Parasitic (Protozoan) cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

Abstract

Human parasitic infections constitute a substantial but neglected disease burden. Protozoa and helminths are two parasites groups known to be pathogenic to the human heart. Trypanosoma cruzi, Trypanosoma brucei, toxoplasma, plasmodium and Leishmania are the most frequent protozoa that can establish infections in human resulting in a wide spectrum of cardiac manifestations. The involvement of the myocardium can manifest as protozoan cardiomyopathy in many resource-constrained countries. However, at present, resource-rich countries are encountering diagnoses of parasitic infections with cardiac involvement attributable to increasing travel and migration, blood transfusions, growing numbers of immunodeficient patients -a worldwide epidemic of acquired immunodeficiency syndrome (HIV/AIDS), and increasing transplant recipients and use of immunosuppressive agents. Clinicians across the globe need to be aware of the potential cardiac involvement after parasitic infection in vulnerable individuals and in endemic areas. This paper reviews published evidence on protozoal parasites that can infect the myocardium, including the pathophysiology, diagnosis and management of protozoan cardiomyopathy. The paper also highlights areas of limited knowledge that could benefit from additional research.