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Results for “Rheumatic Fever”

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PubMed1991

Clinical aspects of acute rheumatic fever.

We review the epidemiology and clinical features of recent outbreaks of acute rheumatic fever. The history of this disorder as well as current management practices are also discussed.

Acute Disease↗
PubMed1985

HLA antigens and acute rheumatic fever: evidence for a recessive susceptibility gene linked to HLA.

From 60 probands with acute rheumatic fever (ARF), 19 multiplex families segregating for ARF were ascertained. The parents and rheumatic and normal sibs of the probands in these 19 families were also studied. HLA typing using the microlymphocytotoxic assay was then performed on the 60 unrelated probands, the multiplex families, and 234 unrelated controls using 23 antigens from the HLA-A and -B loci. The controls lacked a past history of ARF and were from the same geographic locality. Calculations of relative risk demonstrate an increase of HLA-B5 antigen in the 60 patients, but the result might not be significant from the point of view of multiple comparisons. Nevertheless, affected sib pairs from the multiplex families show 93% concordance for both or one HLA haplotype. A formal linkage analysis demonstrates that a recessive etiology is most likely (lod score of 3.3) with approximately 68% of cases being due to a gene closely linked to HLA and in linkage disequilibrium with HLA-B5. The remaining 32% of cases are due to other familial factors such as polygenic inheritance or common environmental factors. The results confirm a strong genetic predisposition to ARF and its heterogeneous nature in families.

Gene Frequency↗
PubMed2004

Rheumatic fever: from sore throat to autoimmune heart lesions.

Molecular mimicry between streptococci and heart components has been proposed as the triggering factor leading to autoimmunity in rheumatic heart disease (RHD). In this review, we present data from cellular autoimmune responses, focusing on the interactions between HLA class II molecules, streptococcal peptides and heart tissue proteins and T-cell receptor (TCR) usage. HLA-DR7DR53 associated with DQ molecules seem to be related with the development of valvular lesions in severe RHD patients. DR7DR53 molecules were also involved in the recognition of an immunodominant M5 peptide in these patients. T cells infiltrating RHD hearts displayed several oligoclonal expansions. Intralesional T-cell clones presenting identical TCR-BVBJ AVAJ and -CDR3 sequences were able to recognize several antigens with little or low homology, showing an intramolecular degenerate pattern of antigen recognition. Peripheral blood mononuclear cells of rheumatic fever (RF) patients produced proinflammatory cytokines, and intralesional mononuclear cells from severe RHD patients produced predominantly Th1-type cytokines. These results illustrate the complex mechanisms leading to heart tissue damage in RF/RHD patients.

Autoimmune Diseases↗
PubMed1994

Rheumatic fever and the HLA complex. A cosegregation study.

BACKGROUND: Considering the controversial results published in the literature concerning associations between human leukocyte antigens (HLA) and rheumatic fever (RF), the purpose of the present study was to investigate by means of cosegregation analysis the participation of HLA genes in susceptibility to RF. METHODS AND RESULTS: The sample reported here was composed of 51 affected and 66 healthy individuals belonging to 22 genetically informative families. The comparison (chi 2 goodness-of-fit test) of the observed numbers of identical-by-descent (IBD) HLA haplotypes among all affected individuals (siblings, cousins, and uncle/nephew and grandparent/grandchild type of pairs) with the expected ones under the assumption of independent segregation of HLA alleles and the presumptive RF susceptibility gene gave a value of P = .088. Since the number of subjects studied was relatively small and the rejection level obtained was near the usual .05 significance level, we calculated the expected HLA IBD scores in the 13 pairs of affected sibs of our sample for all possible frequencies of the presumptive RF susceptibility gene. This analysis allowed clear rejection of a recessive mode, considering susceptibility gene frequencies lower than 20%, whereas the observed values fitted very well a dominant mode of inheritance, with penetrance (K) values varying between 0.5 and 0.9 and a frequency of the susceptibility gene of at least 1%. CONCLUSIONS: The present data support the hypothesis of an RF susceptibility gene within or very near the HLA complex.

Adult↗
PubMed1983

Streptococcal pharyngitis and acute rheumatic fever in Rhode Island.

A comprehensive survey of physicians, laboratories, and hospital records in Rhode Island showed that more than 157,000 throat cultures for a population of 930,000 people were done in 1980. Eighty-seven percent of primary care physicians prescribed antibiotic therapy before culture results were known, and almost 40% continued antibiotic therapy for ten days regardless of culture results. The throat culture positivity rate for beta-hemolytic Streptococcus was 17% statewide in 1980. Only three definite and seven possible cases of acute rheumatic fever were identified by hospital chart reviews and a physician survey covering the five years 1976 through 1980. Current throat culture practices probably have little influence on treatment of streptococcal pharyngitis and control of rheumatic fever in the state.

Acute Disease↗