The NET-HEART book: Neglected tropical diseases & other infectious diseases affecting the heart

Infectious diseases are a major cause of morbidity and mortality in many tropical and subtropical countries. The World Health Organization has defined some neglected tropical diseases (NTDs), including certain parasitic, viral, bacterial and fungal infections. The chief presentations of these infectious diseases are well studied and known to physicians. This book is an attempt to bring out the cardiovascular manifestations of various NTDs, which took a back seat compared to the primary manifestations, but are in no way negligible and can be ominous, to say the least. Knowing about these cardiovascular manifestations would help in screening, early identification and appropriate management of cardiac manifestation of these NTDs.

The book has discussed the cardiovascular involvement of 18 diseases. The viral diseases discussed are chikungunya, Zika, COVID-19, HIV, rabies and dengue. The parasitic infections include malaria, cysticercosis, trypanosomiasis, leishmaniasis, trichinellosis, echinococcosis, toxoplasmosis and schistosomiasis. The bacterial diseases include tuberculosis and Lyme disease. Snakebite and involvement of the heart also find a place in the discussion. There is a brief introduction to the global burden of the disease, its epidemiology and how they contribute to morbidity and mortality. It is followed by a discussion on the pathophysiology of cardiovascular involvement, symptomatology, clinical findings and treatment, with the main focus on the cardiovascular aspects. Each of these topics has been elaborately discussed by the respective authors. An appropriate emphasis has been discussed on the cardiovascular manifestation of each disease. Illustrations of the life cycle of parasites and pathophysiology make the chapters interesting. Flow charts for screening of cardiovascular involvement, diagnosis and treatment have further simplified the understanding. The dedicated chapters on electrocardiogram (ECG) findings (Chapter 21) and atrial fibrillation (Chapter 20) in NTDs make the readers more interested to go through the book.

It would have added value, if prevalent grammatical errors would have been corrected earlier. Furthermore, the treatment regimens suggested for drug-sensitive and drug-resistant tuberculosis are outdated (Chapter 3) and would be misleading to the readers. One would wonder to see a chapter about COVID-19 and the heart (Chapter 10) in a textbook about NTDs particularly since COVID-19 infection is neither a neglected nor a tropical disease, rather it is a global pandemic involving all the four hemispheres of the globe. However, it is important for the medical fraternity to know about the cardiac manifestations of COVID-19 infection. The chapter on cardiovascular manifestations of HIV has some shortcomings (Chapter 12). A description of lipid abnormalities in individuals with untreated HIV vs. following antiretroviral therapy (ART), lipodystrophy and metabolic syndrome following ART are missing. Atherosclerosis in HIV positive individuals has a distinctive pathology of diffuse circumferential vessel involvement with the proliferation of smooth muscle cells mixed and abandoned elastic fibres so it was worth mentioning this. Management of dyslipidaemia and myocardial infarction has received no attention. There is no mention of the prevalence of idiopathic pulmonary hypertension and cerebrovascular disease in HIV-infected individuals. A discussion about the correlation between CD4⁺ count and various cardiovascular manifestations is missing. There is an overlap in the information provided in the last few chapters on ECG findings (Chapter 21) and the respective chapters on various infections.

Despite these drawbacks, this book can be a good reference for physicians who would like to acquaint themselves with cardiovascular manifestations of various infectious diseases.