1/14. Tropical sprue after travel to tanzania. Tropical sprue (TS) is a diagnosis to consider in travelers with prolonged diarrhea and a malabsorption syndrome after return from tropical countries, particularly india and Southeast asia. TS is an unusual condition in tropical Africa. textbooks of tropical medicine indicate a low endemicity in nigeria and a limited number of cases in south africa and zimbabwe. A medline search from 1979 to mid 1998 using "tanzania and tropical sprue" as key words disclosed no hits. We report herein a case of TS in a European traveler, who lived in tanzania for 8 months. ( info) |
2/14. Tropical malabsorption. Tropical malabsorption remains an important clinical problem for both the indigenous population of tropical countries and for short-term visitors and longer-term residents from the industrialized world. In young children, persistent diarrhea and malabsorption can result in severe retardation of growth and development. The most common cause is an intestinal infection notably the small intestinal protozoa including Giardia intestinalis, cryptosporidium parvum, isospora belli, cyclospora cayetanensis, and the microsporidia. Tropical sprue still remains an important diagnostic option but is less common than it was 20 to 30 years ago. It is important to attempt to make a specific microbiological diagnosis as this will influence the choice of antibiotic. However, if laboratory facilities are not available, it is possible to offer empirical therapy although this may involve a trial of more than one antibiotic. ( info) |
3/14. Persistent diarrhea in the returning traveler: think beyond persistent infection. The report describes a young female united nations worker, stationed in east timor for an extended duration, who presented with persistent travelers' diarrhea and who was convinced that she was harboring a persistent infestation. In fact, careful history, laboratory evaluation and endoscopy with duodenal biopsies found all the classical hallmarks of unmasked celiac sprue. The patient then had a dramatic response to a gluten-free diet, with complete resolution of symptoms. Persistent travelers' diarrhea is an entity which carries an interesting and extensive differential diagnosis beyond persistent enteric infections or infestations. Rather, many sufferers have long been cleared of the initial offending pathogen and are left with either a post-infectious disorder of absorption, digestion, motility or visceral sensation or carry a chronic gastrointestinal disorder which has been unmasked by an enteric infection, such as idiopathic inflammatory bowel disease, gastrointestinal malignancy or celiac sprue. Other key issues raised by the case include the vanishing incidence of tropical sprue, an entity to which most clinicians would have mistakenly attributed this malabsorptive syndrome arising in a traveler, and the under-recognition of the protean manifestations of celiac sprue, to which we would add persistent travelers' diarrhea. ( info) |
4/14. Tropical sprue in two foreign residents, with evidence of tropheryma whippelii in one case. Tropical sprue is a rare disease in travelers. Its etiology remains unclear. We report two cases of tropical sprue occurring in long-term residents in nepal and cameroon. In one case, tropheryma whippelii, the agent of Whipple's disease, was identified. Many infectious agents have been suggested to be the etiological agent of tropical sprue, but no association with Whipple's disease has yet been reported. ( info) |
5/14. Tropical sprue in expatriates from the tropics living in the continental united states. The results of clinical, laboratory and therapeutic observations conducted over a seven year period in 40 expatriates from the tropics who presented in new york city with overt tropical sprue have been described. The majority of subjects presented with symptoms referable to the gastrointestinal tract, weight loss and weakness. Only nine were symptomatic at the time of arrival; the remainder developed symptoms within several months to 14 years after arrival. Thirty-five subjects had a megaloblastic anemia; this was a secondary to a combined deficiency of folate and vitamin B12 in 25 and to deficiency of only one of these vitamins in the other ten. serum concentrations of albumin, calcium, and cholesterol were subnormal in approximately one-half and the serum carotene concentrations were low in all but two subjects. serum values of one or more immunoglobulin were reduced in 19. All 40 subjects had malabsorption of xylose; 12 of 19 tested had malabsorption of a pharmacologic dose of folic acid; 27 of 28 tested had malabsorption of vitamin B12; and 23 of 27 persons tested had steatorrhea. Jejunal morphology was abnormal in 34 of 35 subjects biopsied prior to treatment; villi were completely absent in four and showed changes of moderate severity in 30. Treatment with pharmacologic doses of folic acid or vitamin B12 produced a clinical remission in 18 of 21 patients. This remission was sustained in all 14 subjects who were followed for periods of from one to four years and reevaluation of intestinal morphology and function in nine showed improvement in all, but return to normal in less than one-half. Treatment with oral tetracycline for three weeks resulted in clinical improvement in 11 of 12 subjects, a hematologic response in nine of the ten cases who had a megaloblastic anemia, increased absorption of xylose and cessation of steatorrhea in all, and improved jejunal morphology in 11. Vitamin B12 absorption remained subnormal in nine. Continued antibiotic therapy for six months in eight patients was associated with additional weight gain, further improvement in jejunal morphology and xylose absorption in all, and return of vitamin B12 absorption to normal in all except one. Fifty asymptomatic expatriates from the west indies were surveyed for abnormalities of intestinal function. The absorption of xylose was reduced in six (24%) of 25 subjects who had been resident in a temperate climate for less than one year but in only one (4%) of 25 persons who had been away from the tropics for more than a year.(ABSTRACT TRUNCATED AT 400 WORDS) ( info) |
6/14. Chronic enterocyte infection with coronavirus. One possible cause of the syndrome of tropical sprue? A man with a gastrojejunostomy and intestinal malabsorption was found to be excreting large numbers of coronavirus-like particles in his stools over a period of at least eight months. coronavirus-like particles were found in vesicles in degenerating jejunal enterocytes in all of five jejunal biopsies. In a review of electron micrographs, similar structures were found in biopsies from three of 12 patients with classical chronic tropical sprue and in one patient with a sprue-like syndrome associated with agammaglobulinaemia. The hypothesis is advanced that infection with this virus may produce enterocyte damage and may be one cause of the syndrome of tropical sprue. ( info) |
7/14. Pancreatic calcification not due to alcohol consumption. A case report. An 18-year-old woman presented with diabetes, pancreatic calcification and evidence of malabsorption. The features of calcific pancreatitis unrelated to alcohol consumption are discussed. ( info) |
8/14. Hypogammaglobulinaemic sprue in tropics: Report of an Indian patient. Acquired hypogammaglobulinaemia is a rare disease and has not been reported from tropical regions before. A fourteen year old boy, who had symptoms of intestinal malabsorption since the age of seven years, was investigated and found to be suffering from severe hypogammaglobulinaemic sprue which ended fatally. The problems in diagnosis and management of this rare disorder have been highlighted. ( info) |
9/14. Antibiotic-responsive malabsorption: a tropical sprue-like syndrome in countries with temperate climates. Antibiotic-responsive malabsorption is prevalent in the tropics, but has been seen only sporadically in countries with temperate climates. We describe a 19-year-old Israeli patient who has never left the country and was hospitalized with shigellosis and malabsorption of fat and D-xylose. A short course of ampicillin reversed the malabsorption. The syndrome of antibiotic-responsive malabsorption in countries with temperate climates may well be underdiagnosed and should be looked for more actively. ( info) |
10/14. Tropical sprue in travelers and expatriates living abroad. Changes in the world political situation, the rapidity of transportation, and the availability of effective therapy have altered the pattern of sprue in persons going to the tropics. Gone, for the most part, are the days when expatriates liver for years in tropical areas, progressed on the full-blown pattern of debilitating disease when they acquired sprue, and then were never totally cured either by return home or by the then-available forms of therapy. Today, visitors to the tropics usually return home by jet aircraft within weeks or months after acquiring the disease, and thus they present just with manifestations of small bowel disease in the absence of nutritional deficiencies. In this circumstance, the differential diagnosis usually lies between sprue and giardiasis. Both of these disorders are caused by chronic contamination of the small bowel by enteric pathogens, and both can be cured by specific therapy directed at eradicating these organisms. In contrast to the situation in travelers, sprue among the indigenous population of the tropics remains largely unchanged: a chronic debilitating disorder that represents a significant contributory factor to the pathogenesis of morbidity and malnutrition in some areas. ( info) |