Neglected Tropical Diseases (NDTs) are comprised of a discrete list of infectious diseases mainly occurring in tropical or subtropical regions which affect over a billion people and occur largely as a result of extreme poverty. Although rarely acknowledged, a third of the NTDs are primarily disorders of the neurologic system (rabies, neurocysticercosis, African sleeping sickness, leprosy) OR have neurologic system involvement as part of their most extreme and/or end stage manifestations (Chagas, schistosomiasis).
Over 5 million people in Latin America suffer from the effects of Chagas and the January 6th edition of The Lancet offers an excellent review of Chagas which includes a detailed overview of its neurological effects.1 These occur at every stage of this infection.
1-5% of people will present with a meningoencephalitis which has a mortality rate of 0.2-0.5%
Cardiac involvement with conduction disorders and/or myocardial injury occurs in 14-45% increasing the stroke risk of people with chronic Chagas to 2.7 events per 100 person years. In endemic regions, up to a third of strokes are Chagas-related
A sensory polyneuropathy occurs in 10%
Reactivation can occur under any circumstances of immune suppression but is especially problematic in persons with HIV/AIDS. When the CD4 count drops below 200, the primary manifestation are CNS lesions consisting of single or multiple space-occupying lesions or a severe necro-hemorrhagic meningoencephalitis.
Also check out The Lancet’s January 18th edition for a comprehensive review of the infectious causes of microcephaly2, lest we all forget the substantial list of potential causes as Zika captures our attention.
- Perez-Molina JA, Molina I. Chagas disease. Lancet 2018;391:82-94.
- Devakumar D, Bamford A, Ferreira MU, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. Lancet Infect Dis 2018;18:e1-e13.