Assuntos
Diarreia/etiologia , Espru Tropical/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia , Doença Celíaca/diagnóstico , Diagnóstico Diferencial , Duodenoscopia , Duodeno/diagnóstico por imagem , Duodeno/patologia , Feminino , Humanos , Masculino , México , Aposentadoria , Espru Tropical/complicações , Espru Tropical/patologiaRESUMO
The authors report two cases of tropical sprue occurring in Guadeloupe, in the French Lesser Antilles, a region in which this disease had previously been reported only once. One of the patients was treated with quinolone (ofloxacin).
Assuntos
Espru Tropical/diagnóstico , Idoso , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Feminino , Humanos , Ofloxacino/uso terapêutico , Espru Tropical/sangue , Espru Tropical/patologia , Índias OcidentaisRESUMO
We report the case of a 60 year old female who presented with diarrhoea and malabsorption syndrome, confirmed by the laboratory data and the radiologic examination, which developed after a journey to Egypt. The mainly finding was flattening of the villi in the jejunal biopsy; the syndrome recovered after treatment with antibiotics and folic acid. The case fulfills the diagnostic criteria of tropical sprue although this country is not considered as an endemic area.
Assuntos
Espru Tropical , Feminino , Humanos , Pessoa de Meia-Idade , Espru Tropical/diagnóstico , Espru Tropical/tratamento farmacológicoRESUMO
Three patients are described in whom the diagnosis of coeliac disease was missed because of a recent sojourn in the tropics. The differences between coeliac disease and tropical sprue, as well as the diagnostic pathways, are discussed.
Assuntos
Doença Celíaca/diagnóstico , Adulto , Benin , Diagnóstico Diferencial , Feminino , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , Espru Tropical/diagnóstico , Suriname , ViagemRESUMO
The case of a young woman from Guadeloupe developing severe megaloblastic anemia is reported. She presented with fever and hemolysis (she had heterozygotic beta-thalassemia) after a six month history of diarrhea. She was shown to have folate deficiency, steatorrhea, vitamin K and B12 malabsorption. She responded well to intravenous folinic acid and tetracyclines. Diagnosis was based on the following criteria: a) no other cause of malabsorption was found despite a comprehensive inquiry, b) the pattern of the illness corresponded to the definition of disease. Three particular aspects are outlined: the acute onset, malabsorption of vitamin B12 requiring prolonged and combined treatment, and the unusual place in which the disease was contracted.
Assuntos
Anemia Megaloblástica/etiologia , Espru Tropical/complicações , Adulto , Quimioterapia Combinada , Feminino , Ácido Fólico/sangue , Ácido Fólico/uso terapêutico , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/complicações , Deficiência de Ácido Fólico/tratamento farmacológico , Humanos , Infusões Parenterais , Espru Tropical/diagnóstico , Espru Tropical/tratamento farmacológico , Tetraciclina/uso terapêutico , Talassemia/complicações , Vitamina B 12/administração & dosagem , Vitamina B 12/sangue , Vitamina B 12/uso terapêutico , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/tratamento farmacológico , Deficiência de Vitamina K/sangue , Deficiência de Vitamina K/complicações , Deficiência de Vitamina K/tratamento farmacológico , Índias OcidentaisAssuntos
Diarreia/etiologia , Espru Tropical/diagnóstico , Adolescente , Anemia Macrocítica/sangue , Duodeno/patologia , Ácido Fólico/uso terapêutico , Humanos , Íleo/patologia , Jejuno/patologia , Síndromes de Malabsorção/diagnóstico , Masculino , Espru Tropical/sangue , Espru Tropical/tratamento farmacológico , Tetraciclinas/uso terapêuticoRESUMO
Se presentan 75 casos de mala absorción tropical, 65 adultos y 10 niños, estudiados desde el año de 1968 en el Hospital San Juan de Dios de Bogotá. La mayoría de los pacientes provenían de Cundinamarca y del Distrito Especial de Bogotá. En todos hubo mala absorción de la D-xilosa y esteatorrea. La biopsia peroral de la mucosa intestinal practicada en 64, mostró atrofia de 1+ en 16, de 2+ en 30, de 3+ en 18 y en ninguno se observó atrofia de 4+. Se encontró anemia en 58 pacientes, la cual fue de tipo megaloblástico en 45 (60 por ciento), ocasionada a su vez por deficiencia de ácido fólico, en 4, de Vitamina B12 en 9 y de ácido fólico y Vitamina B12 en 32. Fueron hallazgos frecuentes además del peso bajo, la glositis, la carotinemia baja (<40ug/dl) la colesterolemia inferior a 150mg/dl y la albuminemia por debajo de 3.5 g/dl. Fueron tratados exitosamente con dieta balanceada, ácido fólico, Vitamina B12, tetraciclina o sulfas, en forma aislada o empleando combinaciones de estos medicamentos. En presencia de megaloblastosis la terapia ideal es el tratamiento "triconjugado" de Vitamina B12, ácido fólico y tetraciclina; solamente falleció un paciente, por tromboembolismo pulmonar. El diagnóstico diferencial debe hacerse principalmente con la enteropatía por Gluten y con la anemia perniciosa
Assuntos
Humanos , Masculino , Feminino , Adulto , Espru Tropical/diagnóstico , Espru Tropical/etiologia , Espru Tropical/epidemiologia , Tetraciclina/administração & dosagem , Tetraciclina/uso terapêutico , Vitamina B 12/administração & dosagem , Vitamina B 12/uso terapêutico , Ácido Fólico/administração & dosagem , Ácido Fólico/uso terapêutico , Doença Celíaca/diagnóstico , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/etiologia , Xilose/deficiência , Carotenoides/sangue , Anemia Perniciosa/complicações , Anemia Perniciosa/diagnóstico , Anemia Perniciosa/etiologiaRESUMO
Changes in the world political situation, the rapidity of transportation, and the availability of effective therapy have altered the pattern of sprue in persons going to the tropics. Gone, for the most part, are the days when expatriates liver for years in tropical areas, progressed on the full-blown pattern of debilitating disease when they acquired sprue, and then were never totally cured either by return home or by the then-available forms of therapy. Today, visitors to the tropics usually return home by jet aircraft within weeks or months after acquiring the disease, and thus they present just with manifestations of small bowel disease in the absence of nutritional deficiencies. In this circumstance, the differential diagnosis usually lies between sprue and giardiasis. Both of these disorders are caused by chronic contamination of the small bowel by enteric pathogens, and both can be cured by specific therapy directed at eradicating these organisms. In contrast to the situation in travelers, sprue among the indigenous population of the tropics remains largely unchanged: a chronic debilitating disorder that represents a significant contributory factor to the pathogenesis of morbidity and malnutrition in some areas.
Assuntos
Espru Tropical , Viagem , Adulto , Ásia , América Central , Diagnóstico Diferencial , Giardíase/diagnóstico , Humanos , Masculino , América do Sul , Espru Tropical/diagnóstico , Espru Tropical/epidemiologia , Espru Tropical/etiologia , Espru Tropical/fisiopatologia , Espru Tropical/terapia , Estados Unidos/etnologia , Índias OcidentaisAssuntos
Síndromes de Malabsorção/diagnóstico , Espru Tropical/diagnóstico , Doença Aguda , Adulto , Criança , Diagnóstico Diferencial , Diarreia/complicações , Infecções por Escherichia coli/complicações , Haiti , Humanos , Índia , Síndromes de Malabsorção/etiologia , Porto Rico , Espru Tropical/etiologiaRESUMO
Non-specific ileojejunitis, characterised by mild to moderate structural changes in the intestinal mucosa and often associated with asymptomatic malabsorption, is known to occur in the tropics and in countries with hot climates. This acquired condition is probably related to environmental factors, and some consider it to be a subclinical form of tropical sprue. Changes in the intestinal mucosa typical of non-specific ileojejunitis were found in 10 indigenous Indians as well as 5 people of Latin stock living in the Southern Peruvian sierra, where tropical sprue has not as yet been demonstrated and which has a temperate climate.
Assuntos
Enterite/patologia , Ileíte/patologia , Indígenas Sul-Americanos , Jejuno/patologia , Adolescente , Adulto , Idoso , Atrofia , Diagnóstico Diferencial , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Peru , Espru Tropical/diagnósticoRESUMO
A group of subjects had common features of megaloblastic anemia due to vitamin B12 deficiency, normal or high serum folate, and evidence of intestinal malabsorption. They were all former residents of the Caribbean area now living in New York City. Despite similar symptoms and diagnostic studies, two subjects were found to have pernicious anemia and three to have tropical sprue. Achlorhydria, serum anti-intrinsic factor antibody, the severity of small intestinal abnormalities, and posttherapy Schilling tests were helpful differential factors. These subjects illustrate the problems that may be encountered in differentiating tropical sprue and pernicious anemia.