CLINICAL CASES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 1999 October;158(5):151-7

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English

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.