Schistosomiasis & Heart

Schistosomiasis is a neglected tropical disease (NTD) and a major public health concern. According to the World Health Organization (WHO), approximately 240 million people are infected globally with over 90% of the disease burden occurring in Africa (https://www.who.int/features/factfiles/schistosomiasis/en/; Deol et al., 2019). Schistosomiasis is causes by parasitic blood flukes of the genus Schistosoma. It is transmitted by skin-penetrating larvae typically found in freshwater. After penetrating the skin, the larvae spread to different organs, such as the heart. The predominant species which infects humans is Schistosoma mansoni, contributing to potentially life-threatening Physiopathology of cardiovascular (CV) involvement. Schistosomiasis causes either acute infection (known as Katayama syndrome) or chronic infection, both of which are mediated by the host immune response. The predominant CV consequences of schistosomiasis depend on the disease phase. It has been reported myocarditis, pericarditis, and myocardial ischemia mainly occur during the acute phase of the disease, often presenting with no or few symptoms (Epelboin et al., 2010; de Jesus et al., 2002). Pulmonary arterial hypertension (PAH) is the most common CV complication of the chronic infection. The signs and symptoms of PAH in these patients does not differ from those with idiopathic PAH (iPAH). The identification of CV manifestations in schistosomiasis requires either a high degree of clinical suspicion or cardiac imaging modalities such as echocardiogram and cardiac magnetic resonance (CMR) when the diagnosis is unclear. A diagnostic algorithm for improving the identification of CV consequences related to schistosomiasis is proposed in Fig. 18.1.