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Christophe Rosty - One of the best experts on this subject based on the ideXlab platform.

  • Tropical Sprue: revisiting an underrecognized disease
    The American journal of surgical pathology, 2014
    Co-Authors: Ian Brown, Andrew Bettington, Mark Bettington, Christophe Rosty
    Abstract:

    Tropical Sprue is an acquired chronic diarrheal disorder of unclear etiology affecting residents of and visitors to Tropical regions. Patients usually present with profuse diarrhea, weight loss, and malabsorption, notably of vitamin B-12 and folate. The histologic changes typically resemble that of gluten-sensitive enteropathy. Reports of Tropical Sprue have become infrequent in the literature, and the diagnosis is often not considered either clinically or pathologically. This disease may, however, cause significant morbidity, although it is eminently treatable with broad-spectrum antibiotics. In this study, we report the clinical presentation of 12 Tropical Sprue patients along with the histologic changes of the intestinal mucosa and compare it with those of a series of 150 cases of gluten-sensitive enteropathy, the condition with which it is most frequently misdiagnosed. The cohort comprised 6 men and 6 women with a median age of 59 years (range, 38 to 78 y) with a history of residence or visitation in South Asia or Papua New Guinea. Partial villous blunting in the duodenal mucosa was present in 75% of cases, and a marked intraepithelial lymphocytosis was observed in all cases (mean per 100 epithelial cells 77.3; range, 42 to 124). A villous tip accentuation of intraepithelial lymphocytosis was not appreciable in most cases. No case of complete villous blunting (Marsh stage 3c) was identified in Tropical Sprue, contrasting with 25% in gluten-sensitive enteropathy cases. A duodenal mucosa eosinophil infiltrate was present in all cases with significantly higher counts compared with untreated gluten-sensitive enteropathy patients (26.6/HPF vs. 14.6/HPF; P=0.009). The ileal mucosa displayed more severe villous blunting with higher Marsh stages than in the corresponding duodenum from 5 patients. There was a mild intraepithelial lymphocytosis and eosinophil infiltrate in the colonic mucosa of half of the cases. Follow-up biopsies in 6 patients demonstrated a histologic response after oral folates and doxycycline treatment. In summary, Tropical Sprue is a pan-enteric inflammatory process often mistaken for gluten-sensitive enteropathy. Histologic findings suggesting Tropical Sprue in the appropriate clinical context include incomplete duodenal villous blunting without development of flat mucosa, frequent involvement of the terminal ileum with more marked inflammation and villous blunting than in the duodenum, and a conspicuous eosinophil infiltrate in the lamina propria. With the expansion of tourism and increasing employment opportunities in Tropical regions, pathologists in the West are increasingly likely to encounter cases of Tropical Sprue and should be aware of this diagnosis.

Frederick A. Klipstein - One of the best experts on this subject based on the ideXlab platform.

  • Antibiotic Therapy in Tropical Sprue
    Annals of Internal Medicine, 2020
    Co-Authors: Frederick A. Klipstein
    Abstract:

    Excerpt The initial observations made 20 years ago that treatment with sulfonamide preparations arrested the diarrhea of military personnel in India afflicted with Tropical Sprue (1-3) have subsequ...

  • Tropical Sprue in Haiti
    2016
    Co-Authors: Frederick A. Klipstein, Michael I. Samloff, Eric A. Schenk
    Abstract:

    THE FIRST DESCRIPTION of Tropical Sprue was presented over 2 centuries ago by Hillary from the island of Barbados in the West Indies (1, 2). Since that time, the presence of endemic Tropical Sprue in the West Indies has been thoroughly docu-mented on the islands of Cuba (3) and Puerto Rico (4, 5); however, the disease is alleged never to have been seen in Jamaica (4) and has not been reported from Haiti or other islands in the Caribbean. A recent nutritional survey by Sebrell and his associates (6) has indicated that a high prevalence of anemia and multiple nutritional deficiencies exists in the rural population of Haiti. In a preliminary stud

V. I. Mathan - One of the best experts on this subject based on the ideXlab platform.

  • Printed in U.S.A. Syndrome of Tropical Sprue in
    2016
    Co-Authors: S. J. Baker, V. I. Mathan
    Abstract:

    associateti wi tim iimtestinal maiabsorp-tion anti immultiple nutri tioimal deficiencies, has been described under a variety of dif-ferent names (Table i). From the pub-lished descriptions it is clear that all these are synonyms for the same condition. Since “Tropical Sprue ” is the name most commonly enmployed, timere seems little reason, at present, to use any of the other terms. By definitioim, timen, Tropical Sprue is “intestinal malabsorption of unknown etiology, occurring among residents in, or visitors to, time tropics.” This syndronme lmas apparently been present in India for over 2 thousand years, as simown by time excellent description found in time writings of Caraka (1, 8). To-day it is pret1ent timrougimoutt the Indian subcontiiment and occurs in both endemic and epidemic forms (8). It is not known whether time entiemic and epitiemic types are time same or different diseases, but in gen-eral the two resemble eacim other very closely and in timis paper timey imave been groupeti togetimer. Time description which follows is based on patients stuttiied in time metabolic ward of time Wellcome Research Unit over time last 4 years. Fom tlmis analysis “a case

  • Intestinal transit in healthy Southern Indian subjects and in patients with Tropical Sprue
    2015
    Co-Authors: V Jayanthi, A Chacko, Karim I Gani, V. I. Mathan
    Abstract:

    SUMMARY Whole gut transit was measured in a group of 21 healthy volunteers and 21 patients with Tropical Sprue by radio-opaque marker technique, using mean transit time single (MTTS) and single stool transit (SST) method. Mean SST in controls was 25-8 (1P4) (SE) hours, which is considerably shorter than in controls in temperate zones. Mean SST (23-7 (0 6) h) correlated significantly with average MTTS (24-9 (1P6) h) (r=0-88; p<0001) confirming that SST is a valid method to measure intestinal transit in the tropics. Patients with Tropical Sprue had a mean SST similar to controls (24-4 (1.1) h), in spite of significantly higher faecal weights (580 (41-2) g v 252 (17-2) g; p<0 001). Variability in intestinal transit in different population groups may have considerable epidemiological significance because gut transit has been shown to be important in regulating intestinal function.'2 Many of the published reports of intestinal transit are now considered unsatisfactory because of inaccuracies introduced by a high degree of variability in the methods used.3 Though the possibility of changes in gut transit in patients with Tropical Sprue has been suggested,45 the role of transit in the diarrhoea of malabsorption is not fully understood. Therefore we measured whole gut transit in a group of patients with Tropical Sprue and a matched group of asymptomatic controls, using two methods, mean transit time single (MITS) and single stool transit (SST), which have been validated by a continuous steady state marker excretion technique.6

Ian Brown - One of the best experts on this subject based on the ideXlab platform.

  • Tropical Sprue: revisiting an underrecognized disease
    The American journal of surgical pathology, 2014
    Co-Authors: Ian Brown, Andrew Bettington, Mark Bettington, Christophe Rosty
    Abstract:

    Tropical Sprue is an acquired chronic diarrheal disorder of unclear etiology affecting residents of and visitors to Tropical regions. Patients usually present with profuse diarrhea, weight loss, and malabsorption, notably of vitamin B-12 and folate. The histologic changes typically resemble that of gluten-sensitive enteropathy. Reports of Tropical Sprue have become infrequent in the literature, and the diagnosis is often not considered either clinically or pathologically. This disease may, however, cause significant morbidity, although it is eminently treatable with broad-spectrum antibiotics. In this study, we report the clinical presentation of 12 Tropical Sprue patients along with the histologic changes of the intestinal mucosa and compare it with those of a series of 150 cases of gluten-sensitive enteropathy, the condition with which it is most frequently misdiagnosed. The cohort comprised 6 men and 6 women with a median age of 59 years (range, 38 to 78 y) with a history of residence or visitation in South Asia or Papua New Guinea. Partial villous blunting in the duodenal mucosa was present in 75% of cases, and a marked intraepithelial lymphocytosis was observed in all cases (mean per 100 epithelial cells 77.3; range, 42 to 124). A villous tip accentuation of intraepithelial lymphocytosis was not appreciable in most cases. No case of complete villous blunting (Marsh stage 3c) was identified in Tropical Sprue, contrasting with 25% in gluten-sensitive enteropathy cases. A duodenal mucosa eosinophil infiltrate was present in all cases with significantly higher counts compared with untreated gluten-sensitive enteropathy patients (26.6/HPF vs. 14.6/HPF; P=0.009). The ileal mucosa displayed more severe villous blunting with higher Marsh stages than in the corresponding duodenum from 5 patients. There was a mild intraepithelial lymphocytosis and eosinophil infiltrate in the colonic mucosa of half of the cases. Follow-up biopsies in 6 patients demonstrated a histologic response after oral folates and doxycycline treatment. In summary, Tropical Sprue is a pan-enteric inflammatory process often mistaken for gluten-sensitive enteropathy. Histologic findings suggesting Tropical Sprue in the appropriate clinical context include incomplete duodenal villous blunting without development of flat mucosa, frequent involvement of the terminal ileum with more marked inflammation and villous blunting than in the duodenum, and a conspicuous eosinophil infiltrate in the lamina propria. With the expansion of tourism and increasing employment opportunities in Tropical regions, pathologists in the West are increasingly likely to encounter cases of Tropical Sprue and should be aware of this diagnosis.

Guillermo Robles-díaz - One of the best experts on this subject based on the ideXlab platform.