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Tropical sprue: revisiting an underrecognized disease.
Ian S Brown1, Andrew Bettington, Mark Bettington
1*Envoi Specialist Pathologists †Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital §The Conjoint Gastroenterology Laboratory ¶Cancer and Population Studies Group, Queensland Institute of Medical Research, Bancroft Centre ∥School of Medicine, University of Queensland, Herston ‡Sullivan Nicolaides Pathology, Taringa, QLD, Australia.
Tropical sprue is a chronic diarrheal disease often misdiagnosed as gluten-sensitive enteropathy. Early diagnosis and antibiotic treatment are key for managing this treatable condition.
Area of Science:
- Gastroenterology
- Pathology
- Infectious Diseases
Background:
- Tropical sprue is an acquired diarrheal disorder prevalent in tropical regions, characterized by malabsorption.
- Its etiology remains unclear, and it is frequently misdiagnosed, often confused with gluten-sensitive enteropathy.
- Despite its potential for significant morbidity, tropical sprue is effectively treated with broad-spectrum antibiotics.
Purpose of the Study:
- To present the clinical and histological findings of 12 tropical sprue patients.
- To compare these findings with 150 cases of gluten-sensitive enteropathy.
- To highlight key histological features differentiating tropical sprue from gluten-sensitive enteropathy.
Main Methods:
- Retrospective analysis of clinical data and duodenal/ileal mucosal biopsies from 12 tropical sprue patients.
- Histological comparison with 150 cases of gluten-sensitive enteropathy.
- Evaluation of histological response to antibiotic and folate treatment.
Main Results:
- Tropical sprue patients exhibited partial duodenal villous blunting (75%) and marked intraepithelial lymphocytosis (100%).
- A significant duodenal eosinophil infiltrate was noted in all tropical sprue cases, higher than in gluten-sensitive enteropathy.
- Ileal involvement was more severe than duodenal, and histological improvement was observed after treatment.
Conclusions:
- Tropical sprue is a pan-enteric inflammatory condition often mistaken for gluten-sensitive enteropathy.
- Key histological indicators include incomplete duodenal villous blunting, ileal involvement, and eosinophil infiltrate.
- Awareness of tropical sprue is crucial for pathologists, especially with increased travel to tropical regions.
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