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

Abstract

Neglected tropical diseases form an important component of the burden of cardiac disease in resource-constrained countries. Some diseases resulting from infection by helminthic parasites such as endomyocardial fibrosis, schistosomiasis and hookworm infections are part of the neglected tropical diseases. The neglect has contributed to the under-appreciation and under-research of helminthic cardiac diseases. In contrast, infections by helminthic parasites are prevalent in resource-constrained countries and are among the leading aetiology of cardiac diseases including cardiomyopathy often associated with an ominous prognosis. Infection by a wide variety of helminth parasites, more commonly Trichinella, Taenia solium, Echinococcus, Schistosoma, Toxocara and Ascaris, and less commonly, Heterophyes, Paragonimus, Strongyloides and Dirofilaria Immitis can result in myocardial injury ultimately progressing to cardiomyopathy. However, data on epidemiology, presentation, diagnosis and management of helminthic cardiomyopathy are few and disparate effectively undermining exact understanding. Moreover, expert guidelines specific to the diagnosis and management of helminthic cardiac diseases are also conspicuously lacking. Current clinical practices on management of helminthic cardiomyopathy appear to depend on health centre experience. This paper aims to provide a broadened view of the clinical status of helminthic cardiomyopathy by reviewing published evidence with a particular focus on the causative helminthic parasites, pathophysiology, diagnosis and clinical management.