History and exam
Key diagnostic factors
common
prolonged exposure to an endemic area
This is the key risk factor.
constitutional symptoms
Most patients have some constitutional symptoms.
May include fatigue, malaise, anorexia, and weight loss.
Fatigue may reflect underlying anemia and malnutrition.
diarrhea
Gastrointestinal symptoms are seen in up to 80% of patients.[25]
bloating
Gastrointestinal symptoms are seen in up to 80% of patients.[25]
foul-smelling, greasy stools
Gastrointestinal symptoms are seen in up to 80% of patients.[25]
glossitis
A feature of vitamin B deficiency, this is seen in 96% of patients.[2]
uncommon
numbness of fingers and toes
Specific for vitamin B deficiency. Oral symptoms predominate, skin changes are less common, and numbness is only seen in a minority.
Other diagnostic factors
common
abdominal cramping
Gastrointestinal symptoms are seen in up to 80% of patients.[25]
fever
Most patients with TS have some constitutional symptoms. A low-grade fever (100-101°F) peaking in the afternoon has been noted in 30% to 60% of patients.[25]
leg swelling
Related to hypoproteinemia, which is common in TS.
hair loss
Related to hypoproteinemia, which is common in TS.
cheilitis/angular stomatitis
A feature of vitamin B deficiency; one or both of these are found in 40% of patients.[2]
pedal edema
A manifestation of hypoproteinemia, this is seen in up to 66% of patients.[5]
hyperactive bowel sounds/borborygmi
Although nonspecific, this is the only reliable physical finding that is not related to a specific nutrient deficiency.
hyperpigmentation/eczematous rash
Pellagra-like skin changes related to vitamin B deficiency are often seen. Oral symptoms predominate, skin changes are less common, and numbness is only seen in a minority.
pallor
A manifestation of anemia due to both vitamin B12 and folate deficiency; this is commonly seen in patients with TS.
uncommon
dry eyes
Although rare, indicative of vitamin A deficiency seen in TS.
corneal xerosis
A rare manifestation due to vitamin A deficiency.
decreased deep tendon reflexes/decreased vibratory sensation
These neurologic manifestations of vitamin B12 deficiency are seen in 5% to 10% of patients.[25]
night blindness
Although rare, indicative of vitamin A deficiency seen in TS.
Risk factors
strong
prolonged exposure to an endemic area
In a study of British soldiers who acquired TS while serving in India, 86% had been in the tropics for 6 months to 3 years, whereas only 9% had been serving for less than 6 months.[2]
weak
HLA antigen in the Aw-19 series
This is based on one small study of patients from Puerto Rico.[13]
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