Define tropical spure and describe the epidemiology.
Definition: A disease characterized by chronic diarrhea with subsequent malabsorption in association with a stay in the tropics or subtropics.
Epidemiology: occurs in residents of the tropics and subtropics or in travelers returning from these areas (after trips lasting several weeks
What is the cause?
exact cause not known; most likely due to bacterial infection that leads to structural damage of the intestinal mucosa
List clinical features.
Chronic diarrhea with steatorrhea
Abdominal cramps
Progressive weight loss
Fatigue
See clinical features of malabsorption
List diagnostic tests.
Blood tests: megaloblastic anemia (due to deficiency of folate and vitamin B12), hypoalbuminemia, hypocalcemia, vitamin D deficiency
Serology for antibodies to rule out celiac disease (see “Diagnostics” above)
Stool analysis
Fecal fat 10–40 g/d
Rule out infection with pathogens (e.g., Giardia lamblia, Entamoeba histolytica)
Endoscopy of the small bowel and biopsy
Villous atrophy, elongated crypts, presence of inflammatory cells (plasma cells, lymphocytes, eosinophils)
Mainly affects duodenum and jejunum but may progress to ileum
Describe the treatment.
tetracycline in combination with folic acid for 3–6 months
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