WordNet

of or relating to the tropics, or either tropic; "tropical year"
of weather or climate; hot and humid as in the tropics; "tropical weather" (同)tropic
relating to or situated in or characteristic of the tropics (the region on either side of the equator); "tropical islands"; "tropical fruit" (同)tropic
characterized by or of the nature of a trope or tropes; changed from its literal sense
either of two parallels of latitude about 23.5 degrees to the north and south of the equator representing the points farthest north and south at which the sun can shine directly overhead and constituting the boundaries of the Torrid Zone or tropics
a chronic disorder that occurs in tropical and non-tropical forms and in both children and adults; nutrients are not absorbed; symptoms include foul-smelling diarrhea and emaciation (同)tropical_sprue, psilosis

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『熱帯の』,熱帯性の,熱帯産の / 酷暑の
〈C〉回帰線 / 《the tropics》熱帯地方 / 熱帯[地方]の(tropical)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/26 13:03:26」(JST)

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Tropical sprue is a malabsorption disease commonly found in the tropical regions, marked with abnormal flattening of the villi and inflammation of the lining of the small intestine. It differs significantly from coeliac sprue.

Signs and symptoms[edit]

The illness usually starts with an attack of acute diarrhea, fever and malaise following which, after a variable period, the patient settles into the chronic phase of diarrhoea, steatorrhoea, weight loss, anorexia, malaise and nutritional deficiencies. The symptoms of tropical sprue are:

Diarrhea
Steatorrhea or fatty stool (often foul-smelling and whitish in colour)
Indigestion
Cramps
Weight loss and malnutrition
Fatigue

Left untreated, nutrient and vitamin deficiencies may develop in patients with tropical sprue. These deficiencies may have the following symptoms:

Vitamin A deficiency: hyperkeratosis or skin scales
Vitamin B₁₂ and folic acid deficiencies: anaemia
Vitamin D and calcium deficiencies: spasm, bone pain, numbness and tingling sensation
Vitamin K deficiency: bruises

Tropical sprue was responsible for one-sixth of all casualties sustained by the Allied forces in India and Southeast Asia during World War II.^[1]

Investigations[edit]

Diagnosis of tropical sprue can be complicated because many diseases have similar symptoms. The following investigation results are suggestive:

Abnormal flattening of villi and inflammation of the lining of the small intestine, observed during an endoscopic procedure.
Presence of inflammatory cells (most often lymphocytes) in the biopsy of small intestine tissue.
Low levels of vitamins A, B₁₂, E, D, and K, as well as serum albumin, calcium, and folate, revealed by a blood test.
Excess fat in the feces (steatorrhoea).
Thickened small bowel folds seen on barium swallow

Tropical sprue is largely limited to within about 30 degrees north and south of the equator. Therefore, if one resides outside of that geographical region, recent travel to the region is a key factor in diagnosing this disease.

Cause[edit]

The cause of tropical sprue is not known.^[2] It has been suggested that it is caused by bacterial, viral, amoebal, or parasitic infection. Folic acid deficiency and rancid fat have also been suggested as possible causes.

In a condition called coeliac disease (also known as coeliac sprue), which has similar symptoms to tropical sprue, the flattening of the villi and small intestine inflammation is caused by an autoimmune disorder triggered by ingested gluten.

Affected regions[edit]

The disease was first described by William Hillary^[3] in 1759 in Barbados. Tropical sprue is endemic to the Caribbean, Central and South America, and India and southeast Asia.

Treatment[edit]

Once diagnosed, tropical sprue can be treated by a course of the antibiotic tetracycline or Sulfamethoxazole/Trimethoprim (Co-trimoxazole) for 3 to 6 months, as well as supplementation of vitamins B₁₂ and folic acid.

The use of folic acid in the treatment of tropical sprue was promoted in the late 1940s by Dr. Tom Spies of the University of Alabama, while conducting his research in Cuba and Puerto Rico.^[4]^[5]

Prevention[edit]

Preventive measures include using only bottled water for drinking, brushing teeth, and washing food, and avoiding fruits washed with tap water (or consuming only peeled fruits, such as bananas and oranges).

Prognosis[edit]

The prognosis for tropical sprue is excellent. It usually does not recur in patients who get it during travel to affected regions. The recurrence rate for natives is about 20%.

References[edit]

^ UAB Department of Nutrition Sciences - History
^ Cook GC (March 1997). "Tropical sprue: some early investigators favoured an infective cause, but was a coccidian protozoan involved?". Gut 40 (3): 428–9. PMC 1027098. PMID 9135537. Cite uses deprecated parameters (help)
^ Bartholomew C (November 1989). "William Hillary and sprue in the Caribbean: 230 years later". Gut 30 (Special issue): 17–21. PMC 1440696. PMID 2691344. Cite uses deprecated parameters (help)
^ UAB Department of Nutrition Sciences - History
^ JAMA: DR. SPIES RECEIVES DISTINGUISHED SERVICE MEDAL (1957)

External links[edit]

InteliHealth - Tropical Sprue
Health In Plain English - Tropical Sprue
Malabsorption Syndromes: Tropical Sprue at Merck Manual

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 熱帯性スプルー tropical sprue
2. 蛋白漏出性胃腸症 protein losing gastroenteropathy
3. 小腸内細菌過剰繁殖の臨床症状および診断 clinical manifestations and diagnosis of small intestinal bacterial overgrowth
4. ジアルジア症の疫学、臨床症状、および診断 epidemiology clinical manifestations and diagnosis of giardiasis
5. 色素内視鏡検査 chromoendoscopy

English Journal

Neil Hamilton Fairley KBE FRCP FRS (1891-1966): an outstanding tropical physician in the twentieth century.

Cook GC1.
Journal of medical biography.J Med Biogr.2014 Nov;22(4):215-20. doi: 10.1177/0967772013479534. Epub 2014 May 15.
In the late nineteenth and early twentieth centuries, British physicians led the way in tropical medicine research. Several years later scientific advances had slowed, and Fairley's numerous contributions were thus most welcome. Neil Hamilton Fairley was born of Scottish parents at Victoria, Austral
PMID 24833541

The biopsy pathology of non-coeliac enteropathy.

Greenson JK1.
Histopathology.Histopathology.2014 Sep 18. doi: 10.1111/his.12522. [Epub ahead of print]
Tropical sprue (TS) is a malabsorption syndrome of presumed infectious aetiology that affects residents of (or visitors to) the tropics. The histological changes of TS are similar to those of coeliac disease, with increased intraepithelial lymphocytes being central to both. Unlike in coeliac disease
PMID 25234408

Distinguishing tropical sprue from celiac disease in returning travellers with chronic diarrhoea: a diagnostic challenge?

Langenberg MC1, Wismans PJ2, van Genderen PJ3.
Travel medicine and infectious disease.Travel Med Infect Dis.2014 Jul-Aug;12(4):401-5. doi: 10.1016/j.tmaid.2014.05.001. Epub 2014 May 16.
BACKGROUND: Within the present era of worldwide travel, it is important for all clinicians to consider the possibility of tropical sprue (TS) in returning patients with persistent diarrhoea after travel. The symptoms and histologic findings of TS can resemble but also be confused with celiac disease
PMID 24889052

Japanese Journal

吸収不良症候群原発性吸収不良症候群 (ツェアック-スプルーと熱帯性スプルー)

馬場忠雄,佐々木雅也
日本内科学会雑誌 85(7), 1061-1065, 1996-07-10
NAID 10005523978

腸炎における粘膜構造の改築特に絨毛癒着の意義に就て

国田五重,Kunita Yukie
熱帯医学 14(2), 86-96, 1972-06
… The acute enteritis of cholera, at a glance, confusingly resembles the chronic enteritis of sprue, celiac disease etc. …
NAID 120000914023