Trypanosomiasis, cardiomyopathy and the risk of ischemic stroke

Abstract

American (Chagas disease) and African (sleeping sickness) trypanosomiasis are neglected tropical diseases and are a heavy burden in Latin America and Africa, respectively. Chagas disease is an independent risk factor for stroke. Apical aneurysm, heart failure and cardiac arrhythmias are associated with ischemic stroke in chagasic cardiomyopathy. Not all chagasic patients who suffer an ischemic stroke have a severe cardiomyopathy, and stroke may be the first manifestation of Chagas disease. Cardioembolism affecting the middle cerebral artery is the most common stroke subtype. Risk of recurrence is high and careful evaluation of recurrence risk should be addressed. Repolarization changes, low voltage and prolonged QT interval are common electrocardiography alterations in human African trypanosomiasis, and can be found in more than 70% of patients. Epidemiological studies are needed to asses the risk of stroke in African trypanosomiasis perimyocarditis.

Chagas Heart Disease

“…7,31 Although some investigators have developed risk score schemes to assess the likelihood of cardioembolic or ischemic stroke 110 in patients with Chagasic cardiomyopathy, there are insufficient data to make broad recommendations regarding anticoagulation in these patients. Some have recommended that in those patients living in poor conditions and in rural areas, anti-coagulation can be dangerous because of the lack of medical support.…”

Depressive symptoms and disability in chagasic stroke patients: Impact on functionality and quality of life

“…Cardiac dysfunction is an important risk factor for stroke related to chagasic cardiomyopathy. However, an ischemic stroke can be the first manifestation of CD [6,7]. Some studies have even reported stroke in patients with CD without any clinical evidence of cardiopathy [8].…”

Neurologic manifestations of the neglected tropical diseases

“…Although Chagas-related strokes are uncommon (1-3% of cases of Chagas disease) [8,[13][14][15], they account for 10% of Chagas disease-related mortality, and may be the presenting manifestation of the infection in up to 40% of patients [8,[13][14][15]. The middle cerebral arterial territory is most commonly affected (87% of cases of Chagas-associated stroke) [16]. Intravenous tissue plasminogen activator (IV-tPA) appears to be safe for treatment of acute stroke in Chagas disease [17].…”