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PubMed1982

Circulating immune complexes in rheumatic fever.

We measured the circulating immune complex levels in patients with rheumatic fever using the following three methods: the C1q binding test, the conglutinin binding test and Raji cell radioimmunoassay. Thirty-four samples from 21 patients with rheumatic fever were examined, and circulating immune complexes were detected in 47.6% of the patients by one or more of these methods. Especially by the C1q binding test, the sera obtained in the acute phase were found to contain the circulating immune complexes with higher frequency than those obtained in the post-acute phase. Therefore, the C1q binding test was more likely to be useful in the acute phase of this disease. The present study suggests that the circulating immune complexes are related to the pathogenesis of rheumatic fever.

Adolescent↗
PubMed1987

Resurgence of acute rheumatic fever in the intermountain area of the United States.

We describe an outbreak of acute rheumatic fever that occurred in the intermountain area centered in Salt Lake City, Utah. Seventy-four children meeting the modified Jones criteria for the diagnosis of acute rheumatic fever were evaluated by the staff at Primary Children's Medical Center, Salt Lake City, from January 1985 through June 1986. This represents an eightfold increase over the average annual incidence at this hospital during the past decade. Carditis, a dominant feature of the outbreak, was confirmed by auscultation in 53 of the patients (72 percent). An additional 14 patients were found to have mitral regurgitation by Doppler ultrasound examination, raising the total incidence of carditis to 91 percent. The children were predominantly from white (96 percent) middle-class families with above-average incomes and with ready access to medical care. There was no apparent increase in the incidence of streptococcal disease or other explanation for the marked increase in acute rheumatic fever. However, mucoid M type 18 and M type 3 group A streptococcal strains were isolated from several siblings of the patients and from schoolchildren (chosen at random) in the area. We conclude that acute rheumatic fever remains an important health problem in the United States.

Acute Disease↗
PubMed2002

[Is prophylaxis for acute rheumatic fever part of current practice?].

Since the sixties, the incidence of rheumatic fever has dramatically decreased. The main causes thereof are progress in the quality of housing and a decrease in the virulence and rheumatogenic potential of streptococcal strains. The primary prevention of rheumatic fever depends on approved antibiotic treatment of streptococcal pharyngitis, whether confirmed or judged likely on clinical grounds. About the secondary prevention by long action penicillins, it should be stressed that an increased level of anti-streptolysins does not support this treatment if revised clinical Jones' criteria are not met. As a matter of fact, this secondary prevention is rarely indicated at the present time in our country. However, if rheumatic fever would become epidemic again, as it happened abroad rather recently, this secondary prevention should be reactivated.

Acute Disease↗
PubMedDate not supplied

Current status of rheumatic fever control programs in the United States.

A study was undertaken to assess the current status of rheumatic fever control programs administered by State health agencies. Questionnaires, sent to 29 State health departments that had been identified previously as having rheumatic fever control programs, were completed by 27. Only 11 (61 percent) of the 18 States with a registry in 1977, or 41 percent of those replying, indicated that the registry was operational in 1980. A lack of adequate funds was cited by all States as a reason for discontinuing the program. Half of the States that closed down their registries related this to loss of funds previously provided by Section 314D funds (Public Law 95-626). Two-thirds of the replying States indicated, however, that they still provided prophylactic antibiotics for secondary rheumatic fever prophylaxis, free or at a reduced cost.Previous studies have indicated that rheumatic fever registries operated by State health departments in-accurately reflect the actual incidence and epidemiology of this sequel of group A streptococcal infections. Since a decreasing incidence of the disease, as reported to registries, was a primary reason for discontinuing the registries, the author concludes that a potentially effective public health program in preventive medicine can be discontinued for inadequately documented reasons.

Humans↗
PubMed1994

Trends in acute rheumatic fever. The Barbados experience.

A retrospective review of yearly admissions of acute rheumatic fever between 1971 and 1990 showed a declining trend with relative stability since 1986. The incidence rate of acute rheumatic fever (new attacks/year) was 2/100,000 total population or 7/100,000 childhood population (< 19 years old) or 9/100,000 schoolchildren. The incidence rate per 10,000 hospital admissions was a high of 20 in 1971 and remained a low of three since 1986. This low incidence of acute rheumatic fever should not give rise to complacency in its control, as there is an unexplained resurgence in the developed countries.

Barbados↗
PubMed1998

Obsessive-compulsive and related symptoms in children and adolescents with rheumatic fever with and without chorea: a prospective 6-month study.

OBJECTIVE: The incidence and course of neuropsychiatric symptoms were determined in pediatric patients with rheumatic fever. METHOD: The Leyton Obsessional Inventory and National Institute of Mental Health Global Obsessive-Compulsive Scale were used to evaluate children and adolescents who had rheumatic fever with Sydenham's chorea (N=30) or without chorea (N=20). They were assessed three times over 6 months from the onset of rheumatic fever. Psychiatric diagnoses were also determined. RESULTS: Obsessive-compulsive symptoms abruptly appeared and peaked during the 2 months after the onset of rheumatic fever in 21 patients with chorea (70.0%) and were absent in all patients without chorea. Obsessive-compulsive disorder (OCD) was diagnosed in five patients with chorea (16.7%). CONCLUSIONS: The association between Sydenham's chorea and OCD supports suggestions that similar mechanisms involving the basal ganglia underlie both disorders. Obsessive-compulsive symptoms occurred at the beginning of rheumatic fever, so early psychopathological assessments are essential.

Adolescent↗
PubMed1998

Rheumatic fever in the Kimberley region of Western Australia.

The objective of this study was to assess the incidence and clinical presentation of acute rheumatic fever in children and young adults in the north west of Western Australia--a region known as the Kimberley. In this five year retrospective study, residents aged less than 30 years, suspected of having had acute rheumatic fever from 1988 to 1992, were identified and their hospital and clinic records were reviewed. There were 96 cases of acute rheumatic fever that met the revised Jones criteria during the five year period. There were 59 initial attacks and 37 recurrences that occurred in 81 people, of whom 80 were of Aboriginal descent. The overall incidence of acute rheumatic fever in the Kimberley region for those aged under 30 years is 136 cases per 100,000 per year and in the Aboriginal population is 241 per 100,000 per year. The group most at risk are Aboriginal school children aged 5-14 years who accounted for 50 cases and have an annual incidence of 375 cases per 100,000 per year. The clinical presenting features were carditis in 50 per cent, polyarthritis in 59 per cent, chorea in 22 per cent, and subcutaneous nodules in 1 per cent. The hospitalization rate was 80 per cent for new cases and 73 per cent for recurrences with average stays of 14.6 and 1.5 days respectively. Rheumatic heart disease (RMD) developed in 31 of the cases; two required surgery and there was one death attributable to RHD in this group. Rheumatic fever continues to be a significant health problem in the Aboriginal population in this region and the recurrence rate, despite secondary prophylaxis, is also unacceptably high.

Acute Disease↗
PubMed1989

Coxsackie virus and rheumatic fever. A correlative study.

Twenty-one patients of whom 13 had acute rheumatic fever and 8 had recurrence of rheumatic fever were studied for the evidence of coxsackie B viral infection using neutralisation test. A significant rise was noted in 17 cases (81%) and two cases had very high initial titre of neutralising antibodies to coxsackie B viruses type 1 to 6. Mixed infection with more than one serotype was seen in 11 cases. Coxsackie B2 was the commonest type and 14 patients had antistreptolysin 'O' anti-bodies. The high incidence of coxsackie B viral infection in rheumatic fever and the coexistent streptococcal infection and their relationship are discussed.

Adolescent↗
PubMedDate not supplied

[A resurgence of rheumatic fever. New causes or old attitudes?].

Bearing in mind that in the last years there has been an increase in rheumatic fever episodes, the authors evaluate the cases recently observed in the department. The data of 3 children born and living in Portugal, the first known outbreak of rheumatic fever observed between June 93 and March 94, were examined. One case presented polyarthritis, another polyarthritis and carditis and the third chorea and carditis. In just one case was the diagnosis of rheumatic fever considered in the beginning, and over-all, failures in the diagnosis and treatment of tonsillitis, and in echocardiographic diagnosis were detected. In view of these examples, the authors conclude that the increasing incidence and morbidity of rheumatic fever is more probably due to forgetfulness of old attitudes than to new causes. Delay in the diagnosis and errors in secondary prophylaxis may influence long term results.

Child↗
PubMed1981

Follow-up study of ASO, ADN-B and ASK levels in children with rheumatic fever.

In a total of 6 patients with rheumatic fever, antistreptolysin O (ASO), antistreptodeoxyribonuclease-B (ADNase-B) and antistreptokinase (ASK) titer was followed up for 3 months to 6 years. The mean periods of time of normalization of these serological tests were 4 months in ASO, 35 months in ADNase-B. In ASK, the period varied vastly in the range from 5 weeks to 4 years 1 month. Clinically it is not so easy to differentiate rheumatic heart disease from mitral valve disease of unknown etiology. In the case of high ADNase-B level, the patients my be considered to have been attacked by rheumatic fever sometime during a preceding period of as long as about 35 months.

Adolescent↗
PubMed1996

The reference value of erythrocyte sedimentation rate for differential diagnosis of rheumatic fever among Bangladeshi children.

The aim of the present study is to determine the reference value of erythrocyte sedimentation rate for differential diagnosis of rheumatic fever in the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh among patients with signs and symptoms which may be related to acute rheumatic fever. All medical records for the patients aged 5 to 20 years who attended the outpatient department of the hospital between July, 1994 and November, 1995 were reviewed. Fifty-three of 337 such patients had acute rheumatic fever defined by the updated Jones criteria. The performance of erythrocyte sedimentation rate test was evaluated by sensitivity, specificity, positive predictive value, and receiver operating characteristic curve. The findings of this study suggest that the lower limit for a positive test should be considered at 30 mm (Westergren 1 h) in this hospital.

Adolescent↗
PubMed1992

Transient diaphyseal tibial Tc-99m MDP uptake and bone marrow edema in acute rheumatic fever.

The authors describe a patient with acute rheumatic fever and polyarthritis in whom scintigraphy unexpectedly identified Tc-99m MDP uptake in the diaphyses of both tibiae. A dramatic rise in antistreptolysin-O titer and rapid resolution of tibial abnormalities paralleled marked articular improvement. Magnetic resonance imaging demonstrated a pattern consistent with marrow edema in the area of abnormal Tc-99m MDP accumulation. This finding has not been previously described in acute rheumatic fever, and it was suspected that the changes in the tibiae resulted from subclinical diaphyseal hyperemia from the inflammatory process observed in the contiguous joints.

Acute Disease↗
PubMed1986

[Acute rheumatic fever in New Caledonia. Clinical and epidemiological aspects].

Rheumatic fever is frequently encountered in tropical countries. Its distribution, incidence and consequences, notably on the heart, were studied in Nouvelle-Calédonie (South Pacific) on the basis of 76 patients with acute attack. The data were compared with those obtained in controls of the same age, sex and ethnic origin. Many patients developed carditis (often disabling), and relapses were frequent. The epidemiological data confirmed that rheumatic fever preferentially affects young subjects of both sexes and is more common among Melanesians and Polynesians, probably because of their lower socio-economic status.

Adolescent↗
PubMed1982

Sequelae of the initial attack of acute rheumatic fever in children from north India. A prospective 5-year follow-up study.

We determined the outcome of acute rheumatic fever in 85 children from North India who had received regular antistreptococcal prophylaxis after their first attack. By the end of the 5-year follow-up, 33 patients had rheumatic heart disease. Mitral insufficiency, the most common valvular lesion, appeared in 91% of the patients, whereas mitral stenosis developed in only 18%. Initial carditis, congestive heart failure, cardiomegaly or moderate-to-severe mitral insufficiency significantly increased the risk of rheumatic heart disease (p less than 0.001). The recurrence rate of acute rheumatic fever in children who received continuous prophylaxis was 0.006 per patient-year. Most recurrence (92%) mimicked the first attack and produced further cardiac damage in five patients with carditis and in one patient with chorea. Cardiac status during the first attack of rheumatic fever and the continuity of prophylaxis were the major determinants of outcome. Statistical comparisons disclosed that with continuous prophylaxis, the prevalence rate, evolution and clinical spectrum of the sequelae of acute rheumatic fever in children from India do not differ significantly from those in the West.

Child↗