Malabsorption at an American Military Base in the Phillippines

Jones, T. C. (Rockefeller University, New York, N. Y. 10021), A. G. Dean and G. W. Parker. Seasonal gastroenteritis and malabsorption at an American military base in the Philippines. II. Malabsorption following the acute illness. Am J Epidemiol 95: 128-139, 1972.—In two epidemics of gastroenteritis at Clark Air Base in the Philippines, intestinal malabsorption was documented during the acute illness and for varying periods thereafter. The acute illness subsided in 1-5 days, but in 22% of 234 patients it was followed by prolonged symptoms of fatigue, nausea, abdominal discomfort, loose stools and weight loss. Xylose absorption was frequently abnormal during the first few days of illness, but lactose tolerance, intestinal lactase and sucrase levels, and intestinal morphology usually were normal. After the first week, tests of intestinal function usually were abnormal in patients with persistent symptoms and also, with a lesser frequency, in those who had become asymptomatic after the acute illness. The prolonged illness resembled tropical sprue and appeared to respond to therapy with tetracycline and folic acid. No epidemiologic differences were found between patients who recovered quickly from the acute gastroenteritis and those who had prolonged symptoms except that the latter group was slightly older. A single cause, of unknown nature, apparently produces annual seasonal epidemics with a spectrum of symptoms and signs ranging from acute gastroenteritis to mild tropical sprue. The epidemics at Clark Air Base provide a unique opportunity to study the etiology of tropical sprue and its relationship to acute gastroenteritis.