As part of ongoing studies on intestinal schistosomiasis in young children, LSTM researchers draw attention to the likely connection between endomyocardial fibrosis and infections with Schistosoma mansoni.
In a paper published recently in the American Journal of Tropical Medicine and Hygiene, the team from LSTM, along with colleagues in Uganda and the UK, look at the case of an 11-year-old boy who was identified in 2012 while conducting an epidemiological survey of schistosomiasis around Lake Albert in Uganda. The boy, like other children in cross-sectional surveys of this kind had advanced stages of intestinal schistosomiasis. At this level of advanced disease, organs other than the intestine and liver can start to exhibit progressive fibrosis. In this particular child, owing to an altered blood circulation around the abdomen (by-passing the liver for example), venous blood returning from the gut to the right side of the heart likely contains schistosome eggs and egg-toxins. In this particular case the lining of the right ventricle has become irritated and progressed onto develop endomyocardial fibrosis (EMF).
Although EMF is well known in Uganda, and is the leading cause of referral to Mulago teaching hospital in Kampala, its underlying aetiology is not known and still speculative. It is, however, associated with wetland areas surrounding the Nile and Great Lakes. If there is a causal connection between intestinal schistosomiasis and EMF as raised by this unfortunate case and the co-endemic zones, control of schistosomiasis could also be seen as a preventive measure against EMF.
LSTM’s Professor Russell Stothard, senior author on the study, said: “The paper sets a good example encouraging greater cross-talk between cardiologists and infectious disease specialists and multi-disciplinary research between UK-Uganda.”
Amaya L. Bustinduy,Kenneth Luzinda,Simon Mpoya,Philip Gothard,Neil Stone,Stephen Wright, & J. Russell Stothard.Case Report: Endomyocardial Fibrosis (EMF) in a Ugandan Child with Advanced Hepatosplenic Schistosomiasis: Coincidence or Connection? Am J Trop Med Hyg 2014 91:798-800; Published online July 7, 2014,doi:10.4269/ajtmh.14-0156