Tropical sprue

Tropical sprue is a malabsorption syndrome of unknown cause that is prevalent in the tropics and subtropics.

Causes, incidence, and risk factors

The cause of this disease is unknown, but it may be related to an infectious organism. The condition affects residents of or visitors to the tropics. The main symptom is Diarrhea, which may improve on leaving tropical areas, or may reappear years after leaving the tropics. Risk factors are residence in the tropics or prolonged travel to tropical destinations.


  • Diarrhea, worse on high-fat diet  
  • Indigestion  
  • Excessive flatus or gas  
  • Abdominal cramps  
  • Weight Loss  
  • Paleness  
  • Irritability  
  • Numbness  
  • Muscle cramps

In children, sprue most often presents with growth failure and delayed skeletal maturation.

Signs and tests

  • Small bowel biopsy showing findings of tropical sprue (including malabsorption or infection)  
  • Upper endoscopy and upper GI series may show characteristic findings  
  • CBC showing anemia  
  • Stool showing increased fecal fat  
  • CHEM 20 showing low amounts of serum calcium, albumin, serum phosphorus, and serum cholesterol


Treatment begins with rehydration with fluids and electrolytes. Replacement of folate, iron, vitamin B12, and others may also be needed. Antibiotic therapy with tetracycline is given at the beginning of treatment.

Oral tetracycline is usually not prescribed for children until after all permanent teeth have erupted. It can permanently discolor teeth that are still forming.

Expectations (prognosis)

The outcome is expected to be good with treatment.


Vitamin and mineral deficiencies are common complications.

Calling your health care provider

Call your provider if you experience prolonged Diarrhea or other symptoms of this disorder, especially after spending time in the tropics.

Call your provider if tropical sprue symptoms worsen or do not improve with treatment, or if new symptoms develop.


Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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