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PubMed1985

Cost-effective control of rheumatic fever in the community.

Rheumatic fever is declining rapidly in importance in the developed countries, but is still a major public health problem in the developing countries. Primary prevention techniques, consisting of the detection and antibiotic treatment of streptococcal infections of the pharynx, are both feasible and effective, but are also costly, as only 10-20% of all pharyngeal infections are due to the beta-hemolytic Streptococcus, and only a small proportion of those actually develop into rheumatic heart disease. A different concerted approach, which is both effective and economically entirely justifiable, is to use antibiotics as a prophylaxis to prevent secondary infection, i.e. relapses of rheumatic fever. A multi-centre study conducted by the WHO has shown that the cost of antibiotics used for secondary prevention was less than the savings resulting from the lower incidence and shorter hospital stays of recurrencies of rheumatic fever. Given economic restrictions, therefore, priority is given to organized and systematic secondary prevention.

Community Health Services↗
PubMed1988

Mitral valve prolapse in patients with prior rheumatic fever.

It is known that rheumatic heart disease frequently results in isolated mitral regurgitation without concomitant mitral stenosis, especially in countries with a high prevalence of rheumatic fever. However, more recent surgical pathologic data also have demonstrated a high incidence of mitral valve prolapse in cases of rheumatic heart disease, which suggests that rheumatic fever may be a cause of mitral valve prolapse. To determine whether this association of mitral valve prolapse and rheumatic heart disease is present in a stable clinic population, we studied 30 patients who had an apical systolic murmur and a well-documented history of rheumatic fever with dynamic auscultation, two-dimensional echocardiography, and pulsed Doppler examinations. Twenty of the 30 patients (67%) had findings on physical examination consistent with isolated mitral regurgitation and 25 patients (84%) had mitral regurgitation by Doppler examination. Echocardiography demonstrated mitral valve prolapse in 24 patients (80%), whereas only one of the total study group had echocardiographic findings consistent with mitral stenosis. We conclude that (1) the presence of an isolated systolic murmur in patients with a history of rheumatic fever frequently represents pure mitral regurgitation secondary to mitral valve prolapse and (2) postinflammatory changes in valvular tissue resulting from rheumatic fever may be the etiology of mitral valve prolapse in these patients.

Adult↗
PubMed2005

Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis.

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.

Acute Disease↗
PubMedDate not supplied

[Rheumatic fever in Cuba].

Rheumatic fever--is a social disease; it's incidence is connected with the sensitivity of the patients and infection--group A streptococcus. Such factors as social and economic conditions, accessibility of public health services and environmental factors may influence the spread of streptococcus. In the last decade the mortality rate (rheumatic cardiac failure) decreased in the Republic of Cuba from 4.2 x 10(5) in 1968 down to 2.1 in 1985. It's incidence was within 2.1 and 6.0/1.000 (children at an age of 5-14 years).

Adolescent↗
PubMedDate not supplied

Haptoglobin in rheumatic fever.

Serum haptoglobin levels were studied in rheumatic fever and in established rheumatic heart disease to find whether rheumatic activity influenced serum haptoglobin levels. The study was carried out on 90 subjects of paediatric age group, comprising 30 children suffering from acute rheumatic fever (Group I) and Group II of 30 children of established rheumatic heart disease (not having rheumatic activity). They were matched with group III of 30 normal children of the same age as controls. Levels of ASO titre, C-reactive protein, serum haptoglobin and ESR were estimated in all cases of study and control groups. Estimations of serum haptoglobin levels and ESR were repeated in all children of rheumatic fever after 2 weeks. Haptoglobin levels were estimated by electrophoresis on a cellulose acetate paper. In healthy children (Group III) mean serum haptoglobin was 92.2 +/- 19.77 mg%. This was significantly lower when compared with acute rheumatic fever group before treatment (606.58 +/- 171.04 mg%) and rheumatic heart disease group (120.8 +/- 26.03 mg%).

Child↗
PubMed2002

Genome sequence and comparative microarray analysis of serotype M18 group A Streptococcus strains associated with acute rheumatic fever outbreaks.

Acute rheumatic fever (ARF), a sequelae of group A Streptococcus (GAS) infection, is the most common cause of preventable childhood heart disease worldwide. The molecular basis of ARF and the subsequent rheumatic heart disease are poorly understood. Serotype M18 GAS strains have been associated for decades with ARF outbreaks in the U.S. As a first step toward gaining new insight into ARF pathogenesis, we sequenced the genome of strain MGAS8232, a serotype M18 organism isolated from a patient with ARF. The genome is a circular chromosome of 1,895,017 bp, and it shares 1.7 Mb of closely related genetic material with strain SF370 (a sequenced serotype M1 strain). Strain MGAS8232 has 178 ORFs absent in SF370. Phages, phage-like elements, and insertion sequences are the major sources of variation between the genomes. The genomes of strain MGAS8232 and SF370 encode many of the same proven or putative virulence factors. Importantly, strain MGAS8232 has genes encoding many additional secreted proteins involved in human-GAS interactions, including streptococcal pyrogenic exotoxin A (scarlet fever toxin) and two uncharacterized pyrogenic exotoxin homologues, all phage-associated. DNA microarray analysis of 36 serotype M18 strains from diverse localities showed that most regions of variation were phages or phage-like elements. Two epidemics of ARF occurring 12 years apart in Salt Lake City, UT, were caused by serotype M18 strains that were genetically identical, or nearly so. Our analysis provides a critical foundation for accelerated research into ARF pathogenesis and a molecular framework to study the plasticity of GAS genomes.

Acute Disease↗
PubMed1996

[Adult-onset acute rheumatic fever: 4 cases in Guadeloupe].

OBJECTIVE: Rheumatic fever has become infrequent in developed countries. Recent regional epidemics, particularly in North America, brought our attention to this disease in our area. In the French Caribbean Islands, rheumatic fever remains an important health problem despite much progress in the last 15 years. METHODS: A retrospective survey over the last 5 years identified 19 cases of rheumatic fever in Guadeloupe in subjects over 19 years of age. RESULTS: Among these subjects 4 cases of rheumatic fever beginning in adulthood were analysed and compared with data in the literature. CONCLUSION: The diagnosis of rheumatic fever beginning in adulthood is difficult to establish. Joint symptoms are variable and cardiac involvement, which occurs in 30 to 40% of the cases, is highly suggestive. The kinetics of antistreptococci antibodies confirms the diagnosis.

Adult↗
PubMed1989

Recent increase in incidence of acute rheumatic fever in southern West Virginia.

Rheumatic fever appeared to decline in the United States in the 1970s and early 1980s. In the last two years, however, there have been multiple reports of the resurgence of rheumatic fever. Two of these reports originated in states that border West Virginia. This study demonstrates that there has been a similar outbreak in the southern part of West Virginia in 1988. In addition, it appears that the incidence of first-attack heart damage is high, and that physicians should maintain their vigilance in diagnosing and treating acute rheumatic fever.

Acute Disease↗
PubMed1988

Management of streptococcal pharyngitis: the conundrum of acute rheumatic fever.

The incidence of acute rheumatic fever in the residents of three counties in Ontario (population 507,300) from 1975 to 1986 inclusive was 0.17 hospitalized cases per 100,000 population (0.4 per 100,000 for 5- to 19-year-olds). Indigent patients (0.6 per 100,000) and North American Indians (2 per 100,000) had substantially higher rates. This experience is in marked contrast to recent outbreaks of acute rheumatic fever in areas of the United States, but is similar to experience in the United Kingdom. The implications of this data on the current management of the streptococcal sore throat is reviewed, showing the complexities of real-life prevention of acute rheumatic fever.

Cross-Sectional Studies↗