Parasitic infections and the development of endomyocardial fibrosis: systematic review of case reports and case series.

Abstract

Background: Endomyocardial fibrosis (EMF) is a chronic restrictive cardiomyopathy prevalent in tropical regions, often underdiagnosed and associated with poor outcomes. Although its etiology remains unclear, parasitic infections such as schistosomiasis, filariasis, and trypanosomiasis have been implicated in its development. This study conducted a systematic review of case reports and case series to assess the correlation between parasitic infections and the development of EMF, identifying clinical patterns, implicated parasites, diagnostic approaches, and clinical outcomes, aiming to improve strategies for prevention, diagnosis, and treatment.

Methods: Following PRISMA 2020 guidelines, we searched multiple databases for case reports and case series describing patients with confirmed EMF associated with parasitic infections. 12 studies met the inclusion criteria, comprising 8 case reports and 4 case series, encompassing a total of 16 patients diagnosed with EMF related to parasitic infections.

Results: The pooled analysis demonstrated that parasitic infections were predominantly caused by Schistosoma mansoni (10/16; 62.5%), followed by Schistosoma haematobium (3/16; 18.75%), with rare cases of Trypanosoma cruzi and Wuchereria bancrofti (1/16 each; 6.25%). Common clinical manifestations included signs of fibrosis of the right ventricular endocardium (81%), dilated right atrium (75%), pericardial effusion (75%), edema of both lower limbs (63%), and ascites (63%) and symptoms included abdominal distention (63%) and dyspnea (63%. Diagnosis was primarily established by echocardiography (92%), with additional confirmation by other imaging techniques and histopathology. Treatment mainly consisted of antiparasitic therapy and diuretics, with a survival rate of 50%, while 19% (3/16) of patients died from multi-organ failure and thromboembolic complications.

Conclusion: This systematic review suggests a potential association between parasitic infections, particularly Schistosoma mansoni, and the development of endomyocardial fibrosis. Despite the limited sample size, the findings highlight the importance of early diagnosis and antiparasitic treatment. The variability in diagnostic and therapeutic approaches underscores the need for standardized guidelines and prospective studies in endemic areas to enhance clinical recognition and improve patient outcomes.