Tropical Sprue

What is tropical sprue?

Tropical sprue is a rare infectious disease that affects your body’s ability to absorb nutrients. It happens when certain bacteria get into your small intestine.

The disease typically affects people who live in or spend a lot of time in tropical areas of the world like the Caribbean, southern India and Southeast Asia. It may start as sudden and severe diarrhea that develops into a less intense but chronic condition.

Without treatment, tropical sprue may cause serious complications, like anemia and malnutrition.

Why is it called tropical sprue?

Medical historians trace the name back to the 1600s. A Dutch doctor used the term “sprouw” to describe chronic diarrhea. About 200 years later, an English doctor studying diarrheal disorders in tropical countries adopted the term. “Sprowu” became “sprue.” Modern-day healthcare providers may use the term non-tropical sprue when they talk about celiac disease or call it “celiac sprue.”

What are the symptoms of tropical sprue?

At first, tropical sprue symptoms may feel like an unusually fierce bout of traveler’s diarrhea. But while traveler’s diarrhea often goes away on its own, tropical sprue symptoms continue and get worse. Other symptoms are:

• Belly cramps.
• Bloated belly.
• Borborygmi, which is the term for the sound your belly and gut make as you digest food.
• Fatigue.
• Nausea.
• Steatorrhea (greasy, light-colored poop that’s unusually smelly).
• Unexplained weight loss.

What causes tropical sprue?

Experts aren’t sure of the exact cause. Research suggests the condition may happen when harmful bacteria get into your small intestine and damage your enterocytes. Bacteria that may be responsible include harmful strains of Escherichia coli (E. coli) and Klebsiella pneumoniae and a third bacterium Enterobacter cloacae.

Enterocytes are cells lining the inside of your intestines. They help your body absorb essential vitamins and minerals so it can develop and prevent infection. Harmful bacteria in your small intestine cause those vitamins and minerals from food to pass through your digestive system as poop instead of making their way into your bloodstream.

What are the risk factors for tropical sprue?

Living in or spending a month or more in a tropical or subtropical area is the most significant risk factor. The disease rarely happens in other regions of the world like Central America, Europe, Mexico or the U.S. Factors like better access to clean water and medical care may be reasons why tropical sprue isn’t common outside tropical regions.

What are the complications of tropical sprue?

Without treatment, tropical sprue may lead to:

• Macrocytic anemia, which happens because your body doesn’t get enough folate, vitamin B2 and B12.
• Malnutrition, which may be life-threatening.

How do healthcare providers diagnose tropical sprue?

A healthcare provider will do a physical examination. They’ll ask about your symptoms and your overall health. For example, they may ask if you’re losing weight without trying or have frequent infections. If you travel to areas where tropical sprue occurs, a provider may order the following tests to pinpoint what’s causing your symptoms:

• Complete blood count (CBC): A provider will look for low red blood cell count (anemia) and low levels of vitamin B12 and folate.
• Comprehensive metabolic panel (CMP): This test may show abnormal levels of essential electrolytes.
• Stool tests: A provider may do stool tests to look for excess fat in your poop. They may do other stool tests to rule out conditions with similar symptoms like giardiasis, strongyloidiasis or cryptosporidiosis.
• Enteroscopy: Your provider may do this test to examine the inside of your small intestine or get tissue samples. A medical pathologist will examine the tissue samples for changes in your small intestine that may be signs of tropical sprue.

How is tropical sprue treated?

Healthcare providers typically treat tropical sprue with a combination of antibiotics and nutritional supplements. You may receive:

• Tetracycline (an antibiotic), which you may need to take for up to six months.
• Folic acid supplements.
• Vitamin B12 injections.

What’s the treatment for tropical sprue in children?

Children rarely get tropical sprue. When they do, their healthcare provider will prescribe an antibiotic other than tetracycline to avoid tooth discoloration. This is a common side effect of tetracycline in children.

Can tropical sprue be prevented?

If you’re traveling in areas where tropical sprue is common, you should take care to avoid situations where you may be exposed to tropical sprue or the bacteria that can cause it. For example:

• Avoid fresh produce unless you can peel it yourself.
• Make sure your food is well cooked.
• Stick to canned or bottled beverages.
• Wash your hands often, especially before eating.
• Carry an alcohol-based sanitizer.

And if you get sick despite your best efforts, get treatment as soon as possible. Receiving prompt treatment to kill bacteria in your small intestine reduces the risk that you’ll develop tropical sprue.

What can I expect if I have tropical sprue?

Treatment typically cures tropical sprue. You’ll have follow-up appointments with your healthcare provider for blood tests to confirm your red blood cell count and vitamin levels are normal.

What’s the outlook for tropical sprue?

The outlook is good, but people who live in areas where tropical sprue happens may get sick again.

How do I take care of myself?

Tropical sprue can put your digestive system through the wringer. While you recover, focus on foods that are easy on your stomach, like bananas, rice, applesauce and toast. Sip on electrolyte drinks to avoid dehydration.

When should I see my healthcare provider?

If tests show you have tropical sprue, you should contact your provider if your symptoms don’t improve with treatment or get worse. Your provider may order more tests to see if something other than tropical sprue causes your symptoms.

What’s the difference between Whipple’s disease and tropical sprue?

Both diseases are bacterial infections that affect your small intestine so your body can’t absorb nutrients. The difference is that Whipple’s disease can also affect your nervous system, heart and lungs.

A note from Cleveland Clinic

Maybe your bucket list included an extended stay in a tropical part of the world, and despite your best effort to protect your digestive system, you have tropical sprue. Certainly, symptoms like a crampy belly and diarrhea for days are no one’s idea of fun. But tropical sprue can lead to serious medical issues like anemia and malnutrition. If you think your symptoms are something more than a case of traveler’s diarrhea, don’t hesitate to talk to a healthcare provider. Early treatment will cure tropical sprue and prevent its complications.