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PubMedDate not supplied

Towards a vaccine against rheumatic fever.

Rheumatic fever (RF) is an autoimmune disease which affects more than 20 million children in developing countries. It is triggered by Streptococcus pyogenes throat infection in untreated susceptible individuals. Carditis, the most serious manifestation of the disease, leads to severe and permanent valvular lesions, causing chronic rheumatic heart disease (RHD). We have been studying the mechanisms leading to pathological autoimmunity in RF/RHD for the last 15 years. Our studies allowed us a better understanding of the cellular and molecular pathogenesis of RHD, paving the way for the development of a safe vaccine for a post-infection autoimmune disease. We have focused on the search for protective T and B cell epitopes by testing 620 human blood samples against overlapping peptides spanning 99 residues of the C-terminal portion of the M protein, differing by one amino acid residue. We identified T and B cell epitopes with 22 and 25 amino acid residues, respectively. Although these epitopes were from different regions of the C-terminal portion of the M protein, they showed an identical core of 16 amino acid residues. Antibodies against the B cell epitope inhibited bacterial invasion/adhesion in vitro. Our results strongly indicated that the selected T and B cell epitopes could potentially be protective against S. pyogenes.

Animals↗
PubMed1999

[Rheumatic fever and rheumatic heart disease in Northwest Russia].

296 patients who were operated between 1965 and 1993 with mitral commissurotomy, were included in this retrospective study of rheumatic heart disease in North-West Russia. There were 117 (39.5%) reported cases of acute rheumatic fever, with either polyarthritis (n = 88), carditis (n = 23), or Sydenham's chorea (n = 6). There were no reported cases of erythema marginatum and subcutaneous nodules. The first case of acute rheumatic fever in our patients was in 1924. More than 50% of the patients (164) did not get the diagnosis acute rheumatic fever, and became aware of their rheumatic heart disease only when symptoms of mitral stenosis appeared. 15 patients had a subclinical attack of rheumatic fever, i.e. not all of Jones' criteria were fulfilled. At onset of acute rheumatic fever, the mean age was 15 years, when valvular disease was confirmed 24 years, and 33 years at mitral surgery. Dyspnea (n = 293) was the most common symptom of mitral stenosis, followed by atrial fibrillation (n = 105). 15 patients developed cerebral stroke. The Archangel Health Region has one of the highest prevalences of rheumatic heart disease in Europe (3.7/1,000 in those above 16 years of age, 1993). There is high mortality and the disease develops rapidly.

Adolescent↗
PubMed1985

Smooth muscle antibody in children with acute rheumatic fever and rheumatic heart disease.

Smooth muscle antibody (SMA) was positive in 66.7% of children with acute rheumatic fever, in 46.1% of children with chronic rheumatic heart disease, and in only 11.9% of normal Chinese children. These findings indicate that the SMA is one of the bioproducts of acute rheumatic fever and rheumatic heart disease, but the immunopathogenetic role of SMA in these particular disease still needs further investigation.

Acute Disease↗
PubMed1984

Immunological studies on acute rheumatic fever and rheumatic heart disease.

The results of immunologic studies in 27 cases of acute rheumatic fever and 11 cases of chronic rheumatic heart disease are reported. In both groups, there are elevation of peripheral B lymphocytes and depression of T lymphocytes when compared to the normal control subjects. Circulating immune complexes and autoantibodies including anti-smooth muscle antibody, antimitochondria antibody and anti-parietal cell antibody are detectable in certain cases of both groups. Deposition of IgG, beta 1c and Coxsackie antigen are demonstrable in myocardial tissue in autopsy of two cases with acute rheumatic fever in association with the detection of immune complexes in their sera. Our results together with the previous reports suggested that the Coxsackie virus are one of the causative agent of the rheumatic fever. Moreover humoral and cellular immunological reaction are involved in the pathogenesis of the disease.

Antigen-Antibody Complex↗
PubMedDate not supplied

Compliance of secondary prophylaxis for controlling rheumatic fever and rheumatic heart disease in a rural area of northern India.

This study was conducted in a community development block of a district in Haryana to evaluate the compliance of secondary prophylaxis for controlling rheumatic fever (RF) and rheumatic heart disease (RHD). The patients were interviewed using a semi-structured schedule at home. Currently 110 patients are registered in RF/RHD registry of which 53 (48.2%) are males. Mean age of patients was 18.4 +/- 8.6 years, ranging from 6 to 50 years with majority (48, 43.7%) of patients in the age groups of 6-15 and 16-25 years. Out of 110 patients, more than 90 percent had taken 11 out of the 12 due doses of secondary prophylaxis every year in the last eight years of the programme except in 1995 when 92 (83.6%) patients took the prophylactic doses. Only one patient reported recurrent attacks of rheumatic fever after irregular secondary prophylaxis. Eighteen (16.4%) patients were defaulters at the time of interview and were motivated to take secondary prophylaxis regularly. Ninety-seven (88.2%) patients were satisfied with the ongoing programme. In developing countries, it is possible to successfully apply a secondary prevention programme for control of RF/RHD by using existing health infrastructure.

Adolescent↗
PubMedDate not supplied

[Epidemiological course of rheumatic fever and rheumatic heart disease in Spain (1951-1986)].

A study has been made of the death rate due to Rheumatic Fever (R.F.) and Rheumatic Heart Disease (R.H.D.) in Spain (1951-1985) as well as the disease rate due to Rheumatic Fever (1951-1988). It has been found that the death rate due to R.F. and R.H.D. has clearly decreased over the past 20 years, whilst it is important to note that disease rate due to R.F' has shown a noticeable increase over the past 10 years. And on comparing the death rate due to R.F. in Spain and in the United States, one finds that the U.S. death rate began to drop prior to that in Spain, it currently being minimal in both countries. Stress is placed on the need to increase the control of streptococcus infections, specially throat infections, in our environment.

Adolescent↗
PubMed2003

[An epidemiologic investigation of acute rheumatic fever and rheumatic heart disease among students aged 5-18 in west area of Sichuan Province].

OBJECTIVE: To study the incidence of acute rheumatic fever (ARF) and its epidemiologic features and the prevalence rate of rheumatic heart disease in west area of Sichuan province. METHODS: By using disease surveillance program, an epidemiologic investigation of ARF was performed from June 1992 to June 1995 and an annual screening survey was carried out among 46,595 students aged 5-18 in 1993 and 1994. RESULTS: The annual incidence of ARF was 12.87 per 10(5), there was no difference between the rural area and the urban area. ARF was found to be more frequent in students aged 9-15 years and in autumn and winter. All of the ARF patients had rheumatis and 83.3% of the cases were accompanied with heart lesion. The prevalence rate of rheumatic heart disease was 11 per thousand. CONCLUSION: The long-term monitoring of epidemiologic trend and community-based controls of rheumatic fever and rheumatic heart disease among students aged 5-18 are necessary and effective.

Adolescent↗
PubMed1996

[Acute rheumatic fever and rheumatic heart disease: immunological studies].

A total of 216 patients with rheumatic fever and rheumatic heart from the Institute of Rheumatology and 126 patients with rheumatic heart diseases alone from the Center of Cardiosurgery were clinically and immunologically studied. The immunological study included the detection of b-hemolytic group A streptococcus, O-antistreptolysin, the measurement of C-reactive protein, immunoglobulins, C3, C4, Ciq-binding, anticardiolipin antibodies, etc. The findings indicated that the secondary penicillin prophylaxis prevents streptococcal pharyngitis and recurrence of acute rheumatic fever after 5 years. The high levels of Ciq-binding and anticardiolipin antibodies were directly proportional to the incidence rates of acute endocarditis and associated with the occurrence of venous and arterial thromboses.

Acute Disease↗
PubMed1990

Streptococcal antibody cross-reactivity with HLA-DR4+VE B-lymphocytes. Basis of the DR4 associated genetic predisposition to rheumatic fever and rheumatic heart disease?

B-lymphocytes obtained from patients with either rheumatic fever or rheumatic heart disease and from normal subjects were reacted with serum obtained from rabbits immunized with streptococcal cell wall antigen. The presence of cytotoxicity was sought using an inverted phase microscope after differential uptake of eosin dye. The serum was found to be significantly more cytotoxic to HLA-DR4 containing cells of both patients and normals compared with DR4 negative cells (P less than 0.0001).

Antibodies, Bacterial↗
PubMed1999

Rheumatic fever and rheumatic heart disease: an overview.

Rheumatic fever and rheumatic heart disease are still major causes of disease in the developing world today. Diagnosis and prevention, particularly secondary prophylaxis, will become even more important as increased urbanization, with greater population pressure and economic problems, increase the prevalence. The number of children and young adults in their most crucial years of life who would avoid chronic disease and death would more than repay the investment of time and resources.

Adult↗
PubMed1987

Antibody titer to group A streptococcal polysaccharide in rheumatic fever and rheumatic heart disease.

Antibody to group A streptococcal polysaccharide (ASP) is the only antibody of cellular components which is now detectable in clinical practice. Streptococcal polysaccharide is known to have cross-immunity with the glycoprotein of human heart tissue, and has been discussed as a pathogenesis of rheumatic carditis and valvular heart disease. In this study, ASP titer was determined by passive hemagglutination technique in patients with rheumatic fever and rheumatic heart disease. ASP titer showed higher levels in these patients compared to control children, but there was no specificity in rheumatic carditis or rheumatic heart disease.

Antibodies, Bacterial↗
PubMed1976

Juvenile rheumatic fever and rheumatic heart disease at Ramathibodi Hospital, Thailand.

One hundred consecutive cases of rheumatic fever and rheumatic heart disease who were seen at Department of Pediatrics. Ramathibodi Hospital were reviewed. Particular attention was given to the pattern and the outcome of the cardiac status of the patients. The high incidence of severe carditis and tight mitral stenosis was similar to most reports from other developing countries. There was a poor prognosis for the cardiac status of those who came late, had more than valvular lesions, were in congestive heart failure, or had preexisting heart disease and atrial fibrillation. In spite of this, 6 patients had no evidence of heart disease after being followed up for less than 5 years.

Adolescent↗
PubMed1975

HL-A antigens in Europeans and Maoris with rheumatic fever and rheumatic heart disease.

Using a standard microtoxicity technique of tissue typing, the distribution of tissue antigens in 75 Maoris and 514 European disease-free blood donors was determined. Fifty Maori and 50 Europeans with rheumatic fever or rheumatic heart disease were compared with each control group. Normal Maoris had HL-A3 less frequently than Europeans (P less than .0005). HL-A28 was reduced (P less than .005) and HL-A17 increased in European patients (P less than .0005). In Maori patients there were minor differences in the frequency of HL-A3 and 8, which were increased, and HL-A10, which was diminished.

Europe↗
PubMed1989

Rheumatic fever and rheumatic heart disease in developing countries.

Rheumatic fever and rheumatic heart disease can be prevented by simple methods of primary health care. Well-organized prevention programmes can be cost-effective. Lasting benefit depends on the maintenance of both local interest and financial support from governments.

Adolescent↗
PubMed1978

Rheumatic fever and rheumatic heart disease in developing countries.

Studies on the prevalence and other epidemiological features of rheumatic fever and rheumatic heart disease and pilot prophylactic programmes have been carried out in India for the past 12 years or more. The results of these, together with data from other developing countries, have been taken into account in discussing the problems of these diseases in the developing world. Suggestions for their control, to be modified according to local conditions, are made.

Adolescent↗