tropical sprue
Introduction
Introduction to tropical stomatitis diarrhea Tropical pruritus (tropicalsprue), also known as tropical steatorrhea, is a disease of mucosal structure and function caused by bacterial overgrowth in the jejunum. It can cause malabsorption in the later stage. It is clinically characterized by diarrhea and multiple nutrient deficiencies, mainly in the tropics. popular. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia
Cause
Causes of tropical stomatitis diarrhea
(1) Causes of the disease
The cause is unknown, but some phenomena make people highly suspect that the disease is related to infection.
1. The disease is seasonal.
2. Epidemic.
3. Foreign travelers can also get sick.
4. The incidence of cohabitation is high.
5. Broad-spectrum antibiotic treatment is effective.
However, no pathogenic bacteria were found in the culture of feces and small intestine. No pathogens were found in the intestinal mucosa by light microscopy and electron microscopy. Small intestinal absorption was used for virus isolation. Anaerobic bacteria and fungi were not successfully tested. Nutrient deficiency such as lack of protein and vitamins. B12, folic acid, etc., may be secondary factors, not the main cause.
(two) pathogenesis
Most have superficial gastritis, a few have atrophic gastritis, gastric acid secretion is reduced, 20% of patients are completely acid-free, resulting in iron and vitamin B12 malabsorption, intestinal mucosal villi deformation, coarse, flattened, irregular, according to 222 biopsy The specimens were analyzed for mucosal morphology as follows: fingertip 4%, leaf shape 40%, ridge 26%, curl 28%, flat 2%, microscopic jejunal mucosa biopsy, general gland fossa became longer, villi thickened and widened, The nucleus of the glandular cells is hypertrophy, and the argyrophil cells are increased, but the Paneth cells are normal, the epithelial cells are different in size, and they are square or even flat. The cup cells are reduced on the mucosal surface, but the glandular fossa is increased, and the epithelial cell enzyme activity is reduced. Inflammatory cell infiltration, microscopic examination showed micro-villi irregular, agglomeration or segmentation, microsomes and mitochondria increased, due to the organic changes of intestinal mucosa, not only nutrients can not be absorbed, but a large number of proteins and salts are lost. . One-third of patients have fat stools, which are closely related to dietary fat. They are also related to fat types. Long-chain fats are not easily absorbed and excreted in the feces. Medium-chain fats are easily absorbed without causing fat stools. I31I-PVP or albumin test Proof of intestinal loss protein, oral protein tolerance test, also indicates that absorption is delayed, of course, the cause of hypoproteinemia is not limited to this, because these patients, the loss of appetite is reduced, and the synthesis of liver function protein is also reduced, 1/ The glucose tolerance test of 2 patients was not normal. Other lactose and sucrose tolerance tests indicated that the absorption function was reduced. In the xylose absorption test, 94% of the 300 patients had a decrease in urine output, indicating that the monosaccharide absorption was also affected.
Vitamin A absorption test is not normal, accounting for 3/4, vitamin B12 absorption is abnormal, accounting for 59% to 65%, folic acid malabsorption causes large cell anemia.
According to the statistical analysis of 576 cases of chronic tropical stomatitis diarrhea, the jejunal mucosal lesions are closely related to the absorption of nutrients. The jejunum lesions account for 73%-100%; fat absorption disorders account for 50%-90%, wood Sugar absorption disorders account for 73% to 100%; vitamin B12 absorption disorders account for 65% to 100%.
Prevention
Tropical stomatitis diarrhea prevention
1. May be related to bacterial infections. It is mainly caused by residents or tourists in the tropical regions of India, Southeast Asia and Central America.
2, develop good hygiene habits, wash your hands thoroughly with soap before and after meals to ensure that drinking clean water.
3, do not eat spoiled food, raw fruits should be washed; it is also important to maintain optimism and strengthen physical exercise.
4. Avoid contact and infection between people.
Complication
Complications of tropical stomatitis diarrhea Complications anemia
Vitamin A absorption test is not normal, accounting for 3/4, vitamin B12 absorption is abnormal, accounting for 59% to 65%, folic acid malabsorption causes large cell anemia.
Symptom
Symptoms of tropical stomatitis diarrhea Common symptoms Diarrhea, weak tongue, stomatitis, mouth, tingling, anemia, lips, cleft palate
The disease has undergone three evolutionary stages: diarrhea malabsorption, nutrient deficiency and anemia, and phase 1 is also called early, manifested as diarrhea, fatigue, weakness and weight loss, and even steatorrhea; Lack of characteristics, clinical appearance of glossitis, stomatitis, cleft lip and hyperkeratosis; the third stage is characterized by the appearance of large cell anemia, the clinical manifestations of other periods are also aggravated, the general evolution of tropical habitat for 2 to 4 years .
Examine
Examination of tropical stomatitis diarrhea
Giant erythrocyte anemia, serum carotene, vitamin A, albumin, cholesterol and calcium are often lower than normal.
The D-xylose test absorption test showed that the absorption was reduced, the 24h fecal fat was not measured normally, and the fat diarrhea was found in 50%-90%, which was the result of intestinal cell transport defect. The lactose hydrogen breath test was positive, and the vitamin B12 absorption test was abnormal, but After antibiotic treatment, vitamin B12 absorption immediately returned to normal.
Glucose tolerance test is lower than normal, amino acid and dipeptide, folic acid absorption are reduced, calcium absorption is also reduced, partly because of vitamin D deficiency, some may have protein-losing enteropathy, hypoalbuminemia.
1. In the early stage of X-ray, the jejunum may have significant structural abnormalities, but all small intestines may be involved in the future.
2. Histology can be seen that the crypt is elongated, the villi are widened and shortened, the lamina propria has chronic inflammatory cell infiltration and abnormal epithelial surface. The mucosa of 10% of patients can be completely flat, the basement membrane is thickened under light microscope, and a dense microscope is seen by electron microscopy. The substance accumulates in the vicinity of the normal basement membrane layer.
Diagnosis
Diagnosis and diagnosis of tropical stomatitis diarrhea
diagnosis
Diarrhea occurs clinically, and the disease should be suspected in the history of living in the tropics. Intestinal absorption function tests and biopsy changes may help to further confirm the diagnosis.
Differential diagnosis
Diagnosis of tropical stomatitis diarrhea should be identified with the following diseases:
1. Intestinal parasitic diseases such as Giardia lamblia, amoeba, etc., stool egg examination and parasitic examination help to identify.
2. Inflammatory bowel disease Crohn's disease and ulcerative colitis can be malabsorption, but they all have their own X-ray characteristics.
3. Intestinal diseases caused by wheat gelatin can also occur in the tropics.
4. Vitamin B12 deficiency B12 deficiency can also cause xylose malabsorption and cause abnormality of jejunal mucosa. After treatment, the absorption function can be restored, and anemia correction (B12 treatment) is helpful for identification.
