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.[2]
- 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 test for the presence of intestinal enterocyte dysfunction Fecal fat test for detection of steatorrhea | |||||||||||||||||||||||||||||||||||||||||||||||
| Confirmatory tests for malabsoption should be done | |||||||||||||||||||||||||||||||||||||||||||||||
| Positive antiendomysial antibodies and villous atrophy suggests celiac disease Positive breath hydrogen test suggests lactase deficiency Positive microscopy and culture of jejunal aspirate suggests small bowel bacterial overgrowth Low serum immunoglobulin suggests B-cell deficiency HIV serology CT enterography to rule out intestinal inflammatory conditions 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.
- ↑ Misra RC, Kasthuri D, Chuttani HK (1967). "Correlation of clinical, biochemical, radiological, and histological findings in tropical sprue". J Trop Med Hyg. 70 (1): 6–10. PMID 6016817.