Tropical Sprue

[katana]

Hi,

Does anyone know the Thai for 'Tropical Sprue'?

(It's a rare digestive disorder found in the tropics/subtropics/SE Asia etc).

Thanks in advance for any advice/help.

[bina]

funny, i've never heard of that but just looked it up/ my thai worker fits that description exactly (barring the fact that he drinks like a fish which adds to weight loss and malnutrition)diahhrea, weight loss, etc etc..... and his wife has sent him several times vitamins that were for sports people i.e. B12, B6 etc... like an anti stress vitamin... they are issan people... just curious if thai doctors are aware and recommend vitamins and then as typically they do, these guys apply the treatments w/o even knowing the original reason (same reason they all take worming pills once every few months... i asked why they couldnt tell me... i found out they eat a lot of raw meat and so are liable to be infected w/lots of different kinds of parasites)....

a little off the topic but... doesnt look like a terribly life threatening disease unless u are pregnant in which case the folic acid b12 etc and anemia can cause lots fo problmes...

curious if we get this in israel... we have lots and lots of people w/b12 lack and anemia....??

[katana]

Hi,

Someone I know has a suspected diagnosis of Sprue after returning from Thailand. But it’s quite a rare disease and is hard to diagnose and is frequently missed by doctors who just put it down to IBS or Traveller’s diarrhoea etc. It affects natives and travellers alike.

Your friend could have it since it apparently interferes with vitamin absorption (hence the vitamin injections)?

Funnily enough, it responds to antibiotics but there’s never been a bacterium isolated that is held to be responsible for it.

During World War II it was responsible for 1/6 of all allied deaths in India and SE Asia (this was before antibiotics became widely available). I was wondering if there’s some colloquial Thai term for it, since there are reports of it going back at least a couple of hundred years.

[taxexile]

as its an unusual and hard to diagnose complaint i would be surprised to hear that there was a specific thai term for it.

i caught it in nepal in 1985 and lost a lot of weight very quickly , western doctors there failed to diagnose it and told me i probably had colon cancer , (i think they were more interested in getting the kudos for helicoptering climbing casualties off mt. everest than treating dirty travellers with diarrhoea ) i rushed back to london and went to the hospital for tropical diseases where they quickly diagnosed it and put my worried mind at rest.

it is a condition where the lining of the first part of the small intestine loses the ability to absorb (among other things ) fats , hence the weight loss , the treatment was a weeks course of a common antibiotic.

[katana]

Hi,

Thanks for your reply. Glad to hear you made a full recovery.

Can I ask, what tests they did to determine that you had Sprue?

Just contacted the local Thai Hospital, apparently the Thai for Tropical Sprue is ROHK PIT SA-PROO โรคบิดสปรู (literally 'Sprue dysentery illness'), so it seems in part to be direct transliteration from the English (or Dutch).

[waldwolf]

.....Can I ask, what tests they did to determine that you had Sprue?

<{POST_SNAPBACK}>

Griffith's Clinical Consult lists the following diagnosis and treatment:

TROPICAL SPRUE

DIAGNOSIS

SIGNS AND SYMPTOMS:

  •Fatigue

  •Asthenia

  •Weight loss, pallor

  •Diarrhea

  •Abdominal cramps

  •Borborygmus

  •Night blindness

  •Stomatitis

  •Glossitis

  •Cheilosis

  •Anorexia

  •Steatorrhea

  •Hyperkeratosis

  •Edema

  •Abdominal distension

  •Hyperpigmentation

  •Koilonychia

CAUSES:

  •Unknown

  •Possible dietary deficiency

  •Possible infectious agent

  •Vitamin deficiency (folate), B12

  •Food toxins (rancid fats)

  •Toxigenic strains of coliform bacteria

DIFFERENTIAL DIAGNOSIS:

  •Other causes of megaloblastic anemia

  •Other malabsorption syndromes

  •Celiac disease

  •Inflammatory bowel disease

  •Giardiasis

  •Strongylosis

  •Other infectious causes:

      •Coccidial isospora

      •Capillaria philippinensis

      •Cryptosporidium

LABORATORY:

  •Megaloblastic anemia in 60% of cases

  •Steatorrhea

  •Decreased D-Xylose

  •Decreased serum iron

  •Decreased calcium

  •Decreased folic acid

  •Decreased serum vitamin B12

  •Decreased serum carotene

  •Decreased cholesterol, albumin

  •Deficiency of magnesium

  •Deficiency of alpha-tocopherol

PATHOLOGICAL FINDINGS:

Jejunal biopsy - mild villous atrophy, increased villous crypts, mononuclear cell infiltration

SPECIAL TESTS:

Serum vitamin B12

IMAGING:

  •Mild jejunal dilatation

  •Jejunal fold coarsening

  •Flocculation and segmentation of Barium meal

DIAGNOSTIC PROCEDURES:

  •Jejunal biopsy - not specific

  •Malabsorption of at least two nutrients is considered essential for diagnosis

  •D- Xylose, fat and radiolabeled vitamin B12 are used to test for absorptive capacity

  •Stool microscopy

  •Imaging - not specific

MEDICATIONS

DRUG(S) OF CHOICE:

  •Vitamin B12 1000 mcg SC for several days, then monthly thereafter for 6 months

  •Folic acid 5 mg po daily

  •Tetracycline 250 mg qid for 1-2 months, then half doses for up to 6 months. Occasionally, longer course is required.

  •Combination folic acid and B12 plus tetracycline or sulfonamide

Contraindications: Allergy to tetracycline or oxytetracycline

Precautions:

  •Use with caution in patients with lupus, myasthenia gravis, kidney or liver disease

  •Don't take with milk, antacids or iron preparations

  •Don't use during pregnancy

  •Don't use in children under age 8

Significant possible interactions:

  •Antacids, anticoagulants, bismuth subsalicylate

  •Oral contraceptives

  •Lithium

ALTERNATIVE DRUGS:

  •Oxytetracycline

  •Nonabsorbable sulfonamides

As with any potentially serious disease, it is always best to consult a medical professional as early as possible.

[taxexile]

Can I ask, what tests they did to determine that you had Sprue?

after being seen at the hospital and giving my symptoms , (tiredness , huge appetite , weight loss , steatorrhea {lots of fat in the stools , they float !}) they took some blood for testing and sent me home with a big plastic container and asked me to collect my feces for three days and then bring it back. had a nervous journey back to hospital on the london underground carrying my full container and spent a night in there and the next morning had a jejunal biopsy , this involved swallowing a small metal device on a wire thread , it looked like a very small steel frankfurter , that passes through the stomach and into the first part of the smal intestine (jejunum) where it takes a small sample of the lining , then its pulled out and they can look at the sample. the nature of the lining is changed by the disease and they can tell straight away. i was given a few days of antibiotics and everything righted itself.

the biopsy was painless , the worst part of it all was the journey back to the hospital on a crowded train with the container and hoping i wouldnt drop it.

all this was 20 years ago and maybe the testing procedures have changed now.

[katana]

Taxexile and waldwolf,

Thanks for the info.