Tropical sprue natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Natural History

• The clinical presentation depends on the duration of illness.
• Some patients may have symptoms lasting for days to weeks while other have a chronic course with remissions and relapses for many years.
• Malabsorption, may be seen as early as week after the onset of symptoms but manifestations of specific vitamin deficiencies may take longer.
• With no treatment, mortality in an epidemic reaches 30%.
• During the early stages of the illness, the mortality is mainly related to the fluid and electrolyte imbalances.
• Later in the disease deaths are associated with anemia, hypoproteinemia and secondary infection.
• Among the patients who survive, there is a strong tendency to spontaneous recovery even without treatment.

Complications

Vitamin and mineral deficiencies are common complications due to continued fluid and electrolyte losses associated with diarrhea.

• Dehydration
• Hyponatremia
• Hypokalemia
• Hypomagnesemia
• Metabolic acidosis

In children, sprue leads to:

• Delay in the maturing of bones (skeletal maturation)
• Growth

Prognosis

The prognosis for tropical sprue is excellent. It usually does not recur in patients who get it during travel to affected regions. The recurrence rate for natives is about 20%.