Epidemiology
TS is almost exclusively seen in residents of, or long-term visitors to, tropical areas that span a narrow band on either side of the equator. TS is relatively common across countries in south and south-east Asia including Myanmar, Hong Kong, Singapore, Vietnam, Sri Lanka, Indonesia, and the Philippines. In the western hemisphere, TS is most common in Venezuela, Colombia, Haiti, the Dominican Republic, Cuba, and Puerto Rico. TS is curiously absent from Jamaica and the Bahamas, and is rarely seen in Eastern Africa, North America, and Europe.[1] Most epidemiological data comes from studies of soldiers and foreign volunteers in the 1940s and 1960s. These studies showed that TS was seen in 10% of British evacuees from the India-Burma theatre in World War II, 6% of American soldiers returning from Vietnam, 39% of Peace Corp volunteers serving in East Pakistan, and 8% of 600 North Americans living in Puerto Rico who were evaluated for recurrent diarrhoea.[2][3][4] In an Indian study, 40% of adults evaluated for malabsorption had TS.[5]
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