Endomyocardial fibrosis associated with mansoni schistosomiasis

Abstract

Endomyocardial fibrosis (EMF) is a neglected tropical disease that affects millions of people worldwide. EMF is the most common cause of restrictive cardiomyopathy, caused by deposition of fibrous tissue on endocardial surfaces. EMF is a major cause of death in areas where it is endemic, but the pathogenesis of the disease is poorly understood. Schistosomiasis mansoni is a parasitic disease endemic in Brazil, where EMF has also been described. The association between EMF and schistosomiasis has been suggested in various publications, seeking a possible correlation between endocardial and periportal fibroses. This report describes a case of EMF associated with schistosomiasis.

Active schistosomiasis, severe hypereosinophilia and rapid progression of chronic endomyocardialendomyocardial fibrosis

“…An association with Schistosoma mansoni, haematobium and intercalatum has been reported 456. In the our case, Schistosoma infection may have been the trigger for clinical aggravation due to the superimposition of Loeffler’s syndrome on chronic fibrotic EMF.…”

Endomyocardial Fibrosis (EMF) in a Ugandan Child with Advanced Hepatosplenic Schistosomiasis: Coincidence or Connection?

“…Little inference can, therefore, be made in earlier stages clinical interactions. 2,8 Because EMF has a spectrum of disease (acute, subacute, and chronic), finding patients only in the burned out phase likely underreports those in less severe stages. 12 In a populationbased study in Brazil of 152 patients with schistosomiasis, no EMF was detected, but this study may have been underpowered to detect a disease that may not be that prevalent.…”

“…3,6,7 Although associations between hepatosplenic schistosomiasis and EMF have been suggested in Egypt and Brazil, a common pathogenic mechanism remains uncertain. 2,8 We describe the case of a Ugandan child with EMF and advanced liver fibrosis and hypothesize that both diseases are unlikely to be coincidental. To our knowledge, this patient is the youngest child reported with these striking concomitant morbidities.…”

Tropical Endomyocardial Fibrosis

“…[49][50][51][52][53] An excessive immune response to the trigger (Figure 1) has been suggested to be the link between certain parasitic infections and EMF. [54][55][56][57][58][59] This has been demonstrated, for example, by increased circulating levels of IgE 53,60,61 and the occurrence of hyperimmune malaria-related splenomegaly among Rwandan immigrants affected by EMF. 62 Immunological investigations have revealed the presence of autoantibodies (IgG and IgM) directed against myocardial proteins.…”