Tropical sprue laboratory findings
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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.