The NET-Heart Book: Neglected Tropical Diseases and other Infectious Diseases affecting the Heart

By Adrian Baranchuk

Neglected Tropical Diseases and other Infectious Diseases Affecting the Heart provides a comprehensive and systematic review on the literature surrounding Neglected Tropical Diseases and infectious diseases and how they affect the heart. Written by Emerging Leaders of the Interamerican Society of Cardiology (SIAC), the book includes the latest research findings, covering the cardiac involvement of a range of viral, bacterial and parasitic diseases, including COVID19, HIV, Zika, Lyme Disease, and more. Chapters cover epidemiology, the physiopathology of cardiovascular involvement, symptoms, diagnosis, and treatment options for each disease, making the book suitable to researchers, scientists, clinicians and physicians in the field.

• Covers the cardiac involvement of a range of viral, bacterial and parasitic diseases, including COVID19, HIV, Influenza, Lyme Disease, and more
• Explains the diagnosis and management of cardiovascular ailments in neglected tropical diseases
• Written in an easy to read manner with figures, illustrations and tables to aid understanding
• Contains chapter formatted with an Introduction, Epidemiology, Physiopathology of Cardiovascular (CV) involvement, Symptoms, Diagnosis, Treatment, Discussion and Conclusions

• Language: English
• Publisher: Academic Press
• Release date: Oct 12, 2021
• ISBN: 9780323911238

Book preview

The NET-Heart Book

Neglected Tropical Diseases and other Infectious Diseases affecting the Heart

Editor

Clara Saldarriaga, MD

Division of Cardiology, Heart Failure Program, Clinica Cardio VID, Medellin, Colombia

Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellin, Antioquia, Colombia

Adrian Baranchuk, MD

Division of Cardiology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada

Table of Contents

Cover image

Title page

Copyright

Contributors

Foreword

Preface

Chapter 1. Introduction

Neglected tropical diseases: what are they? Epidemiology and socio-economic impact

Relation to cardiovascular system

Barriers to access for diagnosis and management

The NET-Heart project

Emerging leaders from the SIAC

Conclusions and perspectives

Chapter 2. Malaria & Heart

Introduction

Epidemiology

Physiopathology of cardiovascular (CV) involvement

Symptoms

Diagnostic tests

Treatment

Discussion

Conclusions

Chapter 3. Tuberculosis & Heart

Introduction

Epidemiology

Physiopathology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 4. Cysticercosis & Heart

Introduction

Epidemiology

Physiopathology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusion

Chapter 5. Cardiovascular Complications of Chagas' Disease

Introduction

Parasitology

Epidemiology

Pathophysiology of cardiovascular involvement

Symptoms and clinical presentation

Diagnosis

Prognosis

Treatment

Discussion

Conclusion

Chapter 6. Lyme & Heart

Introduction

Epidemiology

Pathophysiology and cardiac involvement

Symptoms

Diagnostic tests

Treatment

Discussion

Conclusion

Chapter 7. Leishmaniasis & Heart

Introduction

Epidemiology

Physiopathology and cardiac involvement

Symptoms

Diagnostic tests

Treatment

Discussion

Conclusions

Chapter 8. Chikungunya & Heart

Introduction

Epidemiology

Physiopathology of cardiovascular (CV) involvement

Symptoms

Diagnosis

Treatment

Novel animal models to study CHIKV-related cardiomyopathies

Discussion

Conclusion

Chapter 9. Zika & Heart

Introduction

Epidemiology

Pathophysiology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 10. COVID-19 & Heart

Introduction and epidemiology

General pathophysiology of cardiovascular involvement in COVID-19

Cardiovascular complications in COVID-19 patients: symptoms, diagnosis and treatment

General treatment of COVID-19

Conclusions

Chapter 11. Trichinellosis & Heart

Introduction

Epidemiology

Physiopathology of cardiovascular (CV) involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 12. HIV & Heart

Introduction

Epidemiology

Pathophysiology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 13. Echinococcosis & Heart

Introduction

Epidemiology

Physiopathology of cardiovascular (CV) involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 14. Human African Trypanosomiasis & Heart

Introduction

Epidemiology

Physiopathology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 15. Snakebite & Heart

Introduction

Epidemiology

Pathophysiology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 16. Rabies & Heart

Introduction

Epidemiology

Physiopathology and clinical presentation of rabies

Diagnosis of rabies

Cardiac involvement in rabies

Treatment

Conclusion

Chapter 17. Toxoplasmosis & Heart

Introduction

Epidemiology

Physiopathology

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 18. Schistosomiasis & Heart

Introduction

Epidemiology

Physiopathology of cardiovascular involvement

Signs and symptoms

Diagnostic tests

Treatment

Discussion

Conclusions

Chapter 19. Dengue & Heart

Introduction

Epidemiology

Pathophysiology and cardiac involvement

Symptoms

Diagnosis

Treatment

Discussion

Conclusions

Chapter 20. Neglected Tropical Diseases & Atrial Fibrillation

Introduction

Pathophysiology of NTDs leading to AF

NTDs associated with AF

Zika virus disease

Dengue fever

Chikungunya fever

Toxoplasmosis

Tuberculosis

COVID-19

Management of AF in patients with NTDs

Discussion

Conclusion

Chapter 21. Electrocardiogram in Neglected Tropical Diseases

Introduction

NTDs and other infectious diseases

Human immunodeficiency virus

Proposed approach to cardiovascular implications of neglected tropical diseases

Conclusion

Chapter 22. Cardiovascular Images in Neglected Tropical Diseases

Introduction

Chagas’ disease

Human immunodeficiency virus (HIV)

Tuberculosis

Echinococcosis

Cysticercosis

Schistosomiasis

Other NET-hearts diseases & CV images

Gaps in evidence

Conclusions

Index

Copyright

Academic Press is an imprint of Elsevier

125 London Wall, London EC2Y 5AS, United Kingdom

525 B Street, Suite 1650, San Diego, CA 92101, United States

50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States

The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom

Copyright © 2022 Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-0-323-91122-1

For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals

Publisher: Stacy Masucci

Acquisitions Editor: Katie Chan

Editorial Project Manager: Sam Young

Production Project Manager: Sreejith Viswanathan

Cover Designer: Mark Rogers

Cover Credit: Kiera Liblik

Typeset by TNQ Technologies

Contributors

Adrian Baranchuk,     Division of Cardiology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada

Hector Isaac Alejandro Ortiz

Department of Cardiology, Hospital Herrera Llerandi, Guatemala City, Guatemala

Division of Cardiology, Hospital Herrera Llerandi, Guatemala City, Guatemala

Bryce Alexander,     Division of Cardiology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada

Jesús Álvarez-García

Heart Failure Unit, Cardiology Department, University Hospital Ramón y Cajal, IRYCIS, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain

Cardiology Department, University Hospital Ramón y Cajal, IRYCIS, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain

Diego Araiza-Garaygordobil,     Coronary Care Unit, National Institute of Cardiology of México, México

Saad Balamane,     Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada

Oswaldo Andrés Ballesteros,     Division of Cardiology, Trinidad Palermo Sanatorium, Buenos Aires City, Argentina

Marcia Barbosa de Melo,     Division of Cardiology, Hospital Socor, Belo Horizonte, Brazil

Lucrecia Maria Burgos,     Department of Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina

Jin Byun,     Faculty of Health Sciences, Queen's University, Kingston, ON, Canada

Karina Gonzalez Carta

Mayo Clinic, Rochester, MN, United States

Ascardio, Barquisimeto, Venezuela

Juan Ignacio Cotella,     Division of Cardiology, Centro Privado de Cardiología San Miguel de Tucumán, Tucumán, Argentina

Luis Eduardo Echeverría,     Department of Cardiology, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia

Juan María Farina,     Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States

Carlos Eduardo García-Martínez

Division of Cardiology, Advanced Cardiovascular Center, Guatemala City, Guatemala

Cardiac Catheterization Laboratory, Centro Cardiológico Americano, Montevideo, Uruguay

Division of Cardiology, Centro Cardiovascular Avanzado, Guatemala City, Guatemala

Sebastián García-Zamora,     Echocardiography Laboratory, Cardiology Division, Delta Clinic, Rosario, Santa Fe, Argentina

Naomi Gazendam,     Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada

Luis Gerardo Gonzalez-Barrera

Electrophysiology, ISSSTE National Medical Center, Mexico City, Mexico

Internal Medicine, IMSS, Metepec, Estado de México, Mexico

Cardiologist, Hospital Angeles, Mexico City, Mexico

Shyla Gupta,     Faculty of Health Sciences, Queen's University, Kingston, ON, Canada

Alejandra González Gutierrez,     Division of Cardiology, General Hospital of Zone No. 1, Mexican Institute of Social Security, Nayarit, Mexico

Dhruv Krishnan,     Department of Medicine, Queen's University, Kingston, ON, Canada

Fernando Lanas,     Universidad de La Frontera, Temuco, Chile

Kiera Liblik

Division of Cardiology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada

Translational Medicine, Queen's University, Kingston, ON, Canada

Medicine, Queen's, Kingston, ON, Canada

Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada

José Patricio López-López

Instituto MASIRA, Universidad de Santander, Bucaramanga, Santander, Colombia

Centro Integral para la Prevención de Enfermedades Cardiometabólicas (CIPCA) and Instituto de Investigaciones Masira, Universidad de Santander (UDES), Bucaramanga, Colombia

Ricardo López-Santi

Division of Cardiology, Hospital Italiano de La Plata, Buenos Aires, Argentina

Head of promotion and prevention at the Hospital Italiano de La Plata, La Plata, Argentina

Manuel Martínez-Sellés

Cardiology Department, Hospital General Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain

Cardiology, H. Gregorio Marañón, Madrid, Spain

Iván Mendoza,     Tropical Cardiology, Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela

Andrés Felipe Miranda-Arboleda,     Department of Cardiology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia

María Gabriela Noval

Department of Microbiology, NYU Grossman School of Medicine, New York, NY, United States

NYU Grossman School of Medicine, Microbiology, New York University, New York City, NY, United States

Gonzalo Emanuel Pérez

Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States

Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina

Carlos I. Ponte-Negretti,     Cardiometabolic Medicine Unit, Instituto Médico La Floresta, Caracas, Venezuela

Edith Liliana Posada-Martínez

Echocardiography Departament, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico

Department of Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico

Gustavo Restrepo,     Medicina, EIA, Medellin, Colombia

Clara Saldarriaga,     Division of Cardiology, Heart Failure Program, Clinica Cardio VID, Medellin, Colombia; Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellin, Antioquia, Colombia

Prashanthan Sanders

Centre for Heart Rhythm Disorders, School of Medicine, University of Adelaide, Adelaide, Australia

Cardiac Electrophysiology and Pacing, Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia

Heart Rhythm Group, Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia

Ana Laura Sauce Pérez,     Division of Cardiology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico

Cristhian Emmanuel Scatularo

Cardiology, Sanatorio de la Trinidad de Palermo, Buenos Aires, Argentina

Advanced Heart Failure, Fundación Favaloro, Buenos Aires, Argentina

Division of Cardiology, Sanatorio de la Trinidad Palermo, Buenos Aires, Argentina

Division of Advanced Heart Failure and Heart Transplantation, Favaloro Foundation, Buenos Aires, Argentina

Division of Cardiology, Trinidad of Palermo Hospital, Buenos Aires, Argentina

Laura Scott,     Division of Cardiology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada

Arjun Sharma,     Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada

Álvaro Sosa-Liprandi,     Department of Cardiology, Sanatorio Güemes, Buenos Aires, Argentina

Mildren del Sueldo,     Cardiology Division and Cardiovascular Prevention, Speciality Clinic, Villa María, Córdoba, Argentina

Melissa Tso,     Resident Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Fernando Wyss,     Technology and Cardiovascular Service of Guatemala - Cardiosolutions, Guatemala City, Guatemala

Cynthia Yeung,     Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada

Ezequiel José Zaidel,     Department of Cardiology, Sanatorio Güemes, Buenos Aires, Argentina

Zier Zhou,     Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada

Foreword

It is estimated that neglected tropical diseases (NTDs) affect over one billion individuals who predominantly live in poor and somehow neglected tropical and subtropical areas. There are several types of NTDs that have been defined by the WHO, including parasitic, viral, bacterial, and fungal infections. The increased burden of NTDs in low-income countries (LICs) is in part due to limited access to basic conditions, such as sanitary conditions of the populations, including clean water and safe ways to dispose of waste. The other significant determinant of this increased burden of NTDs relates with the very limited healthcare resources in these more affected areas. Therefore, strategies targeting the eradication of NTDs are urgently needed and they should include large-scale programs to control vectors that transmit NTDs and to improve sanitation, housing, and access to care for affected populations. The involvement of the heart by these different medical conditions seems to be very frequent, though varying according with the specific condition. The knowledge about these conditions has developed over the years in a nonuniform way and no consistent and clearly designed program has ever been organized. Educating healthcare professionals to better understand these conditions and, consequently, better manage them is an essential task where scientific medical organizations can play a central role.

The NET-Heart project is an innovative project organized by the Interamerican Society of Cardiology or Sociedad Interamericana de Cardiologia (SIAC) under its Emerging Leaders (EL) program. It focuses on making neglected diseases visible and analyzing their critical link with CV diseases. Its main goal is to be a useful tool for the daily medical practice in the most affected areas, generally facing huge difficulties to implement even basic and simple measures. In addition, the project is a call to deepen investigation of these entities and to promote global programs for the improvement in access to healthcare, financial well-being, and sanitation of the affected populations. It was conceived in three phases, the first being a systematic review on the different conditions that resulted in several publications, the second is this book, and the third will be an NET-Heart app, all of them designed to help to improve dissemination of knowledge at the same time as helping to implement practical and feasible medical strategies, that can be implemented in locations where the local conditions may be very limited.

At the World Heart Federation (WHF), a strategy has been defined in order to depict the journey we need to travel to reach our ultimate goal of cardiovascular health for all, the vision of WHF. We have set for ourselves the ambition to become the reference organization for information, knowledge, and policy in the global cardiovascular sphere; to promote and support cardiovascular prevention and control at global level; and to strengthen the capacity of our Members toward the reduction of CVD premature mortality by 33% by 2030. Therefore, it is with great joy that we see the development and implementation of programs such as the NET-Heart project, organized under the auspices of one of our member organizations, which fits perfectly with our strategic options of working closely with our members in order to help promoting their initiatives.

This book is an excellent example of collaboration between different teams and researchers across the American continent, from north to south, involving some of the mostly respected researchers in the different areas of knowledge in the field of tropical diseases, particularly those affecting the heart. The role of the EL of SIAC has been essential and I would like to highlight the relevance of programs like this that foster the interaction of young talented researchers, promoting adequate methodologies and networking, essential for the future implementation of good practices across these regions.

This is certainly the most comprehensive book in this topic published so far and I want to congratulate the editors and authors for the idea and, above all, the capacity to organize such an important tool that will certainly help to implement better strategies to improve the knowledge and management of these different conditions. A special note for Clara Saldarriaga and Adrian Baranchuk, the Editors, who were able to build the project and turn it into the reality of the book you have in your hands.

This initiative will certainly contribute to our common goal of promoting cardiovascular health for everyone and will remain as an important reference for the future. Congratulations to all involved.

Fausto J. Pinto

President, World Heart Federation (WHF)

Lisbon University, Portugal

Preface

We have been given the amazing opportunity to write a preface for this incredible book that our colleagues, Drs. Clara Saldarriaga and Adrian Baranchuk, have put together with the collaboration of the Emerging Leaders (EL) Program of the Inter-American Society of Cardiology (SIAC). The topic they approached is a largely neglected corner of cardiology: Neglected Tropical Diseases (NTDs) and other Infectious Diseases affecting the Heart.

This book is unique in many senses: Each of the chapters was written and led by some of the 33 members that currently participate in the EL Program of SIAC. The group is composed by medicine students, health science students, internal medicine and cardiology residents, and young cardiologists up to the age of 35 years (a requisite to be a member of the EL Program). ELs were supervised by a selected group of professionals with different sets of expertise in NTDs, who contributed their knowledge for the development of this book.

The editors have expressed that their wish is for this book to become a reference for health care practitioners from all over the world; and we believe with no doubt that they have achieved a uniform and solid work, fed by different visions. This book is dynamic and easy to read with similar formatting in each chapter and illustrated with original algorithms to facilitate the diagnosis and management of cardiovascular involvement of each NTD.

NTDs are currently a crucial topic in Public Health; and we believe that the importance of this scientific work lies in the fact that the World Health Organization (WHO) has estimated that the impact of these diseases in poor countries around the world is immense and devastating and still underappreciated as a global health problem. Its impact on the cardiovascular system is poorly explored in some cases, and social barriers remain the major limitation to access proper care. Due to this, in a meeting of the 49th Directing Council of the Pan American Health Organization (PAHO) in the session of the 61st Regional Committee, held from September 28, 2008 to October 2, 2008, it was agreed through Resolution CD49.R19 that the elimination of NTDs and other conditions related to poverty (low economic income) was a priority. In their third consideration, they referred to the importance of completing the unfinished agenda giving priority to the population that suffers from these diseases, living in poor and especially marginalized countries of the world. The goal set was the elimination of NTDs by the year 2015 and, in the most ambitious way, to stop considering them a public health problem by the same year. That has clearly not been achieved to this day and the current COVID-19 pandemic has aggravated the funding and resources to eliminate other NTDs.

The NET-Heart project is an innovative collaborative initiative created to assess burden and impact of NTDs and other infectious diseases over the cardiovascular system. Initially, the ELs under the supervision of Drs. Saldarriaga and Baranchuk have published 13 manuscripts in high-impact factor journals following a rigorous scientific method for systematic reviews, including the original algorithms for management. Once they completed the first task, they embarked on the construction of this amazing book, including other disease that were not covered in the systematic reviews, with a total of 22 chapters. Under the strictest evidence-based medicine, The NET-Heart Book offers the reader an extraordinary approach where all the relevant aspects of each topic are covered in a fantastic way for the reader to learn and enjoy.

The main objective of The NET-Heart Book was to extensively review the available evidence about NTDs and other infectious diseases involving the cardiovascular system. As a secondary objective, this initiative aims to offer recommendations and potential diagnostic and therapeutic algorithms that can aid the management of cardiovascular complications of these infectious diseases. After long considerations, some of the selected chapters are as follows: HIV, Dengue, Zika, Chikungunya, Tuberculosis, African Human Trypanosomiasis, Malaria, Chagas, Schistosomiasis, Lyme, Cysticercosis, Echinococcosis, Fascioliasis, Leishmaniasis, COVID-19, Rabies, and Toxoplasmosis; for each disease, a working group was created and supervised by experts on each topic. The phases for this project included the following: systematic review of the literature, brainstorming workshops, analysis and results, manuscript writing including extraction tables and qualitative analysis of the available literature, and recommendations for diagnosis and management and evaluation of clinical implications.

One of the most important concepts, considered by the authors, was that the advancement of knowledge about these NTDs can provide valuable strategies to improve the daily medical practice of health care teams, more specifically in remote areas where NTDs are more prevalent. As mentioned before, this goal was achieved by the inclusion of the relevant original algorithms included in each chapter.

We are not afraid to say that the insatiable curiosity and extreme ability of the Editors and Coordinators of this book paved the path for these young researchers to achieve a goal that seemed impossible: a book edited by one of the most important medical editorials in the world with extensive distribution to each corner of the world, to help health care providers to provide better and evidence-based care to their communities. From SIAC, we cannot be prouder of our young researchers and their mentors, and we will keep stimulating the inclusion of young individuals to our society from any background with the sole goal of advancing knowledge.

We hope that the authors see this book as a work on continuous development, since this allows us all the health care practitioners to be updated on the diagnosis and treatment approach of the NTDs. We congratulate Clara and Adrian for this new achievement and we are looking forward to what they will bring next in the near future.

For us as representatives of SIAC, it has been a real honor to write these lines and to wish all the success to our colleagues and friends, Clara and Adrian.

Fernando Wyss, President SIAC 2019–21

Alvaro Sosa Liprandi, President SIAC 2021–23

Chapter 1: Introduction

Lucrecia Maria Burgos a , Juan María Farina b , Kiera Liblik c , Clara Saldarriaga d , and Adrian Baranchuk c       a Department of Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina      b Department of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States      c Division of Cardiology, Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada      d Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellín, Colombia

Neglected tropical diseases: what are they? Epidemiology and socio-economic impact

Neglected tropical diseases (NTDs) affect over one billion individuals who predominantly live in tropical and sub-tropical areas disproportionately impacted by poverty (Fig. 1.1). There are several NTDs including parasitic, viral, bacterial, and fungal infections [1,2]. The increased burden of NTDs in low-income countries (LIC) is in part due to limited access to clean water, healthcare resources, and safe ways to dispose of waste [3,4]. Strategies targeting the eradication of NTDs span far beyond their therapeutic management [4]. Large-scale programs to control vectors that transmit NTDs and to improve sanitation, housing, and access to care for affected populations are critical.

NTDs do not only worsen the health of those living in poverty, but also limit their work capacity due to resultant disability, growth restriction, and impaired cognitive development, trapping affected people in a circle of indigency, deprivation and illness [3]. Accordingly, in the 2010 Global Burden of Disease Study, NTDs accounted for 26.06 million disability-adjusted life years (DALYs) [1,4]. DALYs due to NTDs constitute 56% of years lost due to disability (YLD) and for 44% years of life lost (YLL), as compared to 7% of YLD and 93% of YLL for malaria [1,5,6].

Fig. 1.1 Number of NTDs present by country according to WHO estimates. NTDs, neglected tropical diseases; WHO, World Health Organization. 

Reproduced with permissions from Burgos LM, Farina J, Liendro MC, et al. Neglected tropical diseases and other infectious diseases affecting the heart. The NET-Heart project: rationale and design. Global Heart 2020;15(1):60. http://doi.org/10.5334/gh.867.

The following are the NTDs currently recognized by the World Health Organization (WHO):

- Buruli ulcer

- Chagas disease (American trypanosomiasis)

- Dengue and severe dengue

- Chikungunya fever

- Dracunculiasis (Guinea-worm disease)

- Echinococcosis

- Foodborne trematodiases

- Human African trypanosomiasis (sleeping sickness)

- Leishmaniasis

- Leprosy (Hansen's disease)

- Lymphatic filariasis (Elephantiasis)

- Mycetoma, chromoblastomycosis, and other deep mycoses

- Onchocerciasis (river blindness)

- Rabies

- Scabies and other ectoparasitoses

- Schistosomiasis (Bilharzia)

- Soil-transmitted helminthiases

- Snakebite envenoming

- Taeniasis and cysticercosis

- Trachoma

- Yaws

NTDs have remained largely overlooked in global health initiatives [1]. This oversight is largely a result of the lack of a strong political voice of the affected populations, indifference of the mass media, and the scarcity of resources in affected regions to generate reliable statistics and publications related to these diseases [3]. Recently, the WHO launched the roadmap against NTDs in which they target to reduce the number of people requiring treatment for NTDs by 90% by 2030, among other aims [7]. Despite these and other actions by multinational organizations, the battle against these diseases is far from complete.

Relation to cardiovascular system

Physiopathology of cardiovascular (CV) involvement disease is the leading cause of mortality worldwide [8]. Although the burden of CV risk-factors is decreased in LIC, major CV events and mortality rates are higher in LIC than in high-income countries (HIC) [9]. A similar paradox is observed between urban and rural communities. Even when urban communities have a higher risk-factor burden, these areas show lower major CV events and mortality rates than rural regions [9].

It has been postulated that the higher prevalence of CV risk-factors in HIC may be mitigated by better control strategies and increased access to medical interventions [9]. However, this disparity is likely due to a complex interplay of several factors [1]. Consequently, an important contributor to the burden of CV disease in LICs may be the CV impacts of NTDs and other endemic diseases [1]. Little is known about the burden of CV disease secondary to NTDs, and adequate data is lacking to determine the true extent of CV disease resulting from neglected conditions [10].

Approximately half of the CV disease burden in LIC is attributable to ischemic heart disease, followed by a third due to cerebrovascular disease, and the remainder hypertensive and inflammatory causes as well as rheumatic heart disease. NTDs may account for a significant component of