorption and the patients will develop symptoms of vitamin B12 and vitamin A deficiency. The prognosis is excellent with treatment.

What are the 14 signs of vitamin D deficiency? ›

Symptoms of vitamin D deficiency may include:
  • Fatigue.
  • Not sleeping well.
  • Bone pain or achiness.
  • Depression or feelings of sadness.
  • Hair loss.
  • Muscle weakness.
  • Loss of appetite.
  • Getting sick more easily.

What deficiency causes weakness in legs? ›

Muscle weakness due to vitamin D deficiency is predominantly of the proximal muscle groups and is manifested by a feeling of heaviness in the legs, tiring easily, and difficulty in mounting stairs and rising from a chair; the deficiency is reversible with supplementation (15–18).

What vitamin deficiency causes itchy skin? ›

Both vitamin B12 and vitamin A deficiencies may also cause itchy skin, so if you are experiencing chronically itchy skin, getting your level of these vitamins tested can be helpful. This testing will help determine whether these deficiencies are at the root of your skin sensitivities and itchiness.

What foods are good for tropical sprue? ›

Fresh fruits are found best, but when not in season, unsweetened canned fruits are used, saccharine being employed in place of sugar. Cottage cheese is given once or twice daily, according to the amount of protein allowed for the patient.

What tropical fruit helps gut health? ›

Load up on vitamin C, help prevent medical conditions including cancer, and get your antioxidants with these tropical fruit.
  • Papaya. Papayas are a favourite post-meal fruit in Asia because it aids digestion. ...
  • Banana. ...
  • Pineapple. ...
  • Jackfruit. ...
  • Mangoes. ...
  • Avocado. ...
  • Coconut. ...
  • Starfruit.

What vitamins help stomach ulcers? ›

Vitamin U is most often advertised as a treatment for stomach ulcers, though it's also touted to improve digestion, strengthen immune health, protect against food allergies, lower cholesterol, and hasten wound healing.

Which vitamin deficiency is caused by sprue? ›

The infection results in enterocyte injury, intestinal stasis, and possible bacteria overgrowth. Villous destruction and demonstrable nutrient malabsorption occur in varying degrees. Folate, vitamin B-12, and iron deficiencies are the most common nutrient deficiencies.

What medication is used for celiac sprue? ›

Steroids can ease severe signs and symptoms of celiac disease while the intestine heals. Other drugs, such as azathioprine (Azasan, Imuran) or budesonide (Entocort EC, Uceris), might be used.

What are the big three tropical diseases? ›

The world's deadliest infections, including Tuberculosis, Malaria and HIV/AIDS, have been considered as the "Big Three" infectious diseases (BTIDs). With leading infections and deaths every year, the BTIDs have been recognized as the world's greatest pandemics.

What vitamin deficiencies are common in celiac sprue? ›

Micronutrient deficiencies (in particular, iron, folic acid, vitamins B6 and B12, vitamin D, copper, and zinc) are common in celiac patients. If untreated, these micronutrient deficiencies can contribute to neurological complications, psychiatric symptoms, and bone alterations.

How do you get rid of celiac inflammation? ›

The only way to manage the symptoms of celiac disease is to eat a strict gluten-free diet. Eating foods without gluten lets your small intestine heal, and stops future problems and inflammation. You'll need to avoid any foods made with wheat and wheat flour.

How do I heal my gut from celiac disease? ›

Eliminating gluten is the only treatment for this disease. You must not eat gluten for the rest of your life. In most cases, taking gluten out of your diet will stop your symptoms. And, any damage to your intestine will heal.

What probiotic is used for celiac disease? ›

Role of probiotics

Lactobacilli and Bifidobacterium, the most frequently studied bacteria in celiac disease, may play a role in breaking down gluten and its harmful fragments to modify its potential to cause an immune reaction.

What is type 4 celiac disease? ›

Celiac disease is sometimes classified as a Type IV hypersensitivity mediated by T-cell responses whereas allergy is usually classed as a Type I hypersensitivity mediated by E-type immunoglobulins (IgE antibodies).


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