TROPICAL SPRUE

an acquired disease characterized by the small intestine's impaired absorption of fats, vitamins, and minerals. Its cause is unknown; infection, parasite infestation, vitamin deficiency, and food toxins have been suggested as possible causes. It is found primarily in the Caribbean, southeast Asia, India, and areas in which polished rice is a staple food. Sprue often attacks middle-aged adults and is commonly caused by bacterial contamination of the small intestine, which in turn is responsible for inadequate fat digestion and absorption. The onset of the disease is insidious. In the initial phase complaints include fatigue, weakness, loss of appetite, severe vomiting, dehydration, and numerous bulky, frothy, greasy, light-coloured stools. In infants and children, sometimes weeks or months elapse before a typical pattern is revealed. Often profound behavioral changes occur, as temper and irritability alternate with timidity and withdrawal signs. Notable is the sad, fretful facial expression of youngsters so afflicted. The second stage follows in three to six months with prominent weight loss, inflamed and painfully fissured tongue, fissures of the mouth lining, and swelling and scaling of the lips accompanied by changes in the cornea (hyperkeratosis). If the disease progresses to the third stage, severe anemia and imbalance of protein (e.g., albumins, globulins) and electrolytes (e.g., sodium, potassium, and chlorine in solution) may precipitate total debilitation. Dramatic improvement occurs after administering folic acid, a chemical of the vitamin B complex found in leafy vegetables and liver and also produced synthetically. Tropical sprue is to be distinguished from celiac disease (q.v.), which is also called nontropical sprue.