Tropical Sprue in Haiti

Abstract

Studies were conducted in 18 patients who had characteristic symptoms of tropical sprue, 7 asymptomatic subjects, 3 patients with primary protein deficiency, and 4 patients with Fe deficiency anemia. Some degree of histologic abnormality was present in the jejunal mucosa of every patient; urinary excretion of xylose was subnormal in every subject, except one; and Co6O-B12 absorption was reduced in every patient tested. Deficiencies of Fe, Ca, vitamin K, vitamin E, and carotene were common. Malabsorption and deficiency of folate were rare. In addition to the presence of symptoms of diarrhea, anorexia, and weight loss, patients with tropical sprue had a higher incidence of hypoalbuminemia and of megaloblastic anemia secondary to vitamin B12 deficiency than other subjects. Villous atrophy was more severe in the majority of patients with tropical sprue and histochemical studies showed an abnormal distribution of lipid droplets within a prominently thickened basement membrane in all 18 patients with tropical sprue, but in only 2 other subjects. In 100 randomly selected patients, subnormal serum levels of albumin were found in 33, of vitamin B12 in 42, and of folate in 9. Disease of the small intestine with jejunal mucosal changes, impairment of intestinal absorptive capacity and resultant multiple deficiencies are common in indigents of rural Haiti. There is a spectrum of manifestations of small intestinal disease which varies from an asymptomatic state to the symptomatic clinical entity recognized as tropical sprue. These observations support the concept that tropical sprue is an overt manifestation of a disease which is frequently present in subclinical form. The etiology of this disease and the factors which result in the development in some instances of overt tropical sprue remain unknown.