Parasitic disease affecting the heart in childhood.

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http://www.health.gov.mt/impaedcard/issue/issue5/2839/2839.htm

 

 

Gilles H*. Parasitic disease affecting the heart in childhood.

 

Images Paediatr Cardiol 2000;5:29-40

*

Emeritus Professor of Tropical Medicine, University of Liverpool, 3

Conifers Avenue, Birkdale, Southport PR8 4SZ, Merseyside UK

 

MeSH

Myocarditis Pericarditis Myocardial Diseases

Chagas Disease Trypanosomiasis, African Larva Migrans, Visceral

Toxoplasmosis Trichinella spiralis Amebiasis

Echinococcus

 

 

 

Abstract

Parasitic diseases may occasionally affect the cardiovascular system,

albeit rarely in childhood. In this paper, I list the main features of

tropical diseases which may affect the heart.

 

Article

Several parasitic diseases occasionally affect the heart, causing

myocarditis, cardiomyopathy and pericarditis as follows:

 

Myocarditis American trypanosomiasis

African trypanosomiasis

Visceral larva migrans

Toxoplasmosis

Trichinella spiralis

Amoebiasis

Echinococcus

Cardiomyopathy Chagas' disease

Toxoplasmosis

Pericarditis Amoebiasis

African trypanosomiasis

Chagas disease'

Toxoplasmosis

Echinococcus

In the majority of instances, adults are predominantly affected,

cardiac pathology being uncommon in children except in Chagas' disease.

 

 

Chagas' disease - return to top - back

Distribution South and Central America

Figure 1: Distribution of Chagas' disease

 

The parasite Trypanosoma cruzi

The reservoir Humans and arborial animals

The vector Various species of reduviid bugs (Triatoma)

 

Figure 2: Reduviid bug - triatoma species

 

Figure 3: Ideal habitat for reduviid bugs

Transmission

 

* Rubbing infected bug species onto skin

* Blood transfusion

* Congenital infection

 

Acute stage Seen mainly in children:

 

* Reddish area at site of bite (chagoma)

* Unilateral painless orbital oedema (Romana's sign)

* High fever

* Tachycardia persisting through apyrexial periods

* Acute myocarditis with arrhythmias

* Pericarditis

* Heart failure

* Hepatosplenomegaly

* Lymphadenopathy

 

Figure 4: Romana's sign in acute Chagas' disease

Chronic stage Seen mainly in adult life:

 

* Cardiomyopathy with right bundle branch block

* Left anterior hemiblock

* Complete heart block

* Premature ventricular beats

* Atrial fibrillation

* T wave changes

* Heart failure (left and right ventricular decompensation)

* Cardiac arrest with sudden death

* Megasyndromes of the intestines

 

Figure 5: X-ray of chest: cor pulmonale due to pulmonary hypertension

 

Figure 6: X-ray of chest showing global cardiac enlargement

 

Figure 7: Large ventricular apical aneurysm in chronic Chagas' disease

 

Figure 8: Cardiomegaly in chronic Chagas' disease

 

Figure 9: Megacolon

 

Figure 10: Complete heart block

 

Diagnosis

 

* Trypanosomes found in blood

* Serological tests (IFAT or ELISA)

* Polymerase chain reaction

 

Treatment

 

* Supportive

* Benznidazole or nifurtimox

* The elimination of the disease is being achieved in several

South American countries

 

 

 

African trypanosomiasis - return to top - back

Distribution Africa

The parasite Trypanosoma brucei gambiense & rhodesiense

 

Figure 11: T brucei gambeinse in blood film (C/O WHO)

The reservoir Humans and wildlife

The vector Various species of Glossina (Tsetse) flies

 

Figure 12: Tsetse fly - Glossina species

Transmission Bite by fly

Clinical features

 

* Local lesion at site of bite

* Fever

* Lymphadenopathy

* Myocarditis with disproportionate tachycardia

* Tachycardia persisting through apyrexial periods

* Arrhythmias

* Heart failure

* Pericardial effusion

 

Figure 13: Trypanosomal chancre in child (C/O WHO)

Diagnosis

 

* Trypanosomes found in blood, lymph and cerebrospinal fluid

* Serological tests (IFAT)

* Direct and indirect agglutination

* Antigen detection

 

Treatment

 

* Suramin

* Pentamidine (T. gambiense only)

* Melarsoprol

* Alpha-difluoromethlyornithine (DFMO)

 

 

 

Trichinosis - return to top - back

Distribution Worldwide

The parasite Trichinella spiralis

The reservoir Pigs and many wild animals

Transmission Ingestion of raw or undercooked animal flesh -

predominantly pork or wild boar

Clinical features

 

* Fever

* Orbital oedema

* Myalgia

* Myocarditis

* Arrhythmias

* Heart failure

 

Diagnosis

 

* Serological tests (ELISA)

* Eosinophilia

 

Treatment

 

* Mebendazole

* Corticosteroids

 

 

 

Visceral larva migrans - return to top - back

Distribution Worldwide

The parasite Toxocara canis & Toxocara catis

The reservoir Dogs and cats

Transmission Ingestion of toxocara eggs deposited on the ground in

dog faeces

Clinical features

 

* Fever

* Nocturnal cough and wheezing

* Myocarditis

* Unilateral loss of vision

 

Diagnosis

 

* ELISA with larval stage antigens

* Eosinophilia

* Hypergammaglobulinaemia with raised IgM and IgG levels

 

Treatment

 

* Diethylcarbamazine

* Thiabendazole

 

 

Echinococcus - return to top - back

Distribution Africa, Middle East, Latin America

The parasite Echinococcus granulosus

The reservoir Dogs

Transmission Ingestion of echinococcal eggs

Clinical features

 

* Often none and found on routine X-rays or at autopsy

* Specific features relate to affected organ: liver, lung, bone

and brain

* Myocarditis

* Pericarditis

 

Diagnosis

 

* Ultrasonography

* Radiology - crescent shadow or 'water-lily' effect

* Antigen detection

 

Treatment

 

* Surgical removal

* Albendazole

* Praziquantel

 

 

Toxoplasmosis - return to top - back

Distribution Worldwide

The parasite Toxoplasma gondii

The reservoir Cats and migratory birds

Transmission Ingestion of oocysts and meat; congenital

Clinical features

 

* Fever

* Lymphadenopathy

* Retinochoroiditis

* Myocarditis

* Cardiac hypertrophy and dilatation

* Pericarditis

 

Diagnosis

 

* Biopsy and staining

* Serology e.g. dye test

* Immunohistochemistry for antigen

* Polymerase chain reaction

 

Treatment

 

* Sulphonamide and diaminopyrimidine

 

 

Amboebiasis - return to top - back

Distribution Worldwide but more frequent in the tropics and subtropics

The parasite Entamoeba histolytica & Entamoeba dispar

The reservoir Humans

Transmission Faeco-oral route

Clinical features

 

* Diarrhoea with blood and mucus

* Extra-intestinal manifestations e.g. amoebic liver abscess

* Pericardial effusion

 

Diagnosis

 

* Microscopy of fresh stools

* Antibody detection

* Sigmoidoscopy

 

Treatment

 

* Tissue amoebicides e.g. metronidazole

* Lumen amoebicides e.g. diloxanide furoate

 

 

 

Schistosomiasis - return to top - back

Distribution South America and the Caribbean, Middle East, Africa,

Far East

The parasite

 

* Schistosoma haematobium (urinary schistosomiasis)

* Schistosoma mansoni (intestinal schistosomiasis)

* Schistosoma japonicum (intestinal schistosomiasis)

 

The reservoir Humans; various animals (japonicum only)

Intermediate host Various species of fresh water snails

Clinical features

of S. haematobium

 

* Painless haematuria

* Dull ache in urethral or suprapubic areas

* Pulmonary hypertension

* Cor pulmonale

 

Clinical features

of intestinal

schistosomiasis

 

* Recurrent bloody diarrhoea

* Polyposis

* Hepatosplenic disease

* Pulmonary hypertension

* Cor pulmonale

* Spinal cord involvement

* Epilepsy with expanding intracranial mass

 

Diagnosis

 

* Eggs in urine or faeces

* Rectal biopsy

* Renography

* Ultrasonography

* Monoclonal antibody-based dipstick assay

 

Treatment

 

* Praziquantel

 

Contact information

Liverpool School of Tropical Medicine

 

Professor Herbert Gilles

Emeritus Professor of Tropical Medicine

University of Liverpool

3 Conifers Avenue

Birkdale

Southport PR8 4SZ

Merseyside - UK

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