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PubMed1987

Outbreak of acute rheumatic fever in northeast Ohio.

An outbreak of acute rheumatic fever in 23 patients was seen in northeastern Ohio in 1986, with polyarthritis (78%) and carditis (30%) the major manifestations. Results of a questionnaire completed by the parents of all 23 patients indicated that they were generally nonindigent, with good access to medical care, and from a nonurban setting. Records of inpatients with acute rheumatic fever were reviewed for the 10 years prior to 1986. The clinical manifestations in inpatients from 1976 to 1985 were not significantly different from those of inpatients seen during 1986. Similar outbreaks have been reported elsewhere, and physicians should be aware of a possible resurgence of classic acute rheumatic fever and ensure compliance with an adequate course of therapy for patients with streptococcal pharyngitis.

Acute Disease↗
PubMed1991

[The diagnostic significance of the surface B-cell marker carrier state in arthritis and other manifestations of rheumatic fever].

To assess the diagnostic importance of B-cellular marker demonstration with the aid of D8/17 monoclonal antibodies in arthritis and other manifestations of rheumatic fever, 175 persons were examined. Of these, 117 patients presented with rheumatic fever and rheumatic heart disease. The marker was identified in 88.9% of the patients and in 10% of the healthy subjects entering the control group. The rate of the marker demonstration did not depend on the clinical manifestations of rheumatic fever (arthritis, carditis, chorea), the disease phase, the disease standing or the intensity of heart damage. It is concluded that marker demonstration in rheumatic fever is of paramount diagnostic value, particularly in little manifest processes.

Adolescent↗
PubMed2000

The psychiatric symptoms of rheumatic fever.

OBJECTIVE: This study examined the frequency and age at onset of psychiatric disorders among children with rheumatic fever, Sydenham's chorea, or both and a comparison group. METHOD: Twenty children with rheumatic fever, 22 with Sydenham's chorea, and 20 comparison children were assessed by means of a semistructured interview and rating scales for tic disorders and obsessive-compulsive disorder. RESULTS: Obsessive-compulsive symptoms were more frequent in both the Sydenham's chorea and rheumatic fever groups than in the comparison group. The Sydenham's chorea group had a higher frequency of major depressive disorder, tic disorders, and attention deficit hyperactivity disorder (ADHD) than both the comparison and rheumatic fever groups. ADHD symptoms were associated with a higher risk of developing Sydenham's chorea. CONCLUSIONS: Both the rheumatic fever and Sydenham's chorea groups were associated with a higher risk of developing neuropsychiatric disorders than the comparison group. ADHD appears to be a risk factor for Sydenham's chorea in children with rheumatic fever.

Age Factors↗
PubMed1991

[Epidemiologic characteristics of rheumatic fever throughout the world].

In this article we discuss the epidemiologic changes in rheumatic fever leading up to the recent resurgence. The multifocal outbreaks occurred within the same time period, 1984 to 1988, in different sections of the United States and in Italy and Chile. The clinical manifestations in the current outbreaks were strikingly different than in the recent past--carditis was frequently present and very severe. One of the most unsual demographic features was that the majority of the patients lived in suburban or rural communities and were mostly white and middle class. However the average size of the families in which the index cases occurred was higher than in the corresponding populations, pointing out to the importance of crowding for spreading of streptococcal infectious and rheumatic fever occurrence. Still another contrast to prior outbreaks was that the recent ones did not follow clinically apparent epidemics of streptococcal infections. It is clear from the resurgence of acute rheumatic fever in the mid--1980s in developed countries among people with good living conditions, that rheumatic fever is worldwide problem. Intesified efforts to understand the pathogenesis of rheumatic fever should undertaken, but in the meantime, the preventive methods that are available should be vigorously applied.

Chile↗
PubMed1987

The problem of compliance in rheumatic fever.

During a 12-month period 115 patients defaulted from a rheumatic fever clinic, so a study was undertaken to identify factors related to non-compliance by comparing defaulters with a group of 50 regular attenders. Those defaulting were significantly more likely to be coloured, male, and over 12 years old. They lived 10-99 km from the hospital, were on several drugs and despite more frequent appointments, usually had a record of poor attendance. The severity of the underlying heart disease and use of parenteral penicillin did not affect compliance. Since the use of regular penicillin prophylaxis for the secondary prevention of rheumatic fever is an essential step in reducing the prevalence of rheumatic heart disease, rheumatic fever clinics should be structured to address the needs of adolescents. Furthermore, the use of neighbourhood clinics for routine therapy between visits to a rheumatic fever clinic is essential to improve compliance.

Adolescent↗
PubMed1982

Type-specific antibodies to structurally defined fragments of streptococcal M proteins in patients with acute rheumatic fever.

Group A streptococci of M protein type 5 have been epidemiologically related to acute rheumatic fever in a number of reported outbreaks. Preliminary bacteriological evidence suggests that M5 may be an important "rheumatogenic" type in Santiago, Chile. To assess further the relationship of this streptococcal serotype to rheumatic fever in Chile, sera of 34 patients with rheumatic fever and an equal number of age-, sex-, and race-matched controls were assayed for antibodies to types 5, 6, and 24 in an enzyme-linked immunosorbent assay with purified pepsin extracts of the respective M proteins as solid-phase antigens. Sera of 11 rheumatic fever patients (32%) were positive (titer greater than 1:800) for type 5 antibodies, but only 1 (3%) of the matched controls was positive (P less than 0.01). Neither the patients nor the controls had antibodies to type 24. Although 38% of the patient sera contained antibodies to type 6, 29% of the control sera also had such antibodies (P greater than 0.20). The enzyme-linked immunosorbent assay served as an accurate predictor of which sera contained type 5 opsonic antibodies as measured by the opsonophagocytic test. Although antigenic cross-reactivity exists between M protein type 5 and type 6 group A streptococci, this phenomenon is unlikely to have accounted for the preferential occurrence of type 5 antibodies in rheumatic fever sera. The enzyme-linked immunosorbent assay and opsonic antibody results suggest that M5 is an important rheumatogenic type in Chile.

Antibodies, Bacterial↗
PubMed1994

Towards a vaccine for rheumatic fever: identification of a conserved target epitope on M protein of group A streptococci.

Rheumatic fever and rheumatic heart disease remain very common in developing countries, and a vaccine to protect against these disorders would have a great impact on public health. A vaccine must target the M protein of group A streptococci (Streptococcus pyogenes), but until lately immunity was thought to be strain-specific and dependent on antibodies to the variable serotype-specific regions of the protein. Experiments in animals have suggested the conserved region of the M protein as a possible alternative target for protective antibodies. We constructed a 20-aminoacid peptide (peptide 145) within the conserved region of the carboxyl terminus of the protein. In mice the peptide induced serum antibodies that could opsonise reference type 5 streptococci. By enzyme-linked immunosorbent assay, positive responses to peptide 145 were obtained with serum from 77 (90%) of 86 Aboriginal subjects and 135 (81%) of 167 Thai subjects living in areas with high exposure to streptococci. Only 10 (14%) of 71 Caucasian subjects with low exposure to streptococci showed positive responses. There was no difference in the proportion positive between subjects with rheumatic heart disease and control groups (other or no heart disease). Antibodies to peptide 145 were able to opsonise isolates of streptococci from Aboriginal and Thai subjects with acute rheumatic fever as well as reference strains. This highly conserved part of the M protein may be a suitable target for vaccines to prevent streptococcal infections and their sequelae.

Amino Acid Sequence↗
PubMed1976

[Diagnosis of rheumatic fever].

In a survey the frequent possibilities of the diagnostics of rheumatic fever are described. The rheumatic fever is a general disease on immunological basis caused by an infection with beta-haemolysing streptococci of group A. The disease appears as visceral form (carditis rheumatica, chorea minor) or as peripheral manifestation (acute polyarthritis, erythema anulare, subcutaneous nodules, purpura rheumatica). The diagnostics is essentially based on clinical, physical, biochemical and immunoserological findings on the basis of modified criteria after Jones. Immunological methods for the demonstration of circulating antibodies gain an increasing diagnostic significance.

Antistreptolysin↗
PubMed2006

Challenging perceptions of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal community.

AIM: To identify factors that affect rheumatic fever prophylaxis for remote-living Aboriginal patients, and to determine the proportion who received adequate prophylaxis. DESIGN AND SETTING: Interview (with analysis based on principles of grounded theory) of patients with a history of rheumatic fever or rheumatic heart disease and their relatives, and health service providers in a remote Aboriginal community; audit of benzathine penicillin coverage of patients with rheumatic heart disease. PARTICIPANTS: 15 patients with rheumatic heart disease or a history of rheumatic fever, 18 relatives and 18 health care workers. RESULTS: Patients felt that the role of the clinic was not only to care for them physically, but that staff should also show nurturing holistic care to generate trust and treatment compliance. Differing expectations between patients and health care providers relating to the responsibility for care of patients absent from the community was a significant factor in patients missing injections. Neither a biomedical understanding of the disease nor a sense of taking responsibility for one's own health were clearly related to treatment uptake. Patients did not generally refuse injections, and 59% received adequate prophylaxis (> 75% of prescribed injections). CONCLUSION: In this Aboriginal community, concepts of being cared for and nurtured, and belonging to a health service were important determinants of compliance.

Anti-Bacterial Agents↗
PubMed1985

Prevention of rheumatic fever and heart disease.

This brief overview of current information on rheumatic fever and rheumatic heart disease focuses on the problems of diagnosis, prevention, and treatment in relatively undeveloped countries.

Adolescent↗
PubMed1981

Rheumatic fever situation in Czechoslovakia with special reference to long-term prognosis for rheumatic carditis.

In a prospective study (1961-1972) the incidence of rheumatic fever (RF), development of rheumatic heart disease (RHD) and penicillin prophylaxis efficacy were investigated in 300 000 children and 70 000 adults. Only patients whose index attack met the modified Jones' criteria were included; all were enrolled in a prophylaxis programme (i. m. benzathine-penicillin). The RF incidence decreased from an initial 61.2 attacks per 100 000 in children and 42.9 in adults to below 10 by 1969 and remained low thereafter. In total, 541 children (209 with carditis) and 176 adults (108 with carditis) were followed up for 5.5 years (average) after an index attack. At final examination, no valvular involvement was detected where previous attacks had been without clinical carditis. Patients studied from time of the primary attack with carditis (211) had a very favorable prognosis: only up to 3.5% had developed a moderate to severe heart lesion by the end of the study. However, of 68 adult patients followed up only from the time of recurrence with carditis and often having had a prolonged rheumatic history: 23.5% had a moderate to severe heart lesion and a further 20.6% had died of RHD by the end of the study. Prophylaxis efficacy calculated as a cumulative attack-recurrence rate per 100 patients and over a 5-year interval was 2.72 in protected as against 64.75 in unprotected children (mostly failing to comply with prophylaxis); in adults, the respective values were 1.3 and 24.92. The prevalence of serious residual RHD may be expected to decrease substantially in the future, starting with the younger age groups.

Adolescent↗
PubMed1995

Identification of cases of acute rheumatic fever managed on an outpatient basis.

The incidence of acute rheumatic fever has varied over the past several decades. The usual source of case ascertainment has been medical record discharge diagnosis coding. By reviewing both the Children's Hospital of Pittsburgh medical records discharge data and the Division of Cardiology computer database for the years 1982 to 1993, 173 cases of acute rheumatic fever were identified including 63 patients who were managed exclusively as outpatients. Seventy-three percent of patients diagnosed before 1990 were managed as inpatients, compared with 48% of patients diagnosed 1990 and later. The incidence of acute rheumatic fever may be underestimated if patients managed without hospitalization are not identified.

Acute Disease↗
PubMedDate not supplied

Neutrophil, monocyte and lymphocyte locomotion in rheumatic fever and rheumatoid arthritis.

Neutrophil, monocyte and lymphocyte chemotaxis was investigated in 19 patients with active rheumatic fever (10 with carditis), in 15 patients with rheumatoid arthritis and in 20 healthy, age-matched controls. Chemotaxis assays were repeated in the rheumatic fever patients on the fifth day of therapy and two weeks after remission. Neutrophil and monocyte chemotaxis was found to be significantly decreased in the rheumatoid arthritis patients when compared with the controls and rheumatic fever patients. In contrast, neutrophil chemotactic activity was significantly higher in the rheumatic fever patients when compared with the healthy controls. Monocyte and lymphocyte chemotaxis in patients with rheumatic fever was not significantly different when compared with the controls. Neutrophil, monocyte and lymphocyte locomotion was found to be significantly decreased on the fifth day of salicylic acid or prednisolone treatment.

Arthritis, Rheumatoid↗
PubMed2004

[Present-day classification and nomenclature of rheumatic fever].

The paper presents a new classification of rheumatic fever, which has been adopted by the Plenary Session of the Association of Rheumatologists of Russia in May 2003. This classification envisages the abandonment of the term "rheumatism" in its former interpretation. The term "acute rheumatic fever" (ARF) appears to be more justified since it makes a physician elucidate its association with Group A streptococcal infection of the throat and prescribe antibiotics for eradication of this infection in its acute period (primary prophylaxis) and for prevention of repeated attacks (secondary prophylaxis). The current interpretation of the clinical syndromes/symptoms and laboratory parameters that enter into diagnostic criteria for ARF is presented. There are 2 types of outcome of the disease. In case of recovery, we are dealing with the complete regression of the clinical symptomatology of ARF, normalized laboratory parameters and no residual changes. Chronic rheumatic diseases of the heart are considered to mean a disease characterized by a cardiac valvular lesion as postinflammatory marginal fibrosis of valvular leaflets or cardiac abnormality (failure and/or stenosis) developed after prior ARF. Emphasis is laid on the significance of evidence of Group A streptococcal infection that precedes the development of the disease. Examples of clinical diagnosis in accordance with the terminology of the International Classification of Diseases, the 10th edition, are given in the paper.

Anti-Bacterial Agents↗