The Changing Clinical Picture of Tropical Sprue

Tropical sprue is an endemic condition in Puerto Rico, some Caribbean islands and Southeast Asia. It is characterized by diarrhea, poor appetite, weight loss and anemia. In recent years the incidence of tropical sprue has declined and the clinical picture is different. The supplementation of cereals and flours with folic acid for the prevention of neural tube defects in the newborns and to decrease hyperhomocysteinuria has disguised the clinical picture of tropical sprue. The condition can be seen without significant anemia with normal folic acid but low vitamin B 12 levels. The pernicious anemia which is indistinguishable from tropical sprue hematologically. We are reporting eight patients with tropical sprue who had normal or high folic acid levels but low or high vitamin B 12 levels.