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PubMed1989

Acute rheumatic fever in Wisconsin.

Medical records of patients discharged from Children's Hospital of Wisconsin from January 1980 to May 1988 who fulfilled the revised Jones criteria for acute rheumatic fever were reviewed. A total of 13 patients were hospitalized with a first attack of acute rheumatic fever during this period. Migratory polyarthritis was present in 92% of the patients and carditis in 62%. Mitral regurgitation was present in all cases of carditis. Only six patients (46%) had a history of a preceding streptococcal infection, half of whom were treated with antibiotics. While there is no evidence to support a new outbreak of acute rheumatic fever in Wisconsin, our data demonstrate that the disease is still prevalent within the eastern region of the state. Patients with Group A streptococcal pharyngitis must be identified and treated to prevent this disease from increasing in incidence.

Acute Disease↗

PubMed1981

Rheumatic fever in Nigerian children. A prospective study of 66 patients.

Sixty-six Nigerian children with rheumatic fever were studied between 1975 and 1979. Equal numbers of patients had acute and chronic disease. Carditis was the most common major manifestation, being present in 98% of the cases, whereas subcutaneous nodules, erythema marginatum, and chorea were relatively rare. Twelve patients died within two years of the disease's appearance and eight have become unavailable for follow-up. Our findings resemble those from other tropical countries, in contrast with results from temperate countries: rheumatic fever manifests differently and rheumatic carditis runs a more fulminant course in a person from a tropical area.

Adolescent↗

PubMed1990

Adult acute rheumatic fever: a rare case presenting with left bundle branch block.

In contrast to the more common electrocardiographic patterns seen in acute rheumatic fever, such as first-degree heart block, the appearance of left bundle branch block is rare. An adult patient with acute rheumatic fever presented with left bundle branch block on admission, subsequently had sudden cardiac arrest. She was resuscitated successfully and required temporary pacing. An echocardiogram and radionuclide ventriculography were compatible with interventricular septal involvement in the rheumatic carditis. After 20 days of steroid therapy, the left bundle branch block pattern of the electrocardiogram disappeared. A possible mechanism for the development of complete heart block in acute rheumatic fever is discussed. It is suggested that patients with acute rheumatic carditis who have electrocardiographic manifestations of prolonged P-R interval and left bundle branch block should be managed with prophylactic pacing.

Acute Disease↗

PubMed1994

Long-term outcome of patients with rheumatic fever receiving benzathine penicillin G prophylaxis every three weeks versus every four weeks.

OBJECTIVE: To compare the efficacy of injections of 1.2 million units of benzathine penicillin G given every 3 weeks versus every 4 weeks for secondary prevention of rheumatic fever, based on the long-term outcome of patients receiving such prophylaxis. METHODS: A total of 249 consecutive patients with rheumatic fever, randomly assigned to either a 3-week or a 4-week regimen, were examined every 3 to 6 months, and followed for 794 and 775 patient-years, respectively. RESULTS: Compliance with each regimen was comparable: 83 (66.9%) of 124 patients in the 3-week group versus 92 (73.6%) of 125 patients in the 4-week group stayed in the program (p > 0.05). Streptococcal infections occurred less frequently in those receiving the 3-week regimen: 7.5 versus 12.6 per 100 patient-years (p < 0.01). Prophylaxis failed in 2 patients receiving the 3-week regimen and in 10 receiving the 4-week regimen (0.25 and 1.29 per 100 patient-years respectively; p = 0.015). Serum penicillin levels were adequate (> or = 0.02 micrograms/ml) in 100 (56%) of 179 samples obtained 21 days after penicillin injection in the 3-week regimen, and in 51 (33%) of 155 samples obtained 28 days after injection in the 4-week regimen (p < 0.01). Of 71 patients with mitral regurgitation in the 3-week regimen, 47 (66%) no longer had the murmur; of 87 patients in the 4-week regimen, 40 (46%) no longer had the murmur (p < 0.05). CONCLUSIONS: This 12-year controlled study indicates that the outcome of patients with rheumatic fever is better with a 3-week than with a 4-week penicillin prophylaxis regimen. Greater emphasis and more widespread use of the 3-week regimen should be recommended.

Adolescent↗

PubMed1990

[Complete atrioventricular block and acute abdominal pain: initial symptoms in a case of rheumatic fever].

Delayed atrioventricular conduction, as reflected in prolongation of the P-R interval, is commonly found and is a non specific finding in acute rheumatic fever (minor manifestation). Prolongation of atrioventricular conduction may lead to second-degree A-V block, while a complete heart block is a rare event with or without Stokes-Adams attacks. In these cases temporary pace-maker may be usefully employed. Another uncommon symptom of acute rheumatic fever is abdominal pain, which occurs in fewer than 5% of patients, and is usually vague and not acute. An unusual case of onset of rheumatic fever characterized by acute complete heart block and acute abdominal pain simulating appendicitis is reported.

Abdomen, Acute↗

PubMedDate not supplied

Childhood acute rheumatic fever in Ankara, Turkey.

Patients with acute rheumatic fever (ARF) admitted to a tertiary hospital in Ankara between January 1999 and July 2002 were studied cross-sectionally to verify the clinical profile and were followed during the acute period. All patients were investigated for throat culture, streptococcal serologic study, C-reactive protein, and erythrocyte sedimentation rate, and telecardiograms, electrocardiograms and echocardiographic study were done. During the study period, 129 attacks of ARF were observed: 118 were initial attacks and 11 were recurrences. Age on admission was 11.2 +/- 2.73 years (mean +/- SD, range: 6-21 years). Polyarthritis alone was present in 42 cases (33%), carditis alone in 33 (25%), combined carditis and polyarthritis in 36 (28%), combined carditis and chorea in 15 (12%) and chorea alone in 3 (2%). Nineteen (14%) patients with isolated arthritis and pure chorea had silent mitral and/or aortic regurgitation. Carditis was a dominant presenting manifestation, but appeared to be mild or moderate. The present study indicates that ARF is still a significant problem in Turkey. The observation that 8.5% of the attacks were recurrent reaffirms the need for more effective secondary prevention programs.

Acute Disease↗

PubMedDate not supplied

[Rheumatic fever: atypical joint manifestations].

The diagnosis of rheumatic fever (RF) continues to be a difficult one in Pediatrics, mainly because of the polymorphism of its clinical presentation and the lack of specific laboratory test. Among the Jones' major criteria, arthritis is the most frequent and the least specific. Ninety three children with RF who presented 117 flares of the disease were studied in the Department of Pediatrics, Escola Paulista de Medicina, between Dec. 1989 and Dec. 1991. The presence of arthritis was defined as an inclusion criterion. The diagnosis was based on history, physical and laboratory examinations (Modified Jones' Criteria). The mean age was 10 years and the sex ratio was 1 male: 1.4 female. In 45% of the flares, arthritis was the only major criterion. In 44% there were arthritis and carditis, in 7% arthritis and chorea and in 4% arthritis, carditis and chorea. In 64% of the flares the pattern of articular involvement was migratory and in 36% addictive. Polyarthritis and oligoarthritis were observed respectively in 64% and 36%. Monoarthritis was reported in 3%. The definitive diagnosis of RF with atypical articular involvement only was possible in the presence of carditis or chorea. The authors conclude that physicians should be aware of the atypical involvement observed in some cases of RF, specially when arthritis is the only major criterion.

Adolescent↗

PubMed2002

Presence of the d8/17 B-cell marker in children with rheumatic fever in Israel.

A genetic predisoposition to rheumatic fever (RF) has been suspected by several researchers. Ten years ago, using monoclonal antibodies, the B-cell alloantigen D8/17 was identified in 90-100% of patients with RF. The aim of the present study was to evaluate whether the marker is found in patients with RF in Israel, where the population is made up of diverse ethnic groups. The Schneider Children's Medical Center in Petah Tikva, Israel, was the setting for this study. The population included 22 children with RF and nine ethnically matched, disease-free individuals who served as controls. Each of the patients and controls were tested for the B-cell antigen with flow cytometry assay by using monoclonal antibodies. The main outcome measure was the difference in the presence of the D8/17 B-cell marker between the patients with RF and the controls. The mean percentage of B-cells expressing the marker was 11.5 +/- 2.9 in the patients and 4.24 +/- 2.7 in the controls (P < 0.001). There was no statistically significant difference in the frequency of the marker by ethnic origin. The present results support earlier studies suggesting that D8/17 is a disease-specific marker with a world-wide distribution which may potentially serve as an additional diagnostic tool in patients with suspected RF.

Adolescent↗

PubMed1997

Rheumatic fever revisited. Keep this diagnosis on your list of suspects.

The symptoms of recurrent rheumatic fever in adults can be very different from those in children, and the diagnosis is easy to overlook. Nonetheless, rheumatic fever is still a problem in many parts of the world, as illustrated by this case. Dr Capizzi and associates remind us to keep our options open.

Adult↗

PubMed1985

Poststreptococcal neprhitis and acute rheumatic fever in two adults.

In two adult subjects who suffered acute episodes of rheumatic fever, sever kidney involvement developed with proteinuria and renal insufficiency. The clinical and histologic picture was typical of poststreptococcal (infectious) glomerulonephritis. During a follow-up period of more than three years, no clinical or biochemical abnormalities have been detected; thus, it is likely that both patients have recovered from their renal diseases. The coexistence of rheumatic fever and acute glomerulonephritis, which is uncommon even in your age groups, may be observed in adult subjects.

Acute Disease↗

PubMed1995

[Rheumatic fever, a disease undergoing change, based on the experience of the past 15 years].

The authors reviewed the records of paediatric patients treated at the cardiology department of the Svábhegyi Gyermekgyógyintézet during the period from 1 January 1979 to 31 December 1993. All the patients elected for the survey had rheumatic fever and represented about 20 percent of the national patient pool. Among the 62 children referred for suspected rheumatic fever 26 had carditis, and 3 suffered from pancarditis. Two children had chorea minor with carditis and there were 2 additional cases with chorea minor only. Valvular heart disease has developed in 21 patients. There were 16 patients with mitral regurgitation, these conditions have occurred in combination with mitral stenosis in 3 cases, whereas the insuffitientia of the aortic valve developed in two patients. The authors analysed the clinical signs of the patients and established that the chronic syndromes came in front. The authors have observed a favourable trend in the epidemiology of the disease, in particular, while 34 patients were referred during the first 5 years, there were only 18 cases in the second 5-years period. During the interval from 1989 to 1993, only 10 children with rheumatic fever have been referred to or treated at the authors' institute.

Adolescent↗

PubMed1976

Antihyaluronidase level in children with rheumatic fever and other streptococcal infection.

1) The serum ASO and AH assays were performed and compared in a series of 90 healthy children and 7 pediatric patients with rheumatic fever and other disorders related to hemolytic streptococcus infection. 2) The upper physiological limit of serum AH titer was estimated to be 256X for children. 3) In rheumatic fever, sometimes the serum AH level rises earlier than elevation of serum ASO and remains to be high over a long period even after the serum ASO has returned to normal level. 4) The results suggest importance of the serum AH determination in the serologic diagnosis of rheumatic fever and other conditions of hemolytic streptococcus infection.

Adolescent↗

PubMed1999

Rheumatic Fever.

There have been numerous reports stating that treatment of acute rheumatic fever with either aspirin or corticosteroids does not alter the long-term outcome of rheumatic heart disease. Yet, it should be emphasized that most of these studies were carried out with the first generic corticosteroids before the advent of the more active and more potent corticosteroid agents. In spite of this caveat, there is no question that all the clinical and laboratory parameters of inflammation (erythrocyte sedimentation rate, C-reactive protein) return to normal much more rapidly with corticosteroids than with aspirin alone. It is therefore our belief that steroids should be used when clinical and laboratory evidence of carditis exists, and aspirin should be reserved for cases of acute rheumatic arthritis with no evidence of carditis. The incidence of long-term valvular disease in active carditis may be decreased with steroid therapy. For example, the number of valve replacements differs markedly in centers that do use steroids and in those that do not. In Capetown, South Africa, where steroids are routinely used for carditis, valve replacement is quite rare. In contrast, in Johannesburg, where steroids are rarely used, the rate of valve replacement is quite high. The racial backgrounds of both groups of patients are similar, thus eliminating the question of racial differences. Concerning secondary prophylaxis, there is also controversy concerning the best second-line therapy. It is now well known that monthly intramuscular injections of benzathine penicillin are really effective for only 20 days. Thus, there is a window in which penicillin coverage is not adequate. To circumvent this problem, some investigators give benzathine penicillin every 3 weeks. These injections are quite painful, however, and it has been our "rule" that compliance with this treatment is inversely proportional to the ratio of the size of the child to the mother. In our own experience over 30 years with the follow-up of more than 300 patients with acute rheumatic fever, careful discussion of the consequences of missing oral doses has been adequate to insure proper compliance. An analysis of our patients on oral penicillin prophylaxis compared with other groups using benzathine penicillin revealed that there was very little difference in recurrence rate.

Journal Article↗

PubMed1992

Participation of health workers, school teachers and pupils in the control of rheumatic fever: evaluation of a training programme.

In a rural community block of north India we initiated a programme for control of rheumatic fever and rheumatic heart disease (RF/RHD). This included a training campaign for all 74 health workers, 773 school teachers and 12,500 older pupils (class V to X) to enable them to suspect and refer cases of RF/RHD and counsel them about secondary prophylaxis. Training material was used by project staff, medical officers and teachers to convey that this serious disease with onset between 5 and 15 years can be recognized by four simple criteria: fever with joint pain or swelling; breathlessness and fatigue; involuntary face and limb movements. One year later we evaluated awareness generated by training by administering a questionnaire to random samples in the intervention area and in a noncontiguous control area. Health workers, teachers and pupils of the intervention block were significantly better aware of the nature, severity and presentation of the disease and reported having recognized cases whom they had referred for diagnosis, prophylaxis and counselled for follow up. We conclude that a training protocol incorporating simple messages can effectively create practical awareness for RF/RHD control among teachers, health workers and pupils in a rural community.

Community Health Workers↗

PubMed1987

Rheumatic fever in a 2-year-old child.

A 2-year-old boy with rheumatic fever is described. The patient presented with fever, flitting polyarthritis and an elevated erythrocyte sedimentation rate. Treatment with aspirin was successful. Rheumatic fever in this age-group is very rare, but it is important to consider this diagnosis even in children under 3 years of age.

Age Factors↗

PubMed1984

Rheumatic fever prophylaxis: Gisborne experience.

There were 300 admissions to the Cook Hospital with rheumatic fever in 1958-83. During 1958-73 oral penicillin was used for secondary prophylaxis and 77 (35%) of 223 admissions were recurrences. From 1974-83 when parenteral benzathine penicillin was increasingly used there were 77 admissions of which 14 (18%) were readmissions. An effective programme of secondary prophylaxis using benzathine penicillin and co-ordination of hospital and community health services is outlined. One hundred and eight patients with a first attack of rheumatic fever were seen in 1968-82. The chance of a recurrence in patients in whom oral prophylaxis was instituted was 15% two years after the initial attack and 35% after six years. Institution of parenteral prophylaxis significantly reduced the risk of recurrence (p = 0.0009) which was 2% six years after the first attack.

Administration, Oral↗

PubMed1986

Diagnosis of rheumatic fever. A guide to the criteria and manifestations.

Serious errors may arise from misinterpretation of the Jones criteria for rheumatic fever. Many patients "fulfill" the criteria and yet have another disease. The danger in such cases is that the actual illness is not diagnosed and the patient is not treated for it. If salicylates or steroids are administered prematurely, ie, before the signs and symptoms of rheumatic fever are fully recognizable, a vague syndrome may develop and elicit an uncertain diagnosis and improper treatment.

Antistreptolysin↗

PubMed1993

Chorea as a manifestation of rheumatic fever--a 30-year survey (1960-1990).

Sydenham chorea, a major manifestation of acute rheumatic fever, has been the most common form of acquired chorea during childhood. Despite the recent dramatic decline in both incidence and severity of rheumatic fever in our area, the frequency of carditis was unchanged. This study investigated retrospectively the incidence of chorea in the last three decades (1960-1990) in our area. During the 30 years of the survey, 28 patients with Sydenham chorea were treated in our centre of whom 10 were seen between 1960-1970, 17 between 1970-1980, and only one patient between 1980-1990.

Acute Disease↗