Endomyocardial involvement in asymptomatic sub-Saharan immigrants with helminth-related eosinophilia

Abstract

BackgroundAmong immigrants of sub-Saharan origin, parasitic infection is the leading cause of eosinophilia, which is generally interpreted as a defense mechanism. A side effect of the inflammatory mediators released by eosinophils is damage to host organs, especially the heart. The main objectives of this study were to i) assess cardiac involvement in asymptomatic sub-Saharan immigrants with eosinophilia, ii) relate the presence of lesions with the degree of eosinophilia, and iii) study the relationship between cardiac involvement and the type of causative parasite.Methodology/Principle findingsIn total, the study included 50 black immigrants (37 patients and 13 controls) from sub-Saharan Africa. In all subjects, heart structure and function were evaluated in a blinded manner using Sonos 5500 echocardiographic equipment. The findings were classified and described according to established criteria. The diagnostic criteria for helminthosis were those reported in the literature. Serum eosinophil-derived neurotoxin levels were measured using enzyme-linked immunosorbent assay. A significant association was found between the presence of eosinophilia and structural alterations (mitral valve thickening). However, the lack of an association between the degree of eosinophilia and heart valve disease and the absence of valve involvement in some patients with eosinophilia suggest the role of other factors in the appearance of endocardial lesions. There was also no association between the type of helminth and valve involvement.ConclusionsWe, therefore, suggest that transthoracic echocardiography be performed in every sub-Saharan individual with eosinophilia in order to rule out early heart valve lesions.

Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review

“…Four studies examined the associations of helminths with non-atherosclerotic cardiovascular disease, defined in these studies as myocardial injury, myocardium lipid deposits, cardiac hypertrophy, eosinophilic myocarditis, or other endomyocardial manifestations of eosinophilia that may be related to helminth infections [46,[96][97][98]. None of these studies investigated the subsequent effects of anthelmintic treatment on outcomes of non-atherosclerotic cardiovascular disease (S8 Table ).…”

“…Cross-sectional associations between helminth infections and non-atherosclerotic cardiovascular disease. Of these 4 studies, 2 showed some increase in non-atherosclerotic cardiovascular disease [96,98], 1 reported less non-atherosclerotic cardiovascular disease [46], and 1 found no relationship between non-atherosclerotic cardiovascular disease [97] and helminth infections.…”

“…In a third study, 50 young adult immigrants who had come from sub-Saharan Africa were stratified into those with mixed helminth infection and/or eosinophilia (study group) versus those without (control group) to evaluate for the presence of endomyocardial lesions [97]. The study group had thickened posterior mitral valve leaflets on both qualitative and quantitative echocardiography.…”