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PubMed1984

The Northland rheumatic fever register.

A rheumatic fever register retrospective to 1969 was established in Northland during 1980-81 from hospital discharge diagnoses and general practitioner sources. Since 1981 the register has been regularly maintained and updated. From January 1969 to June 1981 303 patients were identified in whom acute rheumatic fever had been diagnosed, but only 218 met the modified Jones criteria. Four others had first presented with rheumatic heart disease without a past record of rheumatic fever. For those aged under 20 the cases on the register represent an annual incidence per 100 000 of 23.6 for non-Maoris and 115.9 for Maoris. There were 106 recurrent attacks recorded during this period amongst 307 patients, with a significantly higher rate from Maoris (p = 0.001). There was a great variation in the period for which prophylaxis was prescribed.

Adolescent↗
PubMed2006

An Auckland regional audit of the nurse-led rheumatic fever secondary prophylaxis programme.

BACKGROUND: Rheumatic fever with ensuing rheumatic heart disease is considered to be a preventable chronic disease. AIM: To assess the compliance rates with the rheumatic fever secondary prophylaxis programme established through the Auckland Rheumatic Fever Register and managed by community nursing services in Auckland, New Zealand. METHODS: An audit of the 1998 and 2000 Auckland Rheumatic Fever Register data was undertaken to establish the compliance rates of patients with the rheumatic fever secondary prophylaxis programme. The sample included all patients on the Auckland Rheumatic Fever Register during this time. RESULTS: Results showed compliance rates across the three Auckland DHBs ranging from 79.9% to 100% for individual community nursing offices. CONCLUSION: A community-based nurse-led secondary prophylaxis programme for Rheumatic Fever heart disease is able to deliver excellent patient compliance levels. Secondary prophylaxis is the WHO-recommended cost effective first step to Rheumatic Fever/Rheumatic Heart Disease control. Community health workers have a key role to play in facilitating this compliance.

Child↗
PubMed1996

Lack of association between mitral valve prolapse and history of rheumatic fever.

To determine whether rheumatic fever is associated with mitral valve prolapse (MVP) diagnosed by echocardiography, records from 561 subjects participating in a prospective family study were reviewed. The prevalence of a history of rheumatic fever by modified Jones criteria was determined in 92 probands and 112 affected relatives or spouses with M-mode and two-dimensional echocardiographic findings of MVP, accompanied in most instances by classic auscultatory findings, and in 357 family members without MVP. The prevalence of rheumatic fever was 5.4% in both MVP sub-groups and 2.2% in the family members without MVP (p<0.05 vs the combined MVP group). However, people with a history of rheumatic fever were older than the remaining subjects (48 +/- 17 vs 36 +/- 20 years, p<0.01) as expected because of the decline in rheumatic fever in the twentieth century, and subjects with MVP were older than subjects without MVP (39 +/- 16 vs 34 +/- 22 years, p<0.01). Multiple logistic regression showed that after the independent relation of older age with a positive history of rheumatic fever (p<0.01) was taken into account, there was a trend toward a lower likelihood of previous rheumatic fever associated with MVP (odds ration 0.42, p=0.07). These results do not support either a true association or a causal role of rheumatic fever in the pattern of mitral leaflet motion and auscultatory abnormalities in adults, for which the term MVP is generally used.

Adult↗
PubMed1998

[The effect of prevention and other factors in the decrease in rheumatic fever].

933 children with rheumatic fever hospitalised in Clinic in the period of 40 years (from 1995 to the end of 1994) were analysed in order to establish the fluctuation of patients number and changes in clinical appearance. Patients were divided in 4 groups: I. the patients hospitalised from 1955-1964 (472 patients), II. from 1965-1974 (307), III. from 1975-1984 (135), IV. from 1985-1994 (19). The data for Republic Croatia show the steady fall of the number of hospitalised children with rheumatic fever. Carditis with polyarthritis were present in the largest part of our patients (446 namely 47.8%). The number of recurrences fell equally with the number of patients with rheumatic fever. However, ratio between the number of patients with rheumatic fever and the number of recurrences did not change essentially, that was 11-15.85% in the periods considered. The percent of hospitalised children with fixed rheumatic heart disease was 4.23% in the I. period to as much as 15.5% in the III. period from totally hospitalised children with rheumatic fever. In the last time the disease became mild in its development. All children with suspicion on rheumatic fever should be hospitalised. The prophylaxis, primary or secondary, should be carried out intramusculary with benzithine penicillin G, as proved as the best, in order to ensure that the child virtually received the prophylaxis.

Adolescent↗
PubMed2002

Rheumatic Fever and Long-term Sequelae in Children.

Rheumatic fever and rheumatic heart disease continue unabated, affecting young individuals in most of the developing nations. Focal outbreaks of smaller magnitude have also been reported since the mid-1980s from industrialized western nations, where this disease had almost disappeared. The introduction of penicillin in the mid-1940s has markedly changed the natural history of rheumatic fever, although the incidence of rheumatic fever declined in developed nations even before that, mainly due to better living conditions. Treatment of rheumatic fever chiefly involves the use of antibiotics (penicillin) and anti-inflammatory drugs, like salicylates or corticosteroids, to eradicate Streptococci. Patients with severe carditis, congestive heart failure, or pericarditis are best treated with corticosteroids because these are more potent anti-inflammatory agents than salicylates. Salicylates may be sufficient for cases with mild or no carditis. The treatment must be continued for 12 weeks. Several studies have shown that valvular regurgitation, and not myocarditis, is the cause of congestive heart failure in active rheumatic carditis. Therefore, surgery with mitral valve replacement or repair is indicated in cases with intractable hemodynamics due to mitral regurgitation. The development of chronic valvular lesion after an episode of rheumatic fever is dependent upon the presence or absence of carditis in the previous attack and compliance with secondary prophylaxis. Recurrences due to inadequate penicillin prophylaxis are responsible for hemodynamically significant chronic valvular lesions requiring surgery. Primary prevention of rheumatic fever is fraught with difficulties and may not be feasible in most of the countries where the disease is rampant. Secondary prevention, ie, preventing recurrence of rheumatic fever, is the appropriate strategy with proven efficacy. A repository form of penicillin, benzathine penicillin G, given as an intramuscular injection at 3 weekly intervals in the dose of 1,200,000 U, remains the treatment of choice for secondary prevention of rheumatic fever. Alternative antibiotics may be used in those allergic to penicillin. An effective and safe vaccine against rheumatic fever is not yet available.

Journal Article↗
PubMed1985

Recurrent rheumatic fever.

Although recurrent rheumatic fever in adults is uncommon and the recurrence rate declines with age and with the interval from the attack, we describe a patient who has had four attacks of rheumatic fever, two in childhood and two in adult life.

Humans↗