背景:嗜酸性粒细胞增多综合征可引起心脏受累和心内膜心肌纤维化,预后不良。然而,关于与蠕虫病相关的嗜酸性粒细胞增多的拉丁美洲移民的心脏受累信息有限.
方法:我们进行了一项初步观察性研究,对来自拉丁美洲的移民进行了超声心动图检查,诊断为嗜酸性粒细胞增多(>450细胞/μL)和蠕虫感染,以及来自拉丁美洲的移民,没有嗜酸性粒细胞增多或蠕虫感染。微生物学技术包括使用Ritchie的福尔马林-乙醚技术进行粪便显微镜检查,和一种特异性血清学方法来检测赤圆圆线虫抗体。
结果:包括37名参与者,20伴嗜酸性粒细胞增多和17无嗜酸性粒细胞增多。20名男性(54.1%),平均年龄为41.3(SD14.3)岁。嗜酸性粒细胞增多组中诊断为蠕虫感染:17例胸骨链球菌感染,1例钩虫感染,2例胸骨链球菌与钩虫共感染。在嗜酸性粒细胞增多的参与者中,超声心动图显示右心室厚度(p=0.001)和左心房面积和容积指数(分别为p=0.003和p=0.004),同时显示左心房下部应变(p=0.006)和E波减速时间(p=0.008)。与无嗜酸性粒细胞增多的参与者相比,二尖瓣前后叶厚度均增加(分别为p=0.0014和p=0.004)。
结论:来自拉丁美洲的与蠕虫感染相关的嗜酸性粒细胞增多的移民可能出现早期超声心动图改变,提示早期舒张功能障碍。这可能与嗜酸性粒细胞增多引起的心内膜改变有关。
BACKGROUND: Hypereosinophilic syndrome can produce cardiac involvement and endomyocardial fibrosis, which have a poor prognosis. However, there is limited information regarding cardiac involvement among migrants from Latin America with eosinophilia related to helminthiasis.
METHODS: We conducted a pilot observational
study where an echocardiography was performed on migrants from Latin America with both
eosinophilia (>450 cells/μL) and a diagnosis of helminth infection, and on migrants from Latin America without
eosinophilia or helminth infection. Microbiological techniques included a stool microscopic examination using the Ritchie\'s formalin-ether technique, and a specific serology to detect Strongyloides stercoralis antibodies.
RESULTS: 37 participants were included, 20 with
eosinophilia and 17 without
eosinophilia. Twenty (54.1%) were men with a mean age of 41.3 (SD 14.3) years. Helminthic infections diagnosed in the group with eosinophilia were: 17 cases of S. stercoralis infection, 1 case of hookworm infection, and 2 cases of S. stercoralis and hookworm coinfection. Among participants with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness (p = 0.001) and left atrial area and volume index (p = 0.003 and p = 0.004, respectively), while showing a lower left atrial strain (p = 0.006) and E-wave deceleration time (p = 0.008). An increase was shown in both posterior and anterior mitral leaflet thickness (p = 0.0014 and p = 0.004, respectively) when compared with participants without eosinophilia.
CONCLUSIONS: Migrants from Latin America with
eosinophilia related to helminthic infections might present incipient echocardiographic alterations suggestive of early diastolic dysfunction, that could be related to eosinophilia-induced changes in the endomyocardium.