From the Guidelines
Diagnosing cardiac parasitosis requires a combination of clinical evaluation, imaging studies, and laboratory tests, with a focus on identifying the specific causative parasite and disease stage, as outlined in the most recent study by 1 in 2024. The diagnostic process typically begins with a thorough medical history, focusing on travel to endemic regions, exposure risks, and symptoms such as chest pain, irregular heartbeat, shortness of breath, or signs of heart failure. Key points to consider in the diagnostic process include:
- Physical examination may reveal abnormal heart sounds, edema, or other cardiac abnormalities
- Echocardiography is essential for visualizing cardiac structures and detecting abnormalities like vegetations, cysts, or chamber enlargement
- Blood tests including complete blood count often show eosinophilia in parasitic infections, while specific serological tests can identify antibodies against parasites like Trypanosoma cruzi (Chagas disease), Echinococcus (hydatid disease), or Schistosoma
- PCR testing of blood samples can detect parasitic DNA, particularly useful in early or chronic infections when parasite loads may be low
- In some cases, endomyocardial biopsy may be necessary to directly visualize parasites in cardiac tissue
- Cardiac MRI provides detailed imaging of heart tissue and can identify inflammation or fibrosis characteristic of parasitic involvement, as discussed in 1 and 1 Early diagnosis is crucial as treatment options and prognosis vary significantly depending on the causative parasite and disease stage, with the overall prognosis for patients with Chagas cardiomyopathy and HF being poor, with 50% of patients dying within a period of 4 years, as noted in 1 and 1.
From the Research
Diagnostic Criteria for Cardiac Parasitosis
The diagnostic criteria for cardiac parasitosis, also known as parasitic heart disease, involve various clinical manifestations resulting from the infection of the heart by parasites. The key diagnostic criteria include:
- Myocarditis: inflammation of the heart muscle, which can be caused by parasites such as Trypanosoma cruzi (Chagas disease) 2, 3
- Pericarditis: inflammation of the pericardium, the sac surrounding the heart, which can be caused by parasites such as Echinococcus 3, 4
- Pancarditis: inflammation of all layers of the heart, including the myocardium, pericardium, and endocardium 2
- Pulmonary hypertension: high blood pressure in the lungs, which can be caused by parasites such as Schistosoma 3, 5
- Cardiomyopathy: disease of the heart muscle, which can be caused by parasites such as Trypanosoma cruzi (Chagas disease) 2, 3
- Endomyocardial fibrosis: scarring of the heart muscle, which can be caused by parasites such as filarial infections 3, 5
Parasites Involved in Cardiac Parasitosis
The parasites involved in cardiac parasitosis include:
- Protozoa: such as Trypanosoma cruzi (Chagas disease), Toxoplasma, and free-living amoebae 2, 3
- Helminths: such as Echinococcus, Schistosoma, and filarial infections 3, 5
Importance of Diagnosis
Diagnosing cardiac parasitosis is crucial, especially in endemic areas, as it can lead to significant cardiac complications and even death if left untreated 2, 3, 5. Clinicians should consider parasitic infections in the differential diagnosis of myocardial and pericardial disease, especially in patients with unknown etiology 2, 3.