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Tropical Sprue
Published in Charles Theisler, Adjuvant Medical Care, 2023
Tropical sprue is a malabsorption disease commonly found in tropical regions. The name sprue derives from a Dutch word describing inflammation of the mouth, wherein a sore tongue (glossitis) is a frequent symptom. In tropical sprue, the small intestine's ability to absorb nutrients is impaired due to abnormal flattening of the villi and inflammation of the lining. The proximal small bowel is involved in absorption and maintenance of an adequate supply of folic acid, whereas the distal portion is essential for absorption of vitamin B12. Therefore, nutritional deficiencies, especially of folate and vitamin B12, eventually develop after several months to years. This condition is characterized by abdominal cramps, abundant nonbloody diarrhea that is pale and foul-smelling, glossitis, anorexia, weight loss, bloating, abdominal cramps, fatigue, and megaloblastic anemia resulting in general weakness.1
Gastrointestinal Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Diagnosis of the syndrome is clinical. In most refugee settings, laboratory support is not available. Take a careful history, including the nature of the diarrhoea (e.g. bloody, watery, duration and associated features). In epidemics, watery diarrhoea (rice water) is suggestive of cholera, whereas dysentery suggests Sd1. Fever, anorexia, crampy abdominal pain and tenesmus are suggestive of the latter. Steatorrhea, bloated, cramps and flatulence suggest giardiasis. Chronic diarrhoea with nutrient malabsorption (particularly B12 and folate deficiency) suggests tropical sprue.
Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Tropical sprue is a malabsorptive disorder of unknown etiology which affects the indigenous population as well as travelers to the tropics. The diagnosis is established by evidence of malabsorption in the appropriate epidemiologic setting. The clinical features include diarrhea, which is occasionally bloody, steatorrhea, abdominal pain, weight loss, fever, glossitis, and anemia. The condition should be suspected when a patient with diarrhea and malabsorption resides in or has recently returned from an endemic tropical area. The duration in the tropics may be brief and may precede the onset of symptoms by months or even years. The disease may be simulated by intestinal infections, especially giardiasis, but also amebiasis and shigellosis. Nontropical sprue is not usually accompanied by fever, and its presence during the course of this disorder suggests a complication such as intestinal lymphoma.
Copper deficiency, a rare but correctable cause of pancytopenia: a review of literature
Published in Expert Review of Hematology, 2022
Nayha Tahir, Aqsa Ashraf, Syed Hamza Bin Waqar, Abdul Rafae, Leela Kantamneni, Taha Sheikh, Rafiullah Khan
A high index of suspicion is required when evaluating a patient with potential copper deficiency. Culprits such as bariatric surgery leading to malabsorption, zinc supplementation for conditions such as macular degeneration, severe malnourishment, use of denture adhesive paste containing high levels of zinc, copper chelation therapy in Wilson’s disease, protein-losing enteropathies like celiac disease, tropical sprue, or inflammatory bowel disease are some conditions in a patient’s medical history that prompt further inquiry. Menkes syndrome, which is a rare X-linked recessive disorder, must be considered especially in boys. Prolonged use of proton pump inhibitors can cause decreased absorption of copper; hence, a review of the medications a patient is taking is valuable [42]. Hence, a thorough past medical, surgical, family, and medication history are essential to collect while interviewing the patient.
Genetic and flow cytometry analysis of seronegative celiac disease: a cohort study
Published in Scandinavian Journal of Gastroenterology, 2019
Raquel Ríos León, Laura Crespo Pérez, Enrique Rodríguez de Santiago, Garbiñe Roy Ariño, Ana De Andrés Martín, Carlota García Hoz Jiménez, Eugenia Sánchez Rodríguez, Ana Saiz González, Francisco León Prieto, Agustín Albillos
This was a retrospective single-center study. The inclusion criteria were: (1) consecutive patients diagnosed with CD over the period 1980–2017 at the Hospital Ramón y Cajal (Madrid, Spain); (2) age of diagnosis ≥15 years. Patients were excluded if:An initial biopsy showed a Marsh = 0;They were seronegative with a biopsy Marsh I score and had not been immunophenotyped or their IELs phenotype was incompatible with a diagnosis of CD.They were seronegative and: (a) lacked the characteristic immunophenotype in the initial biopsy; (b) had been diagnosed with a non-celiac cause of villous atrophy such as Helicobacter pylori, Giardia lamblia or HIV infection, intestinal lymphoma, eosinophilic gastroenteritis, Crohn’s disease, bacterial overgrowth, drug-related mucosal damage (NSAIDs, olmesartan, mofetil mycophenolate, methotrexate and azathioprine), collagen sprue, tropical sprue, radiation enteritis, Whipple’s disease and autoimmune enteropathy [12]; (c) following a GFD at the time of diagnosis.
An updated overview on celiac disease: from immuno-pathogenesis and immuno-genetics to therapeutic implications
Published in Expert Review of Clinical Immunology, 2021
Paolo D’Avino, Gloria Serena, Victoria Kenyon, Alessio Fasano
RCD diagnosis is complex as it has to follow several criteria: small bowel diseases such as autoimmune enteropathy, tropical sprue or common immunodeficiency have to be excluded and patients have to show persistent malabsorption and villous atrophy after one year of strict adherence to GFD. An endoscopy assessment is required [149,150]. Moreover, to diagnose RCD it is necessary to exclude surreptitious or unsuspected ingestion of gluten, or contamination with gluten during processing of foods. The value of the determination of gluten immunogenic peptides (GIP) in feces or urine may allow to differentiate these cases from the true refractory ones [151,152].