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PubMed1996

Antigenic epitope mapping of the M24 protein of Streptococcus pyogenes: implications for serodiagnosis of rheumatic fever.

Rheumatic fever continues to be a significant problem in Australian Aboriginal communities and developing countries worldwide. Early diagnosis could facilitate the institution of penicillin prophylaxis resulting in the prevention of recurrences of rheumatic fever. An overlapping biotinylated peptide bank of 82 peptides, based on the known sequence of Streptococcus pyogenes M24 protein, was used in a standard enzyme immunoassay. A total of 82 sera were tested from both aboriginal and non-aboriginal subjects with clinically proven rheumatic fever, rheumatic heart disease and matched controls. Two peptides with significant sequence homology at the C-terminal end were found to be discriminatory between aboriginal cases and controls. It is proposed that these peptides could be the basis of a serological test for rheumatic fever.

Adult↗
PubMed1991

Association of human leukocyte class II antigens with rheumatic fever or rheumatic heart disease in a Brazilian population.

BACKGROUND: The incidence of rheumatic heart disease is great in Brazil. We analyzed the distribution of human leukocyte (HLA) antigens in a Brazilian population sample with rheumatic fever or rheumatic heart disease, with the aim of better understanding the mechanisms involved. METHODS AND RESULTS: HLA class I (A, B, and C) and class II (DR and DQ) antigen distribution was studied in 40 patients with diagnosis of rheumatic fever or rheumatic heart disease and compared with a control group of 617 healthy individuals for class I typing, from which 118 were drawn for class II typing. A strong correlation between rheumatic fever and rheumatic heart disease and HLA-DRw53 (72.9% in the disease group versus 39% in the control group: p = 0.00061, relative risk, 4.2; etiologic fraction, 0.43) was found. We also found an increase in the frequency of HLA-DR7 (57.5% in the disease group versus 26.3% in control group: p = 0.00715; relative risk, 3.8; etiologic fraction, 0.56). HLA class I and HLA-DQ typing did not point to any association with these diseases. CONCLUSIONS: HLA-DR7 and HLA-DRw53 are markers for susceptibility to rheumatic fever and rheumatic heart disease in Brazil. These results could be explained by genetic differences resulting from racial or geographical diversity.

Adolescent↗
PubMed1984

Rheumatic fever and rheumatic heart disease in Serbia Proper, Yugoslavia, 1970-1979.

The occurrence of rheumatic fever and rheumatic heart disease in the period 1970-1979 is analysed on the basis of morbidity and mortality data. It was found that: Rheumatic fever first attacks rate and rheumatic fever recurrent attacks rate in 1979 were by 80% and 91% lower respectively, compared with 1970 rates; The disease became milder and the number of RF with heart involvement decreased especially in population over 19 years old; In the ten year period mortality rate from rheumatic fever and rheumatic heart disease decreased 2.8 times; In the age group 15-24 mortality did not decline so noticeable and mortality rate in this age group is still ten times higher than the same rate in the most developed countries; Among all defined causes of death (except accidents), in the age group 15-24, rheumatic fever and rheumatic heart disease (taken together) fell from first or second place to the eleventh or tenth place in the last years under review; One can expect that the declining trend of morbidity and mortality from rheumatic fever and rheumatic heart disease will continue though probably slower then in the preceding period.

Adolescent↗
PubMed1990

Role of oxygen free radicals generated by blood monocytes and neutrophils in the pathogenesis of rheumatic fever and rheumatic heart disease.

The generation of oxygen free radicals by peripheral blood monocytes and neutrophils of patients with rheumatic fever and rheumatic heart disease has been studied using luminol enhanced chemiluminescence technique. Five groups of patients; acute rheumatic fever, recurrence of rheumatic activity, chronic rheumatic heart disease, acute pharyngitis and normal controls were studied. In all groups except the controls, measurements were made on 0, 15, 90 and 180 days. The chemiluminescence was measured in response to streptococcal membrane antigen, carbohydrate antigen and latex as triggering agents. Chemiluminescent response of monocytes, as well as, neutrophils was significantly higher (P less than 0.01) in acute rheumatic fever and recurrence of rheumatic heart disease as compared to patients with acute pharyngitis and chronic rheumatic heart disease through the study period and with all the triggering agents. A significant decline (P less than 0.001) in chemiluminescence was observed from day 0 to day 180 in the acute rheumatic fever, recurrence of rheumatic heart disease and pharyngitis patients while no such change, was observed in the chronic rheumatic heart disease group. This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may have a role in the pathogenesis of cardiac disease seen in patients with rheumatic heart disease, through the generation of oxygen free radicals.

Acute Disease↗
PubMed2000

Further observations and characterization of monoclonal antibodies reacting with B cell alloantigens associated with rheumatic fever and rheumatic heart disease.

Elevated levels of B lymphocytes with a unique surface alloantigen have been reported to be characteristic of patients with acute rheumatic fever or rheumatic heart disease. Mouse monoclonal antibodies (mAbs) to this alloantigen have been proposed as being useful in identifying individuals at risk for the development of these sequelae of group A streptococcal infection. However, previous studies have suggested that the discriminating ability of the mAbs was highest when the mAbs were made by using lymphocytes from the same ethnic population. To confirm and extend this observation, additional mouse mAbs were developed and their properties defined. These three mAbs-PG-12A, PG-13A, and PG-20A-reacted with B cells from more than 90% of North Indian patients with acute rheumatic fever or rheumatic heart disease. Each of these three new mAbs identified the highest levels of reactive B cells in patients with active acute rheumatic fever. Lower levels of positive reacting lymphocytes were found in individuals with quiescent chronic rheumatic heart disease, and markedly reduced percentages of reactive cells were observed in normal control subjects. The proportion of reactive lymphocytes in individual patients varied according to which of the three was tested, suggesting the possibility of a spectrum of "rheumatic" epitopes in susceptible individuals. The data further suggested that enhanced discriminatory ability for identifying "at-risk" susceptible patients could be obtained by testing with a combination of mAbs. If reduction in the incidence of acute rheumatic fever can be facilitated by early identification of susceptible individuals, accurate and sensitive detection of a marker antigen would result in more cost-effective public health measures. Additional population studies are required to more precisely define and confirm these detection techniques.

Adult↗
PubMed1999

Mortality due to acute rheumatic fever and rheumatic heart disease in the Northern Territory: a preventable cause of death in aboriginal people.

OBJECTIVE: To determine the death rates and effect on premature mortality in the Northern Territory of acute rheumatic fever and rheumatic heart disease. METHODS: We ascertained deaths due to acute rheumatic fever and rheumatic heart disease for the period 1979-96 from death certificates, a database of all patients with these diseases and mortuary records. Crude and age-standardised death rates were calculated, as were years of potential life lost before age 65, between 15 and 65, and before age 70. RESULTS: Of 182 deaths, 171 (94%) were in Aboriginal people. The mean age at death of Aboriginal people was 35.7 years, compared to 67.3 years in non-Aboriginal people. The age-standardised death rate in Aboriginal people was 30.2 per 100,000 person-years, compared to 1.1 in non-Aboriginal people. Acute carditis caused 13 deaths at a mean age of 14.2 years. Mortality in Aboriginal people was highest in the > 30 age groups and in females. Premature mortality for Aboriginal people was more than four times that from developing countries. CONCLUSIONS: Acute rheumatic fever and rheumatic heart disease are not only common in Aboriginal people, they affect and often kill people in their most productive years. A co-ordinated control program should help in the short term, but will not address underlying causes of these and other preventable diseases.

Acute Disease↗
PubMedDate not supplied

Syncope in a middle aged male due to acute rheumatic fever.

Rheumatic fever is a multi system disease which occurs following infection with group A beta hemolytic streptococcus. It is commonest in the age group of 5-15 years but can occur in adults also. First degree atrioventricular block is a common manifestation of acute rheumatic fever and is included in the Jones criteria but Wenckebacks phenomena and complete heart block are relatively rare manifestations of rheumatic fever. Syncope occurring in acute rheumatic fever is also infrequently reported. We report the case of a 38-year-old male with rheumatic carditis who had advanced atrioventricular block which resulted in syncope and required a temporary pacemaker insertion.

Adult↗
PubMed1989

An association between Gc (vitamin D-binding protein) alleles and susceptibility to rheumatic fever.

Rheumatic fever is associated with exaggerated activity of B cells with massive production of antibody to the Group A streptococcus. Gc (vitamin D-binding protein) is constitutively expressed on B-cell membranes in association with membrane immunoglobulin, and could be involved in cell activation. We therefore looked for associations between the three major Gc alleles and susceptibility to rheumatic fever in a homogeneous Arab population. Patients with tuberculosis or rheumatoid arthritis and control donors, were studied in parallel. Allele frequencies in the controls, rheumatoid and tuberculosis patients were identical to those found in a previous study of normal Arab donors. However, there was a striking association between Gc2 and rheumatic fever. This allele was twice as common in these patients as in controls (p = 0.0024), and was present in 56.4% of all rheumatic fever patients.

Alleles↗
PubMed1991

[Clinical evaluation of anti-DNAse B test in rheumatic fever and rheumatic heart disease].

Anti-DNAse B test was performed with microtechnique in 160 subjects including patients with acute streptococcal pharyngitis, rheumatic fever and rheumatic heart disease as well as normal controls. It was shown that the antibody titer varied with age, stage of rheumatic fever and rheumatic heart disease as well as the frequency of benthazine penicillin injections. It was also shown in this study that the school children group had considerably higher geometric mean antibody titer than the adult group. The upper normal limit of anti-DNAse B titer was 240 units in the school children group and 160 units in the adult group. The anti-DNAse B test shows a higher positive detection rate for streptococcal infection than ASO, especially when these two tests are used in combination. In patients with manifestations of acute rheumatic fever without elevation of ASO titer, anti-DNAse B test will be of great diagnostic value.

Adolescent↗
PubMed1990

Acute rheumatic fever and rheumatic heart disease in a rural central Australian aboriginal community.

A retrospective study of clinical case records was conducted at the health centre of a rural central Australian Aboriginal community to determine the frequency of acute rheumatic fever and of rheumatic heart disease between 1978 and 1987. The case records of 976 residents over 5 years of age were examined for evidence of the clinical indicators of acute rheumatic fever or rheumatic heart disease; together they contributed 8015 person-years of study. During the 10-year study period, 18 patients developed acute rheumatic fever and 12 patients had rheumatic heart disease. The annual incidence of acute rheumatic fever (first and recurrent attacks) for children aged 5-14 years was 815 per 100,000 person-years. For the residents aged 5 years and over, the point prevalence for rheumatic heart disease at the end of 1987 was between 7.9 and 12.3 per 1000 persons, according to health clinic records and the official population census, respectively. These rates are similar to those reported for Third World countries. Preventive measures must include efforts by health professionals to help to alleviate the adverse living conditions in Aboriginal communities.

Acute Disease↗
PubMed1998

[Diagnosis and treatment of rheumatic fever].

Rheumatic fever has become rare in France as in most developed countries. However, recent outbreaks have underlined the need for practitioners to remain vigilant and to maintain careful prevention. Polyarthritis and polyarthralgia are the main manifestations of rheumatic fever but they are not specific. Carditis is a major feature which affects only half the patients; cardiac ultrasonography is therefore very helpful with respect to positive and false positive diagnoses resulting from innocent murmurs. Fever, acute phase inflammatory markers, and evidence of streptococcal infection are of major importance and rheumatic fever must be disregarded in their absence. The treatment includes: 1) steroids for a 3 month-period; 2) early antibiotic treatment of streptococcal carriage; 3) long-term prophylaxis using intramuscular benzathine penicillin.

Child↗
PubMed1983

The changing prevalence and pattern of acute rheumatic fever and rheumatic heart disease in Hong Kong--(1968-1978).

The occurrence and pattern of rheumatic fever and rheumatic heart disease in Hong Kong in the years 1968 to 1978 were surveyed. The incidence of rheumatic fever in hospitals had decreased by four-fifths in the past 10 years. Rheumatic fever nowadays still predominantly affects children and younger adults, but middle-aged patients may also be affected. There are a slight female dominance (1.3 to 1) and a relative predominance of patients from urban areas. A less severe form of manifestation in adult patients is encountered nowadays. Carditis was the dominant feature in 1968, but joint involvement was more common in recent years. Rheumatic nodules, chorea or erythema marginatum remained uncommon throughout the years. Only 49% of cases satisfied the revised Jones criteria (1965). In comparison, chronic rheumatic heart disease still remained prevalent, with a slower trend of decreasing prevalence. It accounted for (36 to 50%) of total cardiac admissions. The mitral valve was involved in (82.7 to 91.7%), aortic valve in (15.5 to 36.3%), while involvement of tricuspid or pulmonary valve was relatively uncommon. The socio-economic implication of this changing trend was analysed, and the problem encountered in diagnosing rheumatic fever discussed.

Acute Disease↗
PubMed1992

Adherence of Streptococcus pyogenes M type 5 to pharyngeal and buccal cells of patients with rheumatic fever and rheumatic heart disease during a one-year follow-up.

In vitro adherence of Streptococcus pyogenes M type 5 to isolated pharyngeal and buccal epithelial cells was studied in patients with acute recurrent rheumatic fever (n = 21), chronic rheumatic heart disease (n = 33), streptococcal pharyngitis (n = 12), and in normal controls. Patients were investigated at admission and one, six and 12 months later. Streptococci adhered significantly more to the pharyngeal cells of patients with rheumatic fever and rheumatic heart disease than to the pharyngeal cells of controls. Adherence of streptococci to pharyngeal cells of patients with pharyngitis was not different from age-matched controls. The adherence of streptococci to the pharyngeal cells of patients with acute rheumatic fever fell during follow-up but even after one year remained significantly higher than in the control group. These findings suggest that host factor(s) controlling streptococcal adhesion and colonization at the pharyngeal mucosa may be important in the pathogenesis of acute rheumatic fever.

Acute Disease↗
PubMed1987

Resurgence of acute rheumatic fever.

Rheumatic fever has been disappearing in the United States, especially during the past two decades. In the past two years, however, there have been 40 patients seen at the Columbus (Ohio) Children's Hospital diagnosed as having acute rheumatic fever. In marked contrast to the infrequency during the preceding ten years. Twenty of the 40 patients had carditis. Five of these patients were suffering from heart failure, and there was one death. The cause for this outbreak has not yet been found, but some possible causes are discussed. A possible nationwide resurgence of this disease may be heralded by our experience and that of others.

Acute Disease↗