Distribution: residence or travel in subtropical and tropical regions
Clinical features:
(1) chronic, recurrent diarrheal disease
(2) malabsorption with steatorrhea
(3) fatigue
(4) anorexia and weight loss
(5) malnutrition
(6) abdominal distention
(7) vitamin deficiency, especially folate and vitamin B12
(8) complications of vitamin deficiency (anemia, glossitis, etc.)
A small bowel biopsy may show:
(1) chronic inflammation and/or
(2) villous blunting and flattening
Diagnosis is supported by reversal of the above with:
(1) antibiotic therapy (tetracyclines, other broad-spectrum agent)
(2) nutritional and vitamin replacement
(3) access to improved sanitation
