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PubMed1959

[Triamcinolone in the treatment of acute rheumatic fever].

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Rheumatic Fever↗

PubMed1977

Raised serum transaminase levels in patients with rheumatic fever treated with salicylates.

Of 11 patients with acute rheumatic fever, 9 were treated with a total daily salicylate dosage of 3,6 g or less, 1 patient required a total daily dosage of 5,4 g and another required 9,0 g daily. Six of the 11 patients had elevated serum transaminase levels, and all were asymptomatic. The elevated transaminase levels appear to bear a direct relationship to the serum salicylate level, and a serum salicylate level of 19,2 mg/100 ml appears to be the critical point. In 5 out of the 6 patients with elevated transaminases, the serum salicylate level exceeded 19,2 mg/100 ml, while in the 5 patients with normal transaminases the serum salicylate level did not exceed 19,2 mg/100 ml. Also, in 10 of the 11 patients eosinophilia was noted, but this decreased despite continued or increased salicylate administration. A narrow margin thus appears to exist between therapeutic serum salicylate levels and hepatotoxic levels, and serial serum transaminase estimations are advocated in patients on long-term salicylate therapy.

Acute Disease↗

PubMed2002

[Acute rheumatic fever among children in the Republic of Congo: report of 56 cases].

Authors report the results of a retrospective study (January 1993-December 1996) concerning 56 patients. The aim of this study was to describe epidemiology, diagnosis, evolution and treatment of rheumatic fever during childhood in the Teaching Hospital of Brazzaville. The frequency of the disease was 1.17%. There were 36 girls and 20 boys (p = 0.02). The mean age was 10 years and 8 months. Past of sore throat and recurrences of acute rheumatic fever have been notified respectively in 27 (48.2%) and 11 cases (19.6%). Arthritis were observed in 3 patients (5.4%), and 7 others (12.5%) didn't have any carditis. Fourty nine patients (87.5%) presented carditis, among which mitral regurgitation was the commonest cardiac lesion. Heart failure was observed in 25 patients (44.6%). The inflammatory process was treated by corticoid drugs and penicillin. Surgery realized in 22 patients consisted in valvuloplasty (5), bioprosthesis replacing (12). Beyond mitral valve replacing, 3 children profited of: tricuspid commissurotmy (1), surgery of congenital heart disease (2). Two patients profited of aortic prothesis. Six patients(10.7%) died because of: cardiac failure(3), infectious endocarditis (2), probable thrombosis of mechanic aortic valve (1). Primary and secondary prevention of this severe affection are primordial in Congo.

Acute Disease↗

PubMed2003

Clinical profile of acute rheumatic fever in Pakistan.

We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.

Acute Disease↗

PubMed1991

[Coagulation and fibrinolytic activity of erythrocytes in varying stages of rheumatic fever with minimal activity].

Lowered, as compared to the normal, coagulation activity of hemolyzed and intact red blood cells was recorded in rheumatic fever patients with minimal activity of the process in the presence of hypercoagulation syndrome detectable in the plasma. This activity is low-dependent on the degree of chronic circulatory insufficiency (CCI), and has a tendency to further lowering but not rising under the effect of the treatment conducted. Aggregation activity of red blood cells in patients with CCI of 0-I degree is lowered, in those with CCI of IIA and IIB-III degree--elevated, and it is highest in patients with CCI of IIB-III degree. Fibrinolytic activity of red blood cells recorded in normal subjects is lost in all the groups of patients, regardless of the observation period, with appearance or elevation of fibrinolysis inhibitors in them. Erythrocytic hemostasis alterations detected at varying stages of the course and treatment of rheumatic fever may be conducive to the reduction or growth of overall plasma-erythrocytic coagulation potential thrombophilia.

Adolescent↗

PubMed1975

Immunoglobulins and complement components in synovial fluid of patients with acute rheumatic fever.

Three components of complement and six other serum proteins were assayed in synovial fluid and serum samples from 25 patients with acute rheumatic fever in Trinidad. The resulting data indicate a relative decrease in both early and late components of complement within the synovial fluids which suggests local activation by immune complexes. Such activation of complement within the joint spaces may play a primary role in development of the inflammatory arthritis of acute rheumatic fever.

Adolescent↗

PubMed2004

D8/17 and CD19 expression on lymphocytes of patients with acute rheumatic fever and Tourette's disorder.

D8/17, an alloantigen found on B lymphocytes, has been reported to be elevated in patients susceptible to rheumatic fever and may be associated with autoimmune types of neuropsychiatric disorders. The pediatric-autoimmune-neuropsychiatric-disorders-associated-with-streptococci model is a putative model of pathogenesis for a group of children whose symptoms of obsessive-compulsive disorder and Tourette's disorder (TD) are abrupt and may be triggered by an infection with group A streptococci. As a test of this model, we have examined D8/17 levels on the B cells of patients with TD and acute rheumatic fever (ARF) along with those on the B cells of normal controls by flow cytometry. We have utilized several different preparations of D8/17 antibody along with a variety of secondary antibodies but have been unable to show an association with an elevated percentage of D8/17-positive, CD19-positive B cells in either ARF or TD. We did find, however, that the percentages of CD19-positive B cells in ARF and TD patients were significantly elevated compared to those in normal controls. Group A streptococcal pharyngitis patients also had an elevated percentage of CD19 B cells, however. These studies failed to confirm the utility of determining the percentage of B cells expressing the D8/17 alloantigen in ARF patients or our sample of TD patients. In contrast, the percentage of CD19-positive B cells was significantly elevated in ARF and TD patients, as well as group A streptococcal pharyngitis patients, suggesting a role for inflammation and/or autoimmunity in the pathogenesis of these disorders.

Acute Disease↗

PubMed1995

Acute rheumatic fever and poststreptococcal acute glomerulonephritis caused by T serotype 12 Streptococcus.

We present a rare case of a 10 year old Japanese boy with acute rheumatic fever accompanied with poststreptococcal acute glomerulonephritis. We isolated group A Streptococcus serotype T 12, a strain that was thought to be nephritogenic but not rheumatogenic, from throat culture. Although rare, physicians should be aware that acute renal disease may accompany rheumatic fever.

Acute Disease↗

PubMed2005

Rheumatic fever: how S. pyogenes-primed peripheral T cells trigger heart valve lesions.

The pathogenesis of rheumatic fever (RF) is related to autoimmune humoral and cellular responses against human tissues triggered by Streptococcus pyogenes. CD4(+) T cells are the ultimate effectors of chronic heart lesions in rheumatic heart disease (RHD). Heart-infiltrating CD4(+) T cell clones are able to recognize heart tissue and streptococcal antigens by molecular mimicry. The streptococcal M5(81-103) region, an immunodominant region, was recognized by both intralesional and peripheral T cell clones (62% and 38%, respectively). Peripheral T lymphocytes from Brazilian patients with severe RHD preferentially recognized the M5(81-96) peptide, in the context of HLA-DR7(+) and DR53(+) molecules. HLA-DR7 seems to be related to the development of multiple valvular lesions in RHD patients from different countries. In addition, the fact that peripheral and intralesional T cells recognized the M5(81-103) region points to this region as one of the streptococcal triggers of autoimmune reactions in RHD. T cell repertoire analysis from peripheral and intralesional T cell lines derived from RHD patients showed several oligoclonal expansions of BV families. Major expansions were found in the heart lesions, suggesting that such T cell populations preferentially migrate from the periphery to the heart. Some cross-reactive intralesional T cell clones displayed the same T cell receptor (TCR) BVBJ and CDR3 sequences, showing a degenerate pattern of antigen recognition. Heart tissue-infiltrating cells from myocardium and valvular tissue produced TNF-alpha, IFN-gamma, IL-10, and IL-4, whereas few cells from valvular tissue produced IL-4, showing that the lack of regulation in the valves could be responsible for the permanent and progressive valvular lesions.

Antigens, Bacterial↗

PubMed1984

Clinical significance of anti-streptococcal esterase (ASE) determination in rheumatic fever and other streptococcal diseases.

Streptococcal esterase is known as one of the extracellular products of Group A streptococci. In this paper, an antibody of streptococcal esterase titers in patients with rheumatic fever, acute glomerulonephritis and other streptococcal infections were determined. In cases with acute rheumatic fever and acute glomerulonephritis, ASE titers showed almost the same changes as ASO, ASK and ADN-B. The characteristics of the ASE determination, however, is that small changes in the titers could be detected because the final definition of this titer was determined by photometer.

Acute Disease↗

PubMed1956