Prevalence of Cardiovascular Complications in Malaria:A Systematic Review and Meta-Analysis

Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950–April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5–9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0–8%, cardiac biomarkers 0–57%, and echocardiography 4–9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged

Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection:a case report from the Amazon Basin

BACKGROUND: Information on cardiopulmonary complications in clinical malaria is sparse and diagnosis may be difficult in resource-limited areas due to lack of proper diagnostic tools and access to medical care. A case of pericardial effusion and pulmonary alterations assessed by ultrasound in a patient with uncomplicated mixed malaria infection is described. CASE PRESENTATION: A previously healthy 23-year-old male from the Amazon Basin was diagnosed with mixed infection of Plasmodium vivax and Plasmodium falciparum by peripheral blood smear. The patient presented with mild malaria symptoms without signs of severe malaria, but reported moderate chest pain and shortness of breath. Laboratory analyses revealed thrombocytopenia and anemia. The electrocardiogram had PR depressions and bedside ultrasound of the cardiopulmonary system showed pericardial effusion (18 mm) accompanied by multiple B-lines in the lungs, identified as vertical artifacts extending from the pleural line. Cardiac biomarkers were normal. The patient was treated according to national guidelines for malaria and suspected pericarditis, respectively. At follow-up on day 5, the pericardial effusion (9mm) and B-lines had markedly decreased. By day 21 the patient was asymptomatic, had completed the treatment, and the electrocardiogram and ultrasound findings had normalized. CONCLUSIONS: This case report highlight the usefulness of bedside ultrasound to identify cardiopulmonary involvement in patients with uncomplicated malaria and relevant symptoms

Case-fatality from orally-transmitted acute Chagas disease: a systematic review and metanalysis

Federal University of Acre. Rio Branco, AC, Brazil.Federal University of Parana. Curitiba, PR, Brazil.Elson S. Floyd College of Medicine. Lumni Tribal Health Center. Spokane, WA, Estados Unidos.University of Pernambuco. Recife, PE, Brazil.University of Amazonas. Manaus, AM, Brazil.University of Tocantins. Palmas, TO, Brazil.Federal University of Acre. Rio Branco, AC, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Federal University of Pará. Medical School. Belém, PA, Brazil.Secretary of Health of the State of Acre. Rio Branco, AC, Brazil.Federal University of Maranhão. Sao Luis, MA, Brazil.Federal University of Ceará. Fortaleza, CE, Brazil.Harvard Medical School. Brigham and Women’s Hospital. Division of Infectious Disease. Boston, USA.Federal University of Acre. Rio Branco, AC, Brazil.Orally-transmitted acute Chagas disease (CD) is emerging as an important public health problem. The prognosis of acute infection following oral transmission is unknown. The aim of this paper was to analyze and summarize data on orally-transmitted acute CD. We searched for studies from 1968 to January 31, 2018. We included studies and unpublished data from government sources that reported patients with acute CD orally-transmitted. We identified 41 papers and we added 932 unpublished cases. In all, our study covered 2470 cases and occurrence of 97 deaths. Our meta-analysis estimated that the case-fatality rate was 1.0% (95% CI 0.0 – 4.0%). Lethality rates have been declined over time (p = 0.02). In conclusion, orally-transmitted acute CD has considerable lethality in the first year after infection. The lethality in symptomatic cases is similar to that from other routes of infection. The lethality rate of orally-acquired disease have declined over the years

Frequency of pleural effusion in dengue patients by severity, age and imaging modality: a systematic review and meta-analysis

Abstract Background Identification of pleural effusion (PE) in dengue infection is an objective measure of plasma leakage and may predict disease progression. However, no studies have systematically assessed the frequency of PE in patients with dengue, and whether this differs across age and imaging modality. Methods We searched Pubmed, Embase Web of Science and Lilacs (period 1900–2021) for studies reporting on PE in dengue patients (hospitalized and outpatient). We defined PE as fluid in the thoracic cavity detected by any imaging test. The study was registered in PROSPERO (CRD42021228862). Complicated dengue was defined as hemorrhagic fever, dengue shock syndrome or severe dengue. Results The search identified 2,157 studies of which 85 studies were eligible for inclusion. The studies (n = 31 children, n = 10 adults, n = 44 mixed age) involved 12,800 patients (30% complicated dengue). The overall frequency of PE was 33% [95%CI: 29 to 37%] and the rate of PE increased significantly with disease severity (P = 0.001) such that in complicated vs. uncomplicated dengue the frequencies were 48% and 17% (P < 0.001). When assessing all studies, PE occurred significantly more often in children compared to adults (43% vs. 13%, P = 0.002) and lung ultrasound more frequently detected PE than conventional chest X-ray (P = 0.023). Conclusions We found that 1/3 of dengue patients presented with PE and the frequency increased with severity and younger age. Importantly, lung ultrasound demonstrated the highest rate of detection. Our findings suggest that PE is a relatively common finding in dengue and that bedside imaging tools, such as lung ultrasound, potentially may enhance detection

Supplemental methods.

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Variance inflation factor of sociodemographic factors.

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Proposed mechanisms of cardiac injury in dengue.

Potential mechanisms for dengue induced myocardial impairment: (1) Direct infection of cardiomyocytes causing apoptosis and inflammation. (2) Vascular leakage induced by NS1, which leads to intravascular volume depletion and reduced preload, eventually causing cardiac ischemia. NS1 has also been associated with endothelial dysfunction and altered coronary microcirculation. (3) Inflammation in the cardiac vasculature and myocardial interstitial edema driven by an imbalanced immune response with release of pro-inflammatory cytokines. Over time the proposed mechanisms may lead to myocardial fibrosis and impaired contractility.</p

Association between number of dengue episodes and LV systolic function.

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