Tropical Sprue

By | June 10, 2022

Tropical sprue is caused by bacteria and can severely damage or destroy the lining of the small intestine. In this respect, it belongs causally to a completely different group of diseases than the native sprue (celiac disease), which is mainly known in Europe. Southern India, some countries in Southeast Asia and the Caribbean are the main distribution areas of tropical sprue. There it affects both local residents and those who have recently arrived in the endemic areas for a longer period of time.

What is tropical sprue?

According to current knowledge, tropical sprue is caused by a chronic infection of the small intestine with toxic strains of a coliform bacterium. This is accompanied by a digestive disorder (malabsorption) based on deficiencies in folic acid and vitamin B12. For introduction to histiocytic necrotizing lymphadenitis, please visit

The frequency of new cases of tropical sprue has demonstrably decreased in recent years, presumably because the use of antibiotics has an effect on acute traveler’s diarrhea. The disease often takes its course with severe diarrhea. It is accompanied by fever and a general feeling of weakness. In the following time the diarrhea weakens; increased states of nausea and loss of appetite occur.

More or less severe stomach cramps are added. The entire clinical picture is also characterized by latent tiredness and listlessness. It is not uncommon for the stool to contain a lot of fat due to insufficient fat digestion. The weight loss can sometimes be serious. The lack of folic acid and vitamin B12 typical of tropical sprue only occurs after months or even years in some cases.


Regardless of this, treatment of tropical sprue is with tetracycline. This antibiotic kills the bacteria that cause the disease. It has been shown in studies to be effective, often after just a few days or a few weeks. Tetracycline is the most commonly used antibiotic worldwide against tropical sprue.

250 mg four times a day is possible here, initially for a maximum of two months. Two units per day can then be administered for up to six months. The dose depends on the success of the therapy, which often occurs very quickly. In addition, folic acid (once a day) and vitamin B12 (once a week) are administered.

To compensate for the deficiencies caused by the digestive disorders, nutrients, other vitamins and electrolytes are added as required. If this therapy does not work after four weeks at the latest, the symptoms could point to other diseases. A tropical sprue can be completely overcome in three to six months with optimal treatment.

Symptoms, Ailments & Signs

The disease term tropical sprue (Flemish “sprouw” = “diarrhea”) was introduced in 1880 by Sir Patrick Manson, who worked as an expert on tropical diseases in China. Research on the subject of the condition has shown that it begins with inflammation in the gut. Whether bacteria alone are responsible for this is not yet 100% certain.

In contrast to native sprue, which results from a gluten intolerance, the different courses of the disease indicate a bacterial overgrowth in tropical sprue. A gluten-free diet alone, as in the case of celiac disease, is not an effective remedy for tropical sprue.

Diagnosis & course of disease

Tropical sprue rarely occurs with a high incidence of cases. A relevant outbreak outside of tropical countries is not yet known. The described symptoms of tropical sprue are similar to some other possible diseases. A bone density measurement, a complete blood count, blood tests for folic acid, vitamin B12 and, if necessary, vitamin D provide certainty in the doctor’s diagnosis.

A colonoscopy, especially in the small intestine, then brings clarity about the disease. If necessary, a tissue sample is taken for the diagnosis in order to prove tropical sprue with certainty. In many cases, the disease is characterized by a noticeable swelling of the mucous membrane of the small intestine.


Tropical sprue is caused due to bacterial inflammation of the gut. As a result, malabsorption disorders occur. These can significantly disrupt the balance of nutrients, vitamins and minerals in the body. In contrast to celiac disease, which is also called sprue in children, tropical sprue is curable.

The typical symptoms of a tropical sprue can already be interpreted as a complication of bacterial overgrowth in the intestine. If abdominal cramps, diarrhoea, excessive fermentation and gas formation in the gastrointestinal tract occur during or after a stay in the tropics, accompanied by muscle cramps, weight loss or inexplicable digestive disorders, the cause should be determined as quickly as possible.

As a complication of prolonged tropical sprue, there is a risk of nutrient losses and vitamin deficiency. The sequelae of tropical sprue can cause further complications in young children. Vitamin and mineral deficiencies can result in growth and development disorders in the child’s organism.

Bone maturation can be affected as well as height growth. Both will be badly affected as a result of the effects of a tropical sprue. It is positive that treatment of the rarely occurring tropical sprue is possible even with such complications. Although the exact cause of tropical sprue has not yet been determined, professional treatment can reverse any consequences that have already occurred. However, treatment of tropical sprue with antibiotics and vitamins is lengthy.

When should you go to the doctor?

With this disease, the person affected is always dependent on a medical examination and treatment by a doctor. Early diagnosis with subsequent treatment always has a very positive effect on the further course of the disease and can also prevent further complications or even worsening of the symptoms. Therefore, a doctor should be contacted at the first symptoms or signs. A doctor should be consulted if the person concerned suffers from severe abdominal pain.

This pain occurs in the lower and also in the upper area of ​​the abdomen and significantly reduces the patient’s quality of life. It can also lead to diarrhea or vomiting. Severe heartburn can also indicate the disease. The doctor should also be contacted if these symptoms occur while staying in a tropical area. In many cases there is also a fever and the usual symptoms of a cold. This disease should always be treated in a hospital. With timely treatment, there are no further complications and no reduced life expectancy of the person affected.

Treatment & Therapy

Because of the very similar symptoms, science has long assumed that native and tropical sprue are two manifestations of the same disease. However, it has now been proven that local sprue (celiac disease) is caused by gluten intolerance, while tropical sprue is principally caused by bacteria. The consequences of each untreated disease are actually the same. They show up in the destruction of the mucous membrane of the small intestine.


In the native sprue, the so-called gluten protein is responsible for this, which leads to an allergic reaction in the small intestine. Anyone who no longer eats grain products will be healthy again and need not fear any further negative effects on the digestive processes. The tropical sprue caused by bacteria, which urgently needs to be treated with medication, runs a completely different course.

Experts are of the opinion that the infestation of the intestine with a toxic bacterium leads to further changes in the digestive tract, which can lead to foreign colonization of the intestine. This would also explain the extremely bulky stools that can characterize tropical sprue. There is still no reliable information about which bacterium triggers a tropical sprue.

Although the disease occurs in travelers who are in a tropical sprue range, it often does not become noticeable until weeks or months after the stay there. This is why it is so difficult to find out exactly what causes a tropical sprue, especially since severe diarrhea and weight loss during a long journey can have many other reasons.


Patients who have been diagnosed with tropical sprue should initially follow the doctor’s instructions. The most important measure is the intake of folic acid and cobalamin. In conjunction with long-term antibiotic treatment, the disease is overcome within a few days or weeks. After recovery, the doctor should be consulted again so that comprehensive follow-up care can be carried out.

Follow-up care for tropical sprue includes a physical exam and anamnesis, i.e. an interview with the doctor. During the physical examination, the doctor first checks whether the abdominal discomfort has completely subsided. Typical symptoms such as nausea and vomiting can persist for a few days after the illness. If too little folic acid or vitamin B12 was ingested during therapy, megaloblastic anemia can develop, which is detected at the latest during follow-up care.

If the fever persists, body temperature may also need to be measured. In the patient consultation, the individual symptoms can be clarified again in detail. If possible, the cause of the disease must be determined. Follow-up care is provided by the family doctor or an internist. In most cases, a one-time follow-up examination, which follows directly after the therapy, is sufficient.

You can do that yourself

Tropical sprue requires medical diagnosis and treatment. If typical symptoms of an infection occur during a trip to the Caribbean, Southeast Asia or southern India, it is advisable to interrupt the trip. A general practitioner or internist should be consulted as soon as possible.

The conservative therapy is supported by an adapted diet. The body must be supplied with folic acid and cobamalin, for example by consuming legumes, veal and poultry liver or dark green leafy vegetables. The necessary vitamin B12 is obtained from fish and eggs, for example. In addition, sufficient liquid must be consumed, especially in the case of severe diarrheal diseases. The diet serves as a support for the prescribed dietary supplements.

In addition, antibiotics such as tetracycline are prescribed. After the tropical sprue has subsided, the weakened organism can be strengthened with sage, thyme or ginger. Antibacterial and anti-inflammatory agents help to destroy residues of the pathogen. Drug treatment for tropical sprue must be continued for up to six months. During this period, regular visits to the doctor and independent monitoring of symptoms apply. A doctor should be consulted if the gastrointestinal symptoms or fever increase.

Tropical Sprue