Bahr is inclined to believe that Monilia albicans (Oidium albicans) is the cause, as he found these saccharomycetes in the deep layers of the tongue, in the mucoid coating of the intestines and in the deposit in the oesophagus. He thinks it the ordinary thrush species which may take on greater virulence in the tropics. Ashford states that he has found a species of Monilia, different from that of thrush, almost constantly in tongue scrapings and stools of sprue cases and he regards this species as the cause of sprue. He states that this organism is common in Porto Rico bread and thinks it possible that the disease is transmitted in this way. It has been called Parasaccharomyces ashfordi. It is a round yeast, 4 to 7 microns in diameter. Wood has recently expressed the view that sprue is not infrequently mistaken for pellagra in the Southern United States.
Castellani, in a study of moulds of the genus Monilia in sprue stools, holds them responsible for the excessive gas production, although not the cause of the disease. Various protozoa, as amoebae and spirochaetes, have been considered as possible causes.
While there does not seem to be any vitamine deficiency implicated yet there is disordered assimilation, which may be due to alimentary tract infection or to insufficiency of pancreatic functioning. It has been suggested that secretin deficiency is the essential disturbance.
Epidemiology.—The disease is rare in natives and is entirely endemic. Some authorities have suggested a greater frequency of the disease in those intimately exposed to a case, as in husband and wife or the members of a family.
Sprue is usually a disease of mature life and affects women more frequently than men. While climate cannot be considered as causing sprue yet the effects of hot climates in producing exhaustion states in Europeans must be borne in mind. The sprue patient should always leave a tropical climate.
Pathology and Morbid Anatomy
The changes in the alimentary tract apparently originate in the structures lying beneath the epithelial coverings, thus indicating that the toxic material acts through the blood rather than as a surface irritant to the mucosa. At first there is congestion of the underlying connective tissue with a round cell infiltration. Later on the epithelial covering of the alimentary tract suffers and auto-intoxication, as evidenced by indicanuria, becomes operative.
At autopsy the subcutaneous fat is found to have almost disappeared. The intestines, especially the ileum, show marked thinning, this atrophy especially affecting the mucosa, the surface of which is covered by a layer of dirty gray mucus. The submucosa generally shows connective-tissue increase. The gut is pale and diaphanous. The solitary follicles may show as small cysts filled with a gelatinous material or as ulcers.
The liver is markedly atrophied. The mesenteric glands are usually enlarged. The pancreas may show cirrhotic changes.