Review authors recommend that stroke patients from endemic regions be screened for infection
FRIDAY, April 16 (HealthDay News) -- Chagas disease -- which affects 18 million people worldwide -- is an independent risk factor for ischemic stroke. Although cardioembolism is the main cause, cryptogenic stroke and small vessel stroke also often occur in indeterminate Chagas disease and in patients with mild chronic heart disease related to Chagas disease, according to a review published in the May issue of The Lancet Neurology.
Francisco Javier Carod-Artal, M.D., of the Virgen de la Luz Hospital in Cuenca, and Joaquim Gascon, M.D., of Hospital Clinic Barcelona, both in Spain, searched the PubMed database for relevant articles published between January 1970 and January 2010, and reviewed articles published in English, Spanish and Portuguese.
The researchers cited multiple epidemiological studies published during the past decade showing a link between Trypanosoma cruzi infection and ischemic stroke, as well as several studies showing that chagasic stroke is associated with heart failure, mural thrombus, left ventricular apical aneurysm, and several types of cardiac arrhythmias. They also cited evidence that the burden of chagasic stroke is likely to increase in Latin America as well as in the United States. According to one study, more than 300,000 Latin American immigrants with Chagas disease may currently live in the United States, resulting in an estimated 30,000 to 45,000 cardiomyopathy cases and 300 congenital infections each year.
"A careful work-up diagnosis of stroke is needed in these patients, and the presence of left ventricular segmental lesions (apical aneurysm and mural thrombus) should be excluded," the authors write. "Early diagnosis and secondary prevention measures should be encouraged in chagasic stroke. Patients with ischemic cardioembolic or cryptogenic stroke should be screened for T cruzi infection if they reside in or have emigrated from endemic regions. Clinical trials are needed to assess the efficacy of long-term oral anticoagulation in primary and secondary prevention of stroke in Chagas disease."
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