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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 1999 October;158(5):151-7
Toxoplasmosis and cardiovascular disorders
Barbosa Vosgerau J. C.
Dermalogist, Centro Municipal de Especialidades, Secretary of Health from Ponta Grossa, Brasil
Chlamydia pneumoniae has been claimed to have a central role in the pathophysiology of atherosclerosis and coronary artery disease, and roxithromycin, an important role in preventing death, acute myocardial infarction and recurrent angina pectoris. Three patients are reported with chronic toxoplasmosis with multiple complaints in different combinations such as exanthema morbiliform, fever, arthralgia/ bone pain, multiplex mononeuropathy, ptosis, hypotension, heart failure, tachycardia, angina pectoris, hypertension recalcitrant to usual anti-hypertensive drugs with ECG alterations such as ST changes and “T” wave diffuse changes, eosinophilia, leukopenia, leukocytosis. There was remission of those symptoms and of cardiovascular disorders with antitoxoplasmosis treatment, using a triplet drugs scheme, particularly with roxithromycin 900 mg/day dapsone and pyrimethamine. These cardiovascular disorders and other complaints relapsed as the toxoplasmosis medicines were interrupted. It is postulated that increased host IFN-γ levels triggered by Toxoplasma has a central role in toxoplasmosis pathophysiology and when associated with other cytokines such as TNF-α may induce heart failure and septic shock and with IFN-α, angina pectoris and hypertension. So the clinical/laboratory disorders reported above are part of the toxoplasmosis reactional state. It seems that atherosclerosis, coronary artery disease and heart failure may not be age-related cardiovascular degenerative disorders, but responses to chronic cytokines-related stimulation, where IFN-γ triggered by intracellular parasites such as Toxoplasma has a central role in their pathophysiology. Early diagnosis and treatment of chronic toxoplasmosis using a triplet drug scheme with roxythromycin, dapsone and pyrimethamine may prevent late and severe cardiovascular complications like death, unstable angina pectoris, myocardial infarction and rebel hypertension.