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Cardiomyopathies, defined as diseases of the myocardium associated with cardiac dysfunction, are classified into dilated, hypertrophic, restrictive and arrhythmogenic right ventricular cardiomyopathy, as well as unclassified.1 More recently, molecular classification has been suggested.2 Cardiomyopathies continue to be a significant cause of morbidity and mortality in the developed world.w1 In developing countries, however, there appears to be an increased incidence of the “usual” forms of cardiomyopathy, with a modified clinical course possibly due to genetic differences or environmental factors such as malnutrition, infections and pollution.w2 In addition, there are specific cardiomyopathies endemic to the tropics such as Chagas and endomyocardial fibrosis, which cause a considerable amount of death and suffering and have been classified as neglected diseases. We here describe what is known about these two diseases, their aetiologies, pathogenesis and management and outline directions for further research. The present article will discuss Chagas disease, and a subsequent article will address endomyocardial fibrosis.
Chagas disease is the leading cause of cardiac disease in many countries in Latin America, and the World Health Organization has estimated that 16–18 million people are currently infected and 90 million are at risk of infection.3 Chagas disease has been classified as one of the most neglected diseases in the world,w3 with no new drug development in the past 30 years.w4 Yet there are still 200 000 new cases of Chagas disease reported each year and some rural communities in Latin America have seroprevalence rates as high as 40%.
Chagas disease is caused by the protozoan parasite Trypanosoma cruzi (fig 1), which is spread by triatomine bugs (fig 2). The disease is mainly constrained geographically to countries where its vector is endemic, ranging from South America to Mexico and southern USA. Transmission has also been shown to occur via blood transfusions, …