Tropical sprue laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
Tropical sprue is diagnosed based on the following criteria: | |||
*Clinical presentation with chronic non bloody diarrhea with malabsorption | |||
*Presence of malabsorption for two different substances | |||
*Abnormal small intestinal histological findings | |||
*Exclusion of other causes of malabsorption | |||
*Response to treatment with tetracycline and folic acid | |||
All the patients with celiac disease unresponsive to gluten free diet, a diagnosis of tropical sprue must be considered. The lab findings are not specific for tropical sprue as it is a diagnosis of exlclusion. <ref name="pmid22405324">{{cite journal| author=Bonnefoy S, Chauvin A, Galéano-Cassaz C, Camilleri-Broet S, Jacquet SF, Carmoi T et al.| title=[Tropical sprue in an expatriate]. | journal=Rev Med Interne | year= 2012 | volume= 33 | issue= 5 | pages= 284-7 | pmid=22405324 | doi=10.1016/j.revmed.2012.01.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22405324 }} </ref> | All the patients with celiac disease unresponsive to gluten free diet, a diagnosis of tropical sprue must be considered. The lab findings are not specific for tropical sprue as it is a diagnosis of exlclusion. <ref name="pmid22405324">{{cite journal| author=Bonnefoy S, Chauvin A, Galéano-Cassaz C, Camilleri-Broet S, Jacquet SF, Carmoi T et al.| title=[Tropical sprue in an expatriate]. | journal=Rev Med Interne | year= 2012 | volume= 33 | issue= 5 | pages= 284-7 | pmid=22405324 | doi=10.1016/j.revmed.2012.01.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22405324 }} </ref> | ||
*Patients with ileal involvement will have low vitamin B12 and folate levels. | *Patients with ileal involvement will have low vitamin B12 and folate levels. | ||
*Normal transglutaminase, immunoglobulin levels are present. | *Normal transglutaminase, immunoglobulin levels are present. | ||
*Peripheral blood smear will demonstrate megaloblastic picture. | *Peripheral blood smear will demonstrate megaloblastic picture. | ||
===Approach to a Patient With Malabsorption in Tropical Region=== | ===Approach to a Patient With Malabsorption in Tropical Region=== | ||
{{familytree/start}} | {{familytree/start}} |
Revision as of 15:34, 13 April 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory Findings
Tropical sprue is diagnosed based on the following criteria:
- Clinical presentation with chronic non bloody diarrhea with malabsorption
- Presence of malabsorption for two different substances
- Abnormal small intestinal histological findings
- Exclusion of other causes of malabsorption
- Response to treatment with tetracycline and folic acid
All the patients with celiac disease unresponsive to gluten free diet, a diagnosis of tropical sprue must be considered. The lab findings are not specific for tropical sprue as it is a diagnosis of exlclusion. [1]
- Patients with ileal involvement will have low vitamin B12 and folate levels.
- Normal transglutaminase, immunoglobulin levels are present.
- Peripheral blood smear will demonstrate megaloblastic picture.
Approach to a Patient With Malabsorption in Tropical Region
Clinical suspicion of malabsoption syndrome | |||||||||||||||||||||||||||||||||||||||||||||||
Initial screening perform: Stool Microscopy to rule out infectious causes D-xylose test to rule out intestinal enterocyte dysfunction Fecal fat test to rule out steatorrhea | |||||||||||||||||||||||||||||||||||||||||||||||
Confirmatory tests for malabsoption should be done | |||||||||||||||||||||||||||||||||||||||||||||||
Antiendomysial antibodies and villous atrophy suggests celiac disease Breath test for lactase deficiency Microscopy and culture of jejunal aspirate for small bowel bacterial overgrowth Serum immunoglobulin for B-celll deficiency HIV serology CT enterography Abdomen CT to rule out chronic pancreatitis | |||||||||||||||||||||||||||||||||||||||||||||||
Once other possibilities are ruled out, suspect diagnosis of tropical sprue | |||||||||||||||||||||||||||||||||||||||||||||||
Start tetracycline therapy Improvement of symptoms with tetracycline confirms the diagnosis | |||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Bonnefoy S, Chauvin A, Galéano-Cassaz C, Camilleri-Broet S, Jacquet SF, Carmoi T; et al. (2012). "[Tropical sprue in an expatriate]". Rev Med Interne. 33 (5): 284–7. doi:10.1016/j.revmed.2012.01.015. PMID 22405324.