The Neurological Burden Buried in the Neglected Tropical Diseases (NTDs)

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.

Acute phase

1-5% of people will present with a meningoencephalitis which has a mortality rate of 0.2-0.5%

Chronic Phase

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 Phase

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.

 

References:

  1. Perez-Molina JA, Molina I. Chagas disease. Lancet 2018;391:82-94.
  2. Devakumar D, Bamford A, Ferreira MU, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. Lancet Infect Dis 2018;18:e1-e13.

 

Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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