TABLE 1.

Epidemiology, pathogenesis, clinical manifestations, and treatment of parasitic infections that affect the heart

Parasitic infectionCausative organismGeographic distributionMode of transmissionHeart involvementCardiac manifestation(s)aEtiological treatment
Chagas' disease (American trypanosomiasis) Trypanosoma cruzi South and Central America, Mexico, and Southern United StatesVector-borne; transfusional congenital organ transplant; food borne; accidentalMyocarditis and pericarditis (acute phase); cardiomyopathy (chronic phase)ECG changes (sinus tachycardia, first-degree atrioventricular block, low Q-R-S voltage, primary T-wave changes); cardiomegaly; pericardial effusion; heart failure; sinus node dysfunction; atrioventricular and intraventricular blocks; ventricular arrhythmias; apical aneurysm; heart failure; sudden cardiac deathBenznidazole or nifurtimox (optional, because benefit is not well established)
African trypanosomiasis (sleeping sickness) T. b. gambiense, T. b. rhodesienseWest and Central Africa, East and Southern AfricaVector borne; others (transfusional, congenital, and accidental are rare)Pancarditis (within months or years after infection); pancarditis (within weeks after infection)ECG changes (ST-T changes, low Q-R-S voltage, Q-Tc prolongation, P-R segment depression); cardiomegaly; pericardial effusion; heart failure (mild); ECG changes; cardiomegaly; pericardial effusion; heart failure (moderate to severe)Pentamidine (early stage); melarsoprol or eflornithine (late stage); suramin (early stage); melarsoprol (late stage)
Toxoplasmosis Toxoplasma gondii WorldwideFecal-oral; food-borne; congenital; transfusional; organ transplantMyocarditis and pericarditis (rare in immunocompetent individuals; more common in immunocompromised infected persons)ECG changes; cardiomegaly; pericardial effusion; constrictive pericarditis; arrhythmias; heart failurePyrimethamine + sulfadiazine or pyrimethamine + clindamycin (plus folinic acid); pyrimethamine (+ azithromycin or atovaquone) for intolerant patients; pyrimethamine + sulfadiazine (pregnancy)
Cysticercosis Taenia solium Worldwide (rural areas in developing countries)Fecal-oralMyocarditis (very rare)Arrhythmias; conduction abnormalitiesAlbendazole or praziquantel (optional because their role is still unclear)
Trichinellosis Trichinella spiralis WorldwideFood-borneMyocarditis and pericarditisArrhythmias; pericardial effusionAlbendazole or mebendazole (in conjunction with steroids for severe cases)
Amebiasis Entamoeba histolytica Worldwide (developing countries in the tropics)Fecal-oralPericarditisECG changes; pericardial effusion; cardiac tamponadeMetronidazole
Echinococcosis Echinococcus granulosus Worldwide (rural areas)Fecal-oralPericarditis; cysts anywhere in the heartArrhythmias; myocardial infarction; cardiac tamponade; pulmonary hypertension; sudden cardiac deathAlbendazole or mebendazole
  • a Q-R-S and ST-T, Q-R-S and ST-T intervals of the ECG; Q-Tc, the Q-T interval of the ECG corrected for heart rate.