Endomyocardial fibrosis in Africa

Abstract

Summary Endomyocardial fibrosis (EMF) is a disease of the rain-forest belt in Africa. There is general agreement as to its pathology in the acute phase, but this is difficult to diagnose clinically. The aetiology is still unknown although there are reports which suggest that eosinophilic endomyocardial disease may be the cause. Further studies are needed to define EMF in its acute stage and find out how chronic EMF evolves. A longitudinal study on young people with eosinophilia and a comparative study of two villages, one in an endemic zone and the other in a zone where EMF is uncommon, will also be helpful in identifying its cause. The most promising form of treatment at present is surgical.

Epidemiology and Etiology of Cardiomyopathy in Africa

“…In Africa, the disease was first described in 1946, 3 and it was subsequently reported in Uganda, Kenya, Tanzania, Mozambique, Gabon, Congo, Cameroon, Sudan, Nigeria, Coté d'Ivoire, and Ghana. 58 It is uncommon in Northern and Southern Africa. 59 EMF in Africa is more commonly right sided or bilateral, and rarely left sided (Figures 1 and 2).…”

“…13 A female preponderance (F:M ratioϭ2:1) has been found in Uganda but not in Nigeria, where some workers have found no sex difference, whereas others have found a male preponderance of 2:1. 58 EMF is said to be a disease of poor people with low educational attainment who walk barefoot and consume cassava as the sole staple diet and minimal amounts of meat and fish. 61 However, EMF is still being described in foreigners who have lived in tropical Africa, 59 suggesting that the disease cannot be explained solely on the basis of social deprivation.…”

Endomyocardial Fibrosis

“…Studies on the role of nutritional deficiencies on the etiopathogenesis of EMF had deceiving results [38], and EMF has been reported in wellnourished people [20]. Plantains and bananas containing high levels of serotonin, consumed in large quantities in some communities from India where EMF is common [39], were proposed as the trigger for EMF since excess of serotonin causes lesions resembling those found in human EMF in guinea pigs [40].…”

<p>Endomyocardial Fibrosis: Diagnosis and Management</p>

“…The issue of ethnicity seemed a relevant etiological factor as most of the cases described were from tropical and subtropical African countries, especially Uganda, Rwanda, Kenya, Nigeria, Sudan, and Mozambique. 21 In addition to a shared ethnic background, other factors included tuber rich (cassava) low protein diet, poverty, and infection. 7 Some of those additional factors prevail in other non-African tropical and subtropical countries like Brazil and India where EMF has been reported.…”