Cardiac abnormalities in the acquired immunodeficiency syndrome. A prospective study with a clinical-pathological correlation in twenty-one adult patients

Herdy, Gesmar Volga Haddad; Herdy, Artur Haddad; Almeida, Patty Fidélis de; Carvalho, Rubens Côrte Real de; Azevedo, Fabiano B.; Azevedo, Kátia Martins Lopes de; Vasconcelos, Márcia Cláudia; Paiva, Raquel; Tchou, Hsu Y.; Nascimento, Pablo; Cosendey, Rachel Ingrid Juliboni; Ferrari, Analise; Lopes, Vânia Silami

doi:10.1590/s0066-782x1999000900004

Cited by 3 publications

(4 citation statements)

References 14 publications

(16 reference statements)

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“…The prevalence of Toxoplasma myocarditis in AIDS autopsies varies from < 1 to 12% [19,20]. There are a few reports of severe Toxoplasma myocarditis occurring in isolation, but a fatal outcome has been described in only a limited number of cases [15,16,21], in the absence of an associated encephalitis [13,14,20]. As acute Toxoplasma infections are usually disseminated, isolated myocarditis probably reflects localized parasite reactivation [13,20].…”

Section: Discussionmentioning

confidence: 99%

“…Establishing the correct diagnosis in such patients can be problematic and a high index of clinical suspicion is essential. A recent study concluded that echocardiography was indicated in HIV‐positive patients with cardiac signs or symptoms, and that those diagnosed with cardiomyopathy or pericardial disease should then undergo further investigations [23] including, if necessary, an endomyocardial biopsy [15].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, in the absence of encephalitic symptoms, toxoplasmosis may not be included in the differential diagnosis. There are few reports of fulminant toxoplasmic myocarditis resulting in death [13–16]. Toxoplasmic pneumonitis is responsible for less than 1% of HIV‐related pulmonary complications [17], and can occasionally cause fatal septic shock, generally associated with adult respiratory distress syndrome (ARDS) [18].…”

Section: Introductionmentioning

confidence: 99%

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Fulminant toxoplasmosis causing fatal pneumonitis and myocarditis

Eza

Lucas

2006

HIV Medicine

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The obligate intracellular protozoa Toxoplasma gondii is a serious cause of morbidity and mortality in patients with AIDS. Toxoplasmosis most frequently manifests as life‐threatening encephalitis, although extracerebral sites may be involved with or without toxoplasmic encephalitis. Consequently, toxoplasmosis can present in an unusual manner, and may not be included in the differential diagnosis in the absence of encephalitic symptoms. There are few reports of fulminant toxoplasmic myocarditis resulting in death. Toxoplasmic pneumonitis is responsible for less than 1% of HIV‐related pulmonary complications, and can occasionally cause fatal septic shock. Two such clinicopathological presentations of toxoplasmosis are reported here. One patient presented with cardiorespiratory signs and symptoms, whilst the second patient presented with pneumonitis and renal failure. Neither patient was initially known to be HIV‐infected, nor did they have clinical symptoms indicating toxoplasmic encephalitis. Toxoplasmosis was only diagnosed on autopsy and had resulted in death by causing a fulminant myocarditis and a pneumonitis. As overwhelming toxoplasmosis infection may prove rapidly fatal, these two case reports serve as a clinical reminder to consider toxoplasmosis in the differential diagnosis of HIV‐infected patients who present with severe cardiorespiratory signs and symptoms. Furthermore, the cases emphasize the potential importance of early tissue biopsy in patients presenting with immunosuppression‐associated organ failure, and show the importance of requesting a postmortem examination if the cause of death cannot be ascertained in vivo.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fulminant toxoplasmosis causing fatal pneumonitis and myocarditis

Eza

Lucas

2006

HIV Medicine

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“…Toxoplasmic pneumonitis is responsible for pulmonary complications related to AIDS that can lead to septic shock (60,61). Myocarditis caused by T. gondii is a rare but serious complication that can result in SCD (56,(62)(63)(64)(65). Cardiac effects are more pronounced in heart-transplant recipients; a retrospective study found that of the 1.3% of persons that developed T. gondii infections in the post-operative period following transplantation, 50% died (66).…”

Section: Toxoplasmosis Affecting Skeletal and Cardiac Musclesmentioning

confidence: 99%

Detrimental effects of malaria, toxoplasmosis, leishmaniosis and Chagas disease on cardiac and skeletal muscles

Marrelli

Fiedler

Biguetti

et al. 2020

MRAJ

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The pathogenic mechanisms of several diseases triggered by protozoan parasites, such as the causative agents of Chagas disease, toxoplasmosis, leishmaniosis, and malaria, have demonstrated to cause direct detrimental effect on cardiac and skeletal muscle. These are amongst the most prevalent and epidemiologically relevant protozoan infections worldwide and infecting millions of people per year. As such, this review focuses on the current knowledge on the pathogenic mechanisms of these diseases on muscles. Case studies and original research addressing the mechanisms of action for direct and indirect damage to cardiac and skeletal muscle were analyzed and the main findings summarized. Importantly, all diseases reviewed here produce an intense inflammatory response, with the associated oxidative stress and pro-inflammatory cytokine production leading to or furthering these detrimental effects. Critically, the disruption of cardiac muscle function can lead to minor arrhythmias and even death, and skeletal muscle damage can result in homeostatic imbalances serving to further morbidity and mortality. Strategies for preventing complications and determining the effectiveness of interventions designed with antioxidant and anti-inflammatory molecules to minimize muscle injury and help the millions of people with these diseases are an urgent need.

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