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Hoffmann S, Henrichsen J, Schmidt K. Incidence and diagnosis of acute rheumatic fever in Denmark, 1980 and 1983. A retrospective analysis of the fulfillment of the revised Jones criteria in hospitalized patients. ACTA MEDICA SCANDINAVICA 2009; 224:587-94. [PMID: 3061291 DOI: 10.1111/j.0954-6820.1988.tb19631.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A review of 1547 official hospital record summaries concerning discharges during the period 1980 through 1983 of patients whose diagnoses had been coded as acute rheumatic fever revealed that in only 61% of the cases had this illness been diagnosed or suspected. A substantial proportion of the remaining patients had had acute non-rheumatic pericarditis diagnosed. The medical records were analyzed for 141 patients diagnosed in 1980 or 1983 by hospital departments as having acute rheumatic fever with regard to the revised Jones criteria. They were fulfilled in 47 patients, 23 of whom were considered unlikely cases of rheumatic fever. Eight patients were considered possible cases, although they did not fulfill the revised Jones criteria. The current annual incidence of acute rheumatic fever was estimated to be at most 0.3 per 100,000 inhabitants.
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Dinkla K, Talay SR, Mörgelin M, Graham RMA, Rohde M, Nitsche-Schmitz DP, Chhatwal GS. Crucial role of the CB3-region of collagen IV in PARF-induced acute rheumatic fever. PLoS One 2009; 4:e4666. [PMID: 19252743 PMCID: PMC2646144 DOI: 10.1371/journal.pone.0004666] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/22/2008] [Indexed: 11/18/2022] Open
Abstract
Acute rheumatic fever (ARF) and rheumatic heart disease are serious autoimmune sequelae to infections with Streptococcus pyogenes. Streptococcal M-proteins have been implicated in ARF pathogenesis. Their interaction with collagen type IV (CIV) is a triggering step that induces generation of collagen-specific auto-antibodies. Electron microscopy of the protein complex between M-protein type 3 (M3-protein) and CIV identified two prominent binding sites of which one is situated in the CB3-region of CIV. In a radioactive binding assay, M3-protein expressing S. pyogenes and S. gordonii bound the CB3-fragment. Detailed analysis of the interactions by surface plasmon resonance measurements and site directed mutagenesis revealed high affinity interactions with dissociation constants in the nanomolar range that depend on the recently described collagen binding motif of streptococcal M-proteins. Because of its role in the induction of disease-related collagen autoimmunity the motif is referred to as “peptide associated with rheumatic fever” (PARF). Both, sera of mice immunized with M3-protein as well as sera from patients with ARF contained anti-CB3 auto-antibodies, indicating their contribution to ARF pathogenesis. The identification of the CB3-region as a binding partner for PARF directs the further approaches to understand the unusual autoimmune pathogenesis of PARF-dependent ARF and forms a molecular basis for a diagnostic test that detects rheumatogenic streptococci.
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Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009; 79:383-390. [PMID: 19275067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4 degrees F (38 degrees C), tonsillar exudates, and cervical adenopathy. Cough, coryza, and diarrhea are more common with viral pharyngitis. Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy. Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness. Amoxicillin is equally effective and more palatable. Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy. Increased group A beta-hemolytic streptococcus (GABHS) treatment failure with penicillin has been reported. Although current guidelines recommend first-generation cephalosporins for persons with penicillin allergy, some advocate the use of cephalosporins in all nonallergic patients because of better GABHS eradication and effectiveness against chronic GABHS carriage. Chronic GABHS colonization is common despite appropriate use of antibiotic therapy. Chronic carriers are at low risk of transmitting disease or developing invasive GABHS infections, and there is generally no need to treat carriers. Whether tonsillectomy or adenoidectomy decreases the incidence of GABHS pharyngitis is poorly understood. At this time, the benefits are too small to outweigh the associated costs and surgical risks.
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Duran NE, Sönmez K, Biteker M, Ozkan M. A case of acute rheumatic fever presenting with syncope due to complete atrioventricular block. ANADOLU KARDIYOLOJI DERGISI : AKD = THE ANATOLIAN JOURNAL OF CARDIOLOGY 2009; 9:68-69. [PMID: 19196582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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WINBLAD S, MALMROS H, WILANDER O. Studies on the pathogenesis of rheumatic fever; the antistreptolysin titre in acute tonsillitis. ACTA ACUST UNITED AC 2007; 133:358-71. [PMID: 18141708 DOI: 10.1111/j.0954-6820.1949.tb09537.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Torres J, de Oliveira S, de Almeida R, Pelajo C, Sztajnbok F, Rodrigues MC. [Acute rheumatic fever associated with Henoch-Schonlein purpura. Case report and review of the literature]. ACTA REUMATOLOGICA PORTUGUESA 2007; 32:377-380. [PMID: 18159205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Henoch-Schonlein purpura is one of the most common vasculitis in children. Some microorganisms have being suggested as possible etiological agents as group A streptococcus. CASE REPORT R.L.B 7 years old presented with purpuric lesions in lower extremities and buttocks following fever and polyarthritis. After 7 days he arrived in our hospital showing pharyngitis new systolic murmur migratory polyarthritis and palpable purpura. His urinalysis had raised proteins and white cell count hemogram was normal sedimentation rate and streptococcal antibody titer were elevated. Electrocardiography showed a prolonged PR interval and echocardiogram confirmed moderate to severe mitral valve regurgitation. The patient was treated with prednisone 2mg kg day and penicillin G benzathine with clinical and laboratorial improvement. DISCUSSION Literature reports HSP associated with rheumatic fever and carditis. Our case adds further evidence to the possibility of streptococcus being a causal agent of HSP.
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Batzloff MR, Pandey M, Olive C, Good MF. Advances in potential M-protein peptide-based vaccines for preventing rheumatic fever and rheumatic heart disease. Immunol Res 2007; 35:233-48. [PMID: 17172649 DOI: 10.1385/ir:35:3:233] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/11/2022]
Abstract
Rheumatic fever (RF) and rheumatic heart disease (RHD) are postinfectious complications of an infection (or repeated infection) with the Gram-positive bacterium, Streptococcus pyogenes (also known as group A streptococcus, GAS). RF and RHD are global problems and affect many indigenous populations of developed countries and many developing countries. However, RF and RHD are only part of a larger spectrum of diseases caused by this organism. The development of a vaccine against GAS has primarily targeted the abundant cell-surface protein called the M-protein. This review focuses on different M-protein-based-subunit vaccine approaches and the different delivery technologies used to administer these vaccine candidates in preclinical studies.
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Guilherme L, Faé KC, Oshiro SE, Tanaka AC, Pomerantzeff PMA, Kalil J. Rheumatic fever: how S. pyogenes-primed peripheral T cells trigger heart valve lesions. Ann N Y Acad Sci 2006; 1051:132-40. [PMID: 16126952 DOI: 10.1196/annals.1361.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The pathogenesis of rheumatic fever (RF) is related to autoimmune humoral and cellular responses against human tissues triggered by Streptococcus pyogenes. CD4(+) T cells are the ultimate effectors of chronic heart lesions in rheumatic heart disease (RHD). Heart-infiltrating CD4(+) T cell clones are able to recognize heart tissue and streptococcal antigens by molecular mimicry. The streptococcal M5(81-103) region, an immunodominant region, was recognized by both intralesional and peripheral T cell clones (62% and 38%, respectively). Peripheral T lymphocytes from Brazilian patients with severe RHD preferentially recognized the M5(81-96) peptide, in the context of HLA-DR7(+) and DR53(+) molecules. HLA-DR7 seems to be related to the development of multiple valvular lesions in RHD patients from different countries. In addition, the fact that peripheral and intralesional T cells recognized the M5(81-103) region points to this region as one of the streptococcal triggers of autoimmune reactions in RHD. T cell repertoire analysis from peripheral and intralesional T cell lines derived from RHD patients showed several oligoclonal expansions of BV families. Major expansions were found in the heart lesions, suggesting that such T cell populations preferentially migrate from the periphery to the heart. Some cross-reactive intralesional T cell clones displayed the same T cell receptor (TCR) BVBJ and CDR3 sequences, showing a degenerate pattern of antigen recognition. Heart tissue-infiltrating cells from myocardium and valvular tissue produced TNF-alpha, IFN-gamma, IL-10, and IL-4, whereas few cells from valvular tissue produced IL-4, showing that the lack of regulation in the valves could be responsible for the permanent and progressive valvular lesions.
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Anderson HC, Kunkel HG, McCarty M. QUANTITATIVE ANTISTREPTOKINASE STUDIES IN PATIENTS INFECTED WITH GROUP A HEMOLYTIC STREPTOCOCCI: A COMPARISON WITH SERUM ANTISTREPTOLYSIN AND GAMMA GLOBULIN LEVELS WITH SPECIAL REFERENCE TO THE OCCURRENCE OF RHEUMATIC FEVER. J Clin Invest 2006; 27:425-34. [PMID: 16695560 PMCID: PMC439510 DOI: 10.1172/jci101986] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Van Howe RS, Kusnier LP. Diagnosis and management of pharyngitis in a pediatric population based on cost-effectiveness and projected health outcomes. Pediatrics 2006; 117:609-19. [PMID: 16510638 DOI: 10.1542/peds.2005-0879] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pharyngitis is a common childhood complaint. Current management for children and adolescents includes 1 of 6 strategies, ie, (1) observe without testing or treatment, (2) treat all suspected cases with an antibiotic, (3) treat those with positive throat cultures, (4) treat those with positive rapid tests, (5) treat those with positive rapid tests and those with positive throat cultures after negative rapid tests, or (6) use a clinical scoring measure to determine the diagnosis/treatment strategy. The sequelae of untreated group A hemolytic streptococcal (GAS) pharyngitis are rare, whereas antibiotic treatment may result in side effects ranging from rash to death. The cost-utility of these strategies for children has not been reported previously. METHODS A decision tree analysis incorporating the total cost and health impact of each management strategy was used to determine cost per quality-adjusted life-year ratios. Sensitivity analyses and Monte Carlo simulations assessed the accuracy of the estimates. RESULTS From a societal perspective with current Medicaid reimbursements for testing, performing a throat culture for all patients had the best cost-utility. For private insurance reimbursements, rapid antigen testing had the best cost-utility. Observing without testing or treatment had the lowest morbidity rate and highest cost from a societal perspective but the lowest cost from a payer perspective. The model was most sensitive to the incidence of acute rheumatic fever and peritonsillar abscess after untreated GAS pharyngitis. Monte Carlo simulations demonstrated considerable overlap among all of the options except for treating all patients and observing all patients. CONCLUSIONS Observing patients with pharyngitis had the lowest morbidity rate. The costs of this option were primarily from parental time lost from work. Before recommending observation rather than treatment of GAS pharyngitis, accurate estimates of the risk of developing acute rheumatic fever and peritonsillar abscess after GAS pharyngitis are needed.
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Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord 2005; 5:11. [PMID: 15927077 PMCID: PMC1164408 DOI: 10.1186/1471-2261-5-11] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2004] [Accepted: 05/31/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic fever continues to put a significant burden on the health of low socio-economic populations in low and middle-income countries despite the near disappearance of the disease in the developed world over the past century. Antibiotics have long been thought of as an effective method for preventing the onset of acute rheumatic fever following a Group-A streptococcal (GAS) throat infection; however, their use has not been widely adopted in developing countries for the treatment of sore throats. We have used the tools of systematic review and meta-analysis to quantify the effectiveness of antibiotic treatment for sore throat, with symptoms suggestive of group A streptococcal (GAS) infection, for the primary prevention of acute rheumatic fever. METHODS Trials were identified through a systematic search of titles and abstracts found in the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 4, 2003), MEDLINE (1966-2003), EMBASE (1966-2003), and the reference lists of identified studies. The selection criteria included randomised or quasi-randomised controlled trials comparing the effectiveness of antibiotics versus no antibiotics for the prevention of rheumatic fever in patients presenting with a sore throat, with or without confirmation of GAS infection, and no history of rheumatic fever. RESULTS Ten trials (n = 7665) were eligible for inclusion in this review. The methodological quality of the studies, in general, was poor. All of the included trials were conducted during the period of 1950 and 1961 and in 8 of the 10 trials the study population consisted of young adult males living on United States military bases. Fixed effects, meta-analysis revealed an overall protective effect for the use of antibiotics against acute rheumatic fever of 70% (RR = 0.32; 95% CI = 0.21-0.48). The absolute risk reduction was 1.67% with an NNT of 53. When meta-analysis was restricted to include only trials evaluating penicillin, a protective effect of 80% was found (Fixed effect RR = 0.20, 95% CI = 0.11-0.36) with an NNT of 60. The marginal cost of preventing one case of rheumatic fever by a single intramuscular injection of penicillin is approximately USD 46 in South Africa. CONCLUSION Antibiotics appear to be effective in reducing the incidence of acute rheumatic fever following an episode of suspected GAS pharyngitis. This effect may be achieved at relatively low cost if a single intramuscular penicillin injection is administered.
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Asbahr FR, Garvey MA, Snider LA, Zanetta DM, Elkis H, Swedo SE. Obsessive-compulsive symptoms among patients with Sydenham chorea. Biol Psychiatry 2005; 57:1073-6. [PMID: 15860349 DOI: 10.1016/j.biopsych.2005.01.037] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Revised: 10/04/2004] [Accepted: 01/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Among patients with tic disorders, a distinctive clinical profile of obsessive-compulsive symptomatology has been described. The present investigation was designed to document the phenomenology of obsessive-compulsive symptoms (OCS) among patients with Sydenham chorea (SC), the neurologic variant of rheumatic fever. We hypothesized that OCS occurring in association with SC would be similar to those among patients with tic disorders. METHODS The authors studied the presence of OCS in 73 patients with SC by using the Yale-Brown Obsessive-Compulsive Scale at the Pediatric Clinics of the University of Sao Paulo Medical Center in Sao Paulo, Brazil (n = 45) and at the National Institute of Mental Health in Bethesda, Maryland (n = 28). RESULTS The most frequent symptoms observed among subjects with comorbid SC and OCS were aggressive, contamination, and somatic obsessions and checking, cleaning, and repeating compulsions. A principal component factor analysis yielded a five-factor solution (accounting for 64.5% of the total variance), with contamination and symmetry obsessions and cleaning compulsions loading highly. CONCLUSIONS The symptoms observed among the SC patients were different from those reported by patients with tic disorders but were similar to those previously noted among samples of pediatric patients with primary obsessive-compulsive disorder.
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Fujikawa S. [Rheumatic fever (RF)]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2005; 63 Suppl 5:352-5. [PMID: 15954375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Baandrup U. Rheumatic fever reappraised. Chin Med J (Engl) 2005; 118:360-1. [PMID: 15780203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Nair DV. Is it possible to prevent rheumatic fever. Indian Heart J 2005; 57:184; author reply 184. [PMID: 16013365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
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Kaplan EL. Pathogenesis of acute rheumatic fever and rheumatic heart disease: evasive after half a century of clinical, epidemiological, and laboratory investigation. Heart 2005; 91:3-4. [PMID: 15604318 PMCID: PMC1768618 DOI: 10.1136/hrt.2004.034744] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatic fever and rheumatic heart disease continue to be a problem for medical and public health communities--the fact that penicillin has failed to eradicate this disease process is irrefutable proof of the need for more laboratory, epidemiological, and clinical research.
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BUCHAN TW. Toxaemia of pregnancy; some epidemiological relationships to nephritis, rheumatic fever, and stillbirth. BRITISH MEDICAL JOURNAL 2004; 2:1011-2. [PMID: 14869796 PMCID: PMC2070283 DOI: 10.1136/bmj.2.4738.1011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ahmed J, Zaman MM, Keramat Ali SM. Identification of serogroups of beta hemolytic streptococci in children with tonsillo-pharyngitis. BANGLADESH MEDICAL RESEARCH COUNCIL BULLETIN 2003; 29:113-7. [PMID: 15053273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Rheumatic fever and post streptococcal glomerulonephritis are common sequelae of beta hemolytic streptococci among Bangladeshi children. The occurrence of these serious complications of beta hemolytic streptococcal throat infections are related to the epidemiology of group A beta hemolytic streptococci. Little is known about the epidemiology of beta hemolytic streptococci in Bangladesh. We have studied 6890 school boys and girls of Narayangonj to find out the prevalence of beta hemolytic streptococcal infections of throat. From them we selected 2175 children, who were suffering from tonsillo-pharyngitis. This cross sectional study was conducted during March-December 1999. All statistical analysis was done by using statistical package SPSS windows version 8. The mean (SD) age of the children was 11.1 (3.3) years. Four hundred and twenty eight isolates of beta hemolytic streptococci were recovered from tonsillo-pharyngeal swab cultures obtained from 428 children. Among the isolated beta hemolytic streptococci, 92 (21.5%) belonged to group A, 5 (1.2%) to group B, 14 (3.3%) to group C and 317 (74.0%) to group G. These findings demonstrated the predominance of group G followed by A infection among school children. Therefore special attention should be paid not only to group A but also to group G. Further studies to determine prevalence of M serotypes are necessary.
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Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Current profile of acute rheumatic fever and valvulitis in southern India. THE JOURNAL OF HEART VALVE DISEASE 2003; 12:573-6. [PMID: 14565708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Rheumatic fever (RF) incidence has declined dramatically in the West, but still accounts for a major percentage of cardiac debility in developing countries. The study aim was to analyze the incidence, clinical profile and echocardiography findings in acute RF over the past decade. METHODS The records of acute RF admissions to a tertiary care medical college hospital in southern India during the past 10 years were analyzed retrospectively. Chronic rheumatic heart disease and recurrence of RF were excluded from the study. Patients with a first episode of acute RF were studied only if the case records were available, and basic laboratory and echocardiography studies were completed. Thus, a total of 163 patients (81 males, 82 females) qualified for the study. RESULTS There was no significant decline in the annual incidence of the first episode of acute RE The most common presenting symptoms were arthralgiaarthritis (n = 157), fever (n = 137) and breathlessness (n = 81). Carditis (67.5%) and arthritis (44.2%) were the most often-reported Jones criteria. Trivial to mild mitral regurgitation by echocardiography occurred in 81%, followed by significant mitral regurgitation in 5.5% and mild aortic regurgitation in 25%. The 'youngest' and 'oldest' first episodes of RF were recorded at ages of 2 and 29 years, respectively. CONCLUSION The incidence of RF in India does not show the declining trends of the Western world. The application of Jones criteria for diagnosis remains relevant, though echocardiography is increasingly called upon to 'confirm' clinical diagnosis and help manage these patients in an appropriate manner.
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Faustino PC, Terreri MTRA, da Rocha AJ, Zappitelli MC, Lederman HM, Hilário MOE. Clinical, laboratory, psychiatric and magnetic resonance findings in patients with Sydenham chorea. Neuroradiology 2003; 45:456-62. [PMID: 12811441 DOI: 10.1007/s00234-003-0999-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2002] [Accepted: 02/07/2003] [Indexed: 10/26/2022]
Abstract
The objective of this study was to determine the clinical and laboratory characteristics, psychiatric manifestations and magnetic resonance imaging (MRI) findings in children and adolescents with Sydenham chorea (SyC). The imaging examination was repeated 1 year after the acute phase of SyC. There were 19 patients with a mean age of 11.7 years and a predominance of females (79%);68% had generalized chorea and 53% moderate chorea. SyC presented as an isolated manifestation in 74%. No association between SyC and obsessive-compulsive disorder was found. Mental health problems were present in 45% of the patients. MRI analysis revealed persistent alterations in the caudate nucleus in three patients (16%), who presented recurrent episodes of chorea during the study. In one patient, MRI revealed the presence of nodular heteropathy close to the caudate nucleus region. We conclude that attention problems can be associated with acute clinical features of SyC and persistent alterations in the basal nuclei, evidenced by MRI, can be found in some patients who tend to suffer prolonged attacks and a greater number of recurrences.
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Dudka PF, Sakharchuk II, Il'nyts'kyĭ PI, Lukasevych LM, Tarchenko IP, Bondarenko IM, Mykhaĭlevs'ka TV. [Modern views on rheumatic fever]. LIKARS'KA SPRAVA 2003:76-80. [PMID: 12669550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Submitted in the paper are modern conceptions on etiology, pathophysiology, diagnosis and treatment of acute inflammatory rheumatism (IR). Some aspects of IR course in different age groups are highlighted, high informative value of new laboratory methods of diagnosis of its latent forms are validated. The place of interferons and selective inhibitors of COG-2 in the treatment of IR is determined.
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Manyemba J, Mayosi BM. Intramuscular penicillin is more effective than oral penicillin in secondary prevention of rheumatic fever--a systematic review. S Afr Med J 2003; 93:212-8. [PMID: 12768947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND People with a history of rheumatic fever (RF) are at high risk of recurrent attacks and of developing rheumatic heart disease following a streptococcal throat infection. Giving penicillin to these people can prevent recurrent attacks of RF and subsequent rheumatic heart disease. However, there is no agreement on the most effective method of giving penicillin. OBJECTIVES To assess the effects of different penicillin regimens and formulations for preventing streptococcal infection and RF recurrence. SEARCH STRATEGY We searched the Controlled Trials Register (Cochrane Library Issue 2, 2001), Medline (January 1966-July 2000), Embase (January 1985-July 2000), reference lists of articles, and contacted experts in the field. SELECTION CRITERIA Randomised and quasi-randomised studies comparing: (i) oral with intramuscular penicillin; and (ii) 2- or 3-weekly with 4-weekly intramuscular penicillin in patients with previous RF. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS Six studies were included (1,707 patients). Data were not pooled because of clinical and methodological heterogeneity of the trials. Four trials (1,098 patients) compared intramuscular with oral penicillin and all showed that intramuscular penicillin was more effective in reducing RF recurrence and streptococcal throat infections than oral penicillin. One trial (360 patients) compared 2-weekly with 4-weekly intramuscular penicillin. Penicillin given every 2 weeks was better at reducing RF recurrence (relative risk (RR) 0.52, 95% confidence interval (CI): 0.33-0.83) and streptococcal throat infections (RR 0.60, 95% CI: 0.42-0.85). One trial (249 patients) showed that 3-weekly intramuscular penicillin injections reduced streptococcal throat infections (RR 0.67, 95% CI: 0.48-0.92) compared with 4-weekly intramuscular penicillin. CONCLUSIONS Intramuscular penicillin seemed to be more effective than oral penicillin in preventing RF recurrence and streptococcal throat infections. Two-weekly or 3-weekly injections appeared to be more effective than 4-weekly injections. However, the evidence is based on poor-quality trials and the use of outdated formulations of oral penicillin.
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Abstract
Microbes will evolve and the epidemics they cause will continue to occur in the future as they have in the past. Microbes emerge from the evolutionary stream as a result of genetic events and selective pressures that favor new over old. It is nature's way. Microbes and vectors swim in the evolutionary stream, and they swim much faster than humans. Bacteria reproduce every 30 minutes and, for them, a millennium is compressed into a fortnight. They are "fleet afoot," and the pace of research must keep up with them or they will overtake. Microbes were here on Earth 2 billion years before humans arrived, learning every trick of the trade for survival, and they are likely to be here 2 billion years after we depart. Current research on the rise and decline of epidemics is broadly based and includes evolutionary and population genetics of host-microbe relationships. Within this context, the 19th century pandemic of scarlet fever has been described. The possibility is raised that the GAS, which currently cause STSS, possess some of the virulence factors that caused pandemic scarlet fever. Furthermore, the GAS isolated during the recent outbreaks of ARF in certain locales in the United States have the virulence properties of the GAS frequently isolated in the first half of the 20th century. Finally, it is suggested that the strategy to confront emerging infectious diseases should be the study of infectious diseases from all points of view. They remain the greatest threats to our society.
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Steer AC, Carapetis JR, Nolan TM, Shann F. Systematic review of rheumatic heart disease prevalence in children in developing countries: the role of environmental factors. J Paediatr Child Health 2002; 38:229-34. [PMID: 12047688 DOI: 10.1046/j.1440-1754.2002.00772.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To consider the worldwide prevalence of rheumatic heart disease in children in developing countries using surveys with uniform methodologies, and to consider the effect of environmental factors including socio-economic status, overcrowding, urbanization, nutrition and access to medical services on the distribution of rheumatic heart disease in developing countries. METHODS Sixty-one surveys of the prevalence of rheumatic heart disease in developing countries were found using a systematic review of MEDLINE from January 1976 to July 1999. Twenty-four studies were selected for comparison based on their uniform methodological and diagnostic techniques. RESULTS There is a high prevalence of rheumatic heart disease in the Pacific region with a lower prevalence in the Indian subcontinent, Asian, sub-Saharan African, Mediterranean, Latin American and Caribbean regions. However, aside from the Indian subcontinent, these regions have not been well studied, and it may be that the true prevalence is actually higher. CONCLUSIONS There is a lack of good quality prevalence surveys of rheumatic heart disease in developing countries. It appears that a threshold level where higher socio-economic status is associated with reduced prevalence of rheumatic heart disease is not reached in developing countries. Therefore, differences in prevalence between socio-economic groups in the one area cannot be detected. A similar case can be made for overcrowding. Many regions need well-designed studies of rheumatic heart disease that incorporate assessment of environmental factors as well as the study of the microbiological epidemiology of rheumatic heart disease and group A streptococci.
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