TROPICAL SPRUE

·         Usually seen in tropical areas.

·         Most common causes of chronic diarrhea in tropical countries are Infectious agents (Giardia lamblia, Yersinia enterocolitica, Clostridium difficile, Cryptosporidium parvum, and Cyclospora), Therefore, to establish a case of tropical sprue, first rule out infectious causes (via excluding presence of cysts & trophozoite in three stool samples)

·         Etiology – Uncertain (maybe infectious, as it usually responds to antibiotics)

·         Histological features-

SIMILARITIES WITH CELIAC SPRUE	DIFFERENCES FROM CELIAC SPRUE
Shortening & blunting of villi Crypt hyperplasia Intraepithelial lymphocytes ↑ lymphocytes & plasma cells in lamina propria	Severity of disease is same throughout the small intestine (in celiac disease, there is proximal-to-distal distribution of severity)
	Less alteration of villous-architecture but ↑ mononuclear infiltrate in lamina propria & megaloblastic change (atypical enlargement of nuclei of epithelial cells)
	Non-responsive to gluten-free diet
	No risk of lymphoid malignancy

·         Clinical features-

§  Chronic diarrhea

§  Steatorrhoea

§  Weight loss

§  Nutritional deficiencies (esp. Vit B₁₂ & Folic Acid)

·         Treatment-

§  Broad spectrum antibiotics (Tetracycline for 6mths.) + Folic acid

§  Leave the tropical area