Poverty and eosinophilia are risk factors for endomyocardial fibrosis (EMF) in Uganda

Abstract

Summaryobjective To determine the relative risks of socio-demographic, dietary, and environmental factors for endomyocardial fibrosis (EMF) in Uganda.method Unmatched case control study in Mulago Hospital, Kampala. Cases (n ϭ 61) were sequential patients hospitalized with an echocardiographic diagnosis of EMF from June 1995 to March 1996. Controls (n ϭ 120) were concurrent patients with other forms of heart disease (heart controls, n ϭ 59) and subjects admitted for trauma or elective surgery (hospital controls, n ϭ 61). All consenting subjects answered a structured questionnaire administered by trained interviewers. Complete blood counts, malaria films and stool examination for ova and parasites were performed. Questionnaires elicited information on home address, economic circumstances, variables concerned with environmental exposures and usual diet before becoming ill.results After adjustment for age and sex, cases were significantly more likely than controls to have Rwanda/Burundi ethnic origins (P ϭ 0.008). Compared with controls, cases had a lower level of education (P Ͻ 0.001 for heart controls and P ϭ 0.07 for hospital controls), were more likely to be peasants (P Ͻ 0.001), and to come from Luwero or Mukono Districts (P ϭ 0.003). After further adjustment for peasant occupation, cases were more likely than controls to walk barefoot (P ϭ 0.015), consume cassava as their staple food (P Ͻ 0.001) and to lack fish or meat in dietary sauces (P ϭ 0.02). Cases were more likely to exhibit absolute eosinophilia (P ϭ 0.006). The effect of cassava diet was more marked in the younger age group, while the effect of eosinophilia was greater in adults. Socio-economic disadvantage is a risk for EMF. Absolute eosinophilia is a putative cause of EMF, a finding not explained by parasitism.conclusion Data indicate that relative poverty and environmental factors triggering eosinophilia appear to act in a geographically restricted region of Uganda in the aetiology of EMF. keywords endomyocardial fibrosis, cassava, eosinophilia correspondence Prof. J. L. Ziegler,

Epidemiology and Etiology of Cardiomyopathy in Africa

“…In Uganda, the disease is more common among immigrants from neighboring Rwanda and Burundi who have settled in specific geographic districts of the country. 61 Apart from a report of a Rwandese family in whom EMF was associated with an unusually high incidence of hyperimmune malarial splenomegaly, 62 the role of familial and genetic factors has not been studied systematically in this condition. EMF predominates in children and young adults, with a peak incidence at the ages of 11 and 15 in both sexes; women show a second peak between 26 and 30 years.…”

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

“…The high prevalence of EMF found in schistosomiasis-endemic countries, such as Uganda, Mozambique, and Nigeria, suggests that there may be an unidentified link. 6,7,11 Therefore, cause or coincidence remains an open question in this impoverished part of Uganda, where hepatosplenic schistosomiasis is particularly rife and there is a dearth of cardiovascular disease surveillance.…”

“…4,5 Several theories of its etiology have been postulated 3,5 : associations have been found with eosinophilia ( 30% of patients 5 ) possibly linked to helminth infections, such as lymphatic filariasis, poverty in general, and low-protein or imbalanced diets in particular. 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.…”

Patogênese da endomiocardiofibrose: perfil imunológico e análise proteômica de tecido cardíaco

“…A associação entre eosinofilia e EMF surgiu após a observação da presença de ambos os fatores em pacientes na Uganda. (73) No Brasil, Iglezias em 2009 tentou associar a patogênese a esse tipo celular, sem sucesso. (12) Em nosso estudo, é provável que o fato de não encontrarmos indícios da participação dessa célula se deva ao estágio avançado da EMF em nosso grupo de pacientes.…”

“…Considerando ainda a associação entre EMF e condições precárias de vida (por exemplo: andar descalço, baixa escolaridade e deficiências nutricionais), (73) …”