Response by Grimaldi et al to Letter Regarding Article, “Tropical Endomyocardial Fibrosis: Natural History, Challenges, and Perspectives”
We agree that a significant body of evidence points to a role for eosinophils, and accordingly we have presented this as 1 of the potential hypotheses for the genesis of EMF in our article. However, as we point out, issues of geographical mismatch with parasitic infestations, lack of universal presence of eosinophils, and associations with certain dietary patterns do not allow at present for a clear picture of causality to emerge. Improvements in socioeconomic conditions, while allowing for a decline of parasitic infections, may also result in changes in dietary habits that can hypothetically lead to a decline in EMF related to ingestion of toxins or microelement deficiency. It may well be possible that fibrosis and cavity obliteration represent a common endpoint to multiple pathways triggered by various factors or an interplay of them.
We certainly agree with Kothari on the need for further enthusiastic and rigorous research into the role of eosinophils, but until such time that all the facets in the pathogenesis of this still mysterious disease are completely decoded, we must remain open to other potential etiologies of EMF.
Circulation is available at http://circ.ahajournals.org.
- © 2016 American Heart Association, Inc.