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PubMed1982

Changes in T-lymphocyte subsets during acute rheumatic fever.

Relative proportions and numbers of helper [OKT4(+)] and suppressor [OKT8(+)] peripheral blood lymphocytes were examined in 32 young patients during the acute phase of rheumatic fever. No significant decrease in percentage T cells during acute rheumatic fever was noted in comparison to normal children controls from the same population. A decrease in absolute numbers of OKT4(+) T cells was also noted in acute rheumatic subjects not receiving corticosteroids (P less than 0.05). In addition, a significant decrease was documented in both proportions and total numbers of OKT8(+) putative suppressor cells during acute rheumatic attacks. C-reactive protein binding to T-lymphocyte subsets showed no preferential reactivity in vivo for suppressor or helper T cells. Antigen-reactive T lymphocytes identified with the T29 mouse hybridoma reagent showed similar proportions and numbers in rheumatic children as were noted in controls. The present data indicate profound alterations in both helper- and suppressor-cell types in the peripheral blood profile of children with acute rheumatic fever.

Acute Disease↗

PubMed1974

Rheumatic fever prophylaxis: a three-year study.

An effective programme of secondary prophylaxis against rheumatic fever has been established in Barbados over the last three years. Relatively unsophisticated patients collaborated well over prolonged periods. Adequate secondary prophylaxis was achieved with monthly injections of benzathine penicillin, with a resultant decrease in the complication rate.A total of 84 admissions over 32 months from a population of some 60,000 children under the age of 12 emphasizes the need for registration and prophylactic treatment of children with rheumatic fever. The low yield in the survey of schoolchildren between the ages of 5 and 11 and the large number of personnel required for the survey suggest that it might be extended to include older age groups. Automatic screening devices should be used when possible so that more may be screened.

Child↗

PubMedDate not supplied

Unilateral pulmonary edema: unusual presentation of acute rheumatic fever.

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical condition and not readily recognized early and managed accordingly. Acute rheumatic fever, which is a common disease in developing countries, does not commonly present with UPE. We report a 13-year-old girl presenting with UPE following acute rheumatic fever mimicking pneumonia. We conclude that UPE should be considered in the differential diagnosis for the patient with clinical criteria of rheumatic fever who presents with unilateral lung opacification. With early recognition and antifailure treatment, it is possible to reduce morbidity and mortality in such patients.

Adolescent↗

PubMed2001

Sister-chromatid exchange analysis on long-term benzathine penicillin for secondary prophylaxis of rheumatic fever.

A single intra-muscular injection of 1.2 millions units of benzathine penicillin every 4 weeks is the most widely used method for the antibiotic prophylaxis of rheumatic fever. The aim of this study is to evaluate the effect of long-term benzathine penicillin on DNA in patients with rheumatic fever. Thirty children with confirmed rheumatic fever who were on the benzathine penicillin prophylaxis were enrolled in the study, and 30 similar normal children served as a control group. To detect any DNA damage, SCE analysis were performed in circulating lymphocytes of the subjects. A statistically significant increased frequency of SCE was observed in children on the benzathine penicillin prophylaxis (no = 30, mean SCEs/cell +/- SD 7.54 +/- 1.81) as compared to a control group (no = 30, mean SCEs/cell +/- SD 5.82 +/- 1.40). It has been suggested that the difference in the SCE frequencies was induced by the administration of the benzathine penicillin for a long time, and further investigations are needed to confirm this toxic effect.

Adolescent↗

PubMed1993

Discontinuing rheumatic fever prophylaxis in selected adolescents and young adults. A prospective study.

OBJECTIVE: To assess the safety of discontinuing prophylaxis with antimicrobial agents in patients judged to be at relatively low risk for recurrence of acute rheumatic fever. DESIGN: Observational cohort study. SETTING: Public health clinics in the Southeast Health District of Santiago, Chile. PATIENTS: Fifty-nine patients (19 men, 40 women) ranging in age at study entry from 15 to 44 years (mean, 24.5 years). Forty-eight had completed their prescribed period of prophylaxis. Eleven refused or were allergic to intramuscular benzathine penicillin G and were non-compliant with oral sulfadiazine. INTERVENTION: In patients who did not have carditis during their previous attack(s), prophylaxis was discontinued after 5 years or at age 18, whichever was longer. In those with only mild mitral regurgitation or healed carditis, prophylaxis was stopped after 10 years or at age 25. Symptomatic intercurrent streptococcal throat infections were treated with antibiotics. MEASUREMENTS: Patients were seen every 3 months during the study (July 1982 to September 1988). For the first 4.25 years, throat cultures as well as sera samples for antistreptolysin O and anti-DNAse B assays were obtained at each visit. RESULTS: During laboratory surveillance, significant increases in antibody titers were detected in 56 instances (28.1 [95% CI, 21.7 to 36.5] per 100 patient-years), and 29 isolations of group A streptococci occurred (14.5 [CI, 10.1 to 20.8] per 100 patient-years). The patients were followed for a total of 3349 patient-months, during which time two acute rheumatic fever recurrences were observed (0.7 [CI, 0.2 to 2.6] per 100 patient-years). No recurrences occurred during an outbreak of acute rheumatic fever in 52 patients in the study area in 1986. CONCLUSIONS: These and other data indicate that acute rheumatic fever prophylaxis can safely be discontinued in young adults judged to be at low risk for recurrence and who are maintained under careful prospective surveillance.

Adolescent↗

PubMed1991

Release of oxygen free radicals by macrophages and neutrophils in patients with rheumatic fever.

The generation of oxygen free radicals (OFR) by peripheral blood monocytes and neutrophils of patients with rheumatic fever (RF) and rheumatic heart disease (RHD) has been studied using the luminol-enhanced chemiluminescence technique. The mechanism of OFR generation was studied by measuring NADPH oxidase enzyme activity. The effect of substrate was studied by measuring the hexose monophosphate (HMP) shunt enzymes: glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Three groups of patients [i) recurrent rheumatic activity, (ii) chronic RHD, (iii) acute pharyngitis) and normal controls were studied at day 0 and followed-up serially at 15, 90 and 180 days. The release of OFR, was significantly higher (P less than 0.001) in patients with recurrent rheumatic activity than in those with acute pharyngitis or chronic RHD, throughout the study period. A significant decline (P less than 0.001) in OFR release was observed from day 0 to day 180 in these patients, whereas no such change was observed in the chronic RHD group. This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may through generation of OFR, have a role in the pathogenesis of cardiac damage seen in patients with RHD.

Free Radicals↗

PubMed2002

The quality of management of rheumatic fever/ heart disease in the Kimberley.

OBJECTIVE: To evaluate the quality of management of Kimberley patients with rheumatic fever (RF) and rheumatic heart disease (RHD). METHODS: A retrospective analysis of medical records for 215 residents of the Kimberley region of Western Australia, diagnosed with RF or RHD during the years 1982 to 1996. RESULTS: Among patients prescribed intramuscular penicillin for secondary prophylaxis, 67% of prescribed doses were given, with individuals receiving 8-100% of doses prescribed. Of patients recommended visiting specialist or echocardiographic review, 78% and 64% attended respectively. Only 34% of patients with RHD in 1996 were recommended dental review in 1996 or 1997. Appropriate blood testing occurred in 34% of the months in which people had anticoagulant prescribed. CONCLUSIONS: A clinical audit can be used to evaluate the management received by this population and hence identify areas to improve management. We found much room for improvement if optimal clinical outcomes are to be obtained.

Echocardiography↗

PubMed1997

Acute rheumatic fever in adults: a resurgence in the Hasidic Jewish community.

OBJECTIVE: To describe a series of adults diagnosed with acute rheumatic fever (ARF). METHODS: Retrospective chart review of 14 patients age > 18 years with suspected ARF between 1990 and 1994 in a private rheumatology practice setting. Four additional patients treated at our medical center were included in the study. RESULTS: Twelve patients met Jones criteria for rheumatic fever and were included in the study. Of these, only 3 had a childhood history of rheumatic fever. All had recent onset of arthritis and a history of antecedent sore throat. Only 4 patients, however, had throat cultures positive for B-hemolytic streptococcus. Nine patients were Hasidic Jews. Four patients had carditis. One patient had erythema marginatum, while chorea and subcutaneous nodules were not seen. Nine patients improved taking nonsteroidal antiinflammatory drugs or acetylsalicylic acid; 3 required steroid treatment to control severe arthritis. CONCLUSION: Our clinical experience suggests that ARF occurs frequently, especially among Hasidic Jewish adults. Due to the disabling nature of the arthritis and the significant incidence (33%) of carditis, strict adherence to penicillin prophylaxis guidelines is indicated.

Adult↗

PubMedDate not supplied

[Changes in the incidence and clinical picture of rheumatic fever in 6 communities in the Istrian Subregion (1962-1986)].

Two hundred patients up to 13 years of age who were admitted to the Department of Pediatrics, Pula, between 1962 and 1986 with acute rheumatic fever were studied. Of these patients, 21 (10.5%) were in relapse. During the first 12 years of follow-up, 177 patients were treated and during the last 13 years only 23 patients. The average hospital incidence declined from 2.7% in 1963 to 0.3% or less between 1975 and 1986. The average annual incidence of acute rheumatic fever in a group of patients aged 0 to 14 years decreased from 67/100,000 in 1963 to 5.4/100,000 children in 1986. Within the last 13 years of follow-up, no relapse was observed. From 1966, no patient with decompensation of the heart was treated; and from 1961, no mortality was observed as a consequence of acute rheumatic fever. There are a number of factors which influenced these good trends, such as advances in health protection of children, better primary and secondary antirheumatic prophylaxis and, of course, continued improving of the standards of living in this subregion. It is concluded that in spite of the declining incidence and milder course of acute rheumatic fever, the disease still remains a serious public health problem due to a possible cardiac damage.

Acute Disease↗

PubMed1959