Department of Medicine, Emory University School of Medicine, 550 Peachtree St. MOT, 7th Floor, TravelWell Clinic, Atlanta, GA 30308, USA.
Clin Microbiol Rev. 2010 Apr;23(2):324-49. doi: 10.1128/CMR.00054-09.
Parasitic infections previously seen only in developing tropical settings can be currently diagnosed worldwide due to travel and population migration. Some parasites may directly or indirectly affect various anatomical structures of the heart, with infections manifested as myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Thus, it has become quite relevant for clinicians in developed settings to consider parasitic infections in the differential diagnosis of myocardial and pericardial disease anywhere around the globe. Chagas' disease is by far the most important parasitic infection of the heart and one that it is currently considered a global parasitic infection due to the growing migration of populations from areas where these infections are highly endemic to settings where they are not endemic. Current advances in the treatment of African trypanosomiasis offer hope to prevent not only the neurological complications but also the frequently identified cardiac manifestations of this life-threatening parasitic infection. The lack of effective vaccines, optimal chemoprophylaxis, or evidence-based pharmacological therapies to control many of the parasitic diseases of the heart, in particular Chagas' disease, makes this disease one of the most important public health challenges of our time.
由于旅行和人口迁移,以前仅在热带发展中地区发现的寄生虫感染现在可以在全球范围内诊断。一些寄生虫可能直接或间接影响心脏的各种解剖结构,感染表现为心肌炎、心包炎、全心炎或肺动脉高压。因此,对于发达国家的临床医生来说,在全球任何地方考虑寄生虫感染作为心肌和心包疾病的鉴别诊断变得非常重要。恰加斯病是迄今为止最重要的心脏寄生虫感染,由于来自这些寄生虫高度流行地区的人口向非流行地区迁移,目前它被认为是一种全球性寄生虫感染。目前,在治疗非洲锥虫病方面的进展为预防这种危及生命的寄生虫感染的神经系统并发症以及经常出现的心脏表现带来了希望。缺乏有效的疫苗、最佳的化学预防措施或基于证据的药理学疗法来控制许多心脏寄生虫病,特别是恰加斯病,这使得这种疾病成为我们这个时代最重要的公共卫生挑战之一。