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PubMedDate not supplied

Acute rheumatic fever and rheumatic heart disease on the Navajo reservation, 1962-77.

The occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Navajos was ascertained for the period from 1962 through 1977 by means of hospital discharge diagnoses and patients' charts. The annualized attack rate for ARF was 12.4 per 100,000 population, with no clear evidence of an overall secular trend. The proportion of recurrences (19.6 percent) and clinical features were similar to those reported elsewhere, but no seasonal variation in attack rates was noted. Between 1962-71 and 1972-77, the age of RHD patients increased, suggesting few newly diagnosed cases and the aging of known patients. A streptococcal disease control program was instituted in many Navajo elementary schools before 1975. In the program, throat cultures were performed routinely for some asymptomatic children and for all symptomatic children. During the subsequent 3 years, ARF rates declined from 13.5 to 8.2 per 100,000 in areas covered by the program, while in the noncovered areas the rates showed little change-9.5 to 10.1 per 100,000.

Acute Disease↗
PubMedDate not supplied

Present status of rheumatic fever and rheumatic heart disease in India.

This paper examines the present status of Rheumatic fever (RF) and Rheumatic heart disease (RHD) in India with reference to both prevalence and incidence, and evaluates the currently available methods of control. Data available over the last 10 years shows that the prevalence of RF/RHD in the most vulnerable group i.e. school children between 5 to 15 years of age is still unacceptably high. RHD is encountered in 1 to 5.4 per 1,000 in large samples of school children and RF in 0.3 to 0.5 per 1,000 children. There appears to be no obvious decline in its prevalence in school children over a 20 year period. Because of preoccupation with adult cardiac diseases specially ischemic heart disease (IHD), the problem of RF/RHD has been sidelined and studies on prevalence, treatment and prevention receive scant attention. Only exotic palliative methods such as balloon mitral valvotomy (BMV) have become the centre stage. Studies are needed on the lines of WHO recommendations for the regional prevalence of RF/RHD in school children throughout the country to detect regional variations. The most effective method for control is primary prevention by treating streptococcal sore throat and secondary prevention by early detection and continuous penicillin prophylaxis. This could be done most effectively by general physicians (GP's) who need motivation and education and through school health services. The latter needs to be organised on a state-wise basis throughout the country as it is available in only a few cities. Public health education by all available media specially, through video films is also recommended. The lacunae in our knowledge of RF/RHD calls for further research.

Adolescent↗
PubMed1953

Rheumatic fever and rheumatic heart disease; incidence in California.

The statistics quoted in this and other published reports appear to substantiate the impression that rheumatic fever in California, although still an important public health problem which varies widely from one locality to another, is of lower incidence and perhaps of more benign character than in most other parts of the United States. It also appears that in California aortic insufficiency may be of higher relative incidence and occurs more frequently as a clinically diagnosable sequel of rheumatic fever than does classical mitral stenosis. Congenital defects of the heart constitute a large proportion of the cases of organic heart disease in children and young adults in this state.

Adult↗
PubMed2006

Association of polymorphisms within the promoter region of the tumor necrosis factor-alpha with clinical outcomes of rheumatic fever.

Rheumatic fever (RF)/rheumatic heart disease (RHD) is an inflammatory disease with a complex etiology in which Group A streptococci within a genetically susceptible host untreated for strep-throat may deviate the innate and adaptive arms of the immune system towards recognition of autoantigens. The TNFA gene has been associated with a number of autoimmune diseases, including RF. We investigated whether the G-308A and G-238A polymorphisms of the TNFA gene are associated with clinical outcomes of RF in a cohort of 318 patients and 281 healthy controls (HC). Both polymorphisms showed borderline associations with RF (TNFA -308G/A, OR=1.4 [1-2.2], P=0.026; TNFA -238G/A, OR=1.9 [1-3.3], P=0.015). The presence of either one of the minor alleles (-308A and -238A) was more common among patients with RF/RHD than controls (P=0.0006). Stratification of patients according to clinical phenotype also showed significant associations between presence of either one of the minor alleles and RHD (Pc=0.0006) when compared with controls. This association was stronger with the development of aortic valve lesions. In contrast, there was no association between genotype and Sydenham's chorea or RF patients with mild carditis. In conclusion, we show that the TNFA is a susceptibility locus for RF. The ability to predict which RF patients will develop valve lesion may have therapeutic, economic and social implications.

Adolescent↗
PubMed1986

Rheumatic fever and rheumatic heart disease in Japan.

Rheumatic fever (RF) is the common cause of rheumatic heart disease (RHD) in the 5-30 age group and is usually preceded by group A streptococcal pharyngitis. The annual mortality caused by RF and RHD has changed remarkably in Japan between 1960 and 1981 according to the report of the Ministry of Health and Welfare. The annual incidence of RF among schoolchildren as surveyed from pediatric clinics of 20 major hospitals between 1952 and 1980 varied year by year, and is now steadily declining. Follow-up studies of 287 patients with carditis over ten years showed that cardiac murmur disappeared in 44.9% of total patients within 4 years through use of antibiotic prophylaxis. Other patients continued to have cardiac murmur 10 years after the first attack of RF. Valvular involvement due to RF was mostly confined to mitral valve and the appearance of mitral regurgitation was particularly common in schoolchildren. Survey of RHD in schoolchildren showed that mitral regurgitation was the most common anomaly, but the prevalence rate of RHD decreased from 4.6/1000 population in 1958 to 0.14/1000 population in 1981. By contrast, mitral stenosis was predominant in adults, according to the records of patients admitted in three university hospitals. Since socio-economic conditions have improved, and penicillin has been introduced to control group A streptococcus, mortality and morbidity from RF and RHD have remarkably decreased in well developed countries. These factors may have contributed predominantly to the sharp decrease in first and recurrent attack of RF in Japan.

Adolescent↗
PubMed1987

Polymorphonuclear leukocyte functions in patients with acute rheumatic fever and rheumatic heart disease.

Polymorphonuclear (PMN) cell function was assessed in 30 children with active rheumatic fever (ARF) (Group I), 30 cases with active rheumatic heart disease (RHD) (Group II), 28 cases of ARF and RHD in remission (Group III) and 34 adults with quiescent RHD along with their age matched controls. All the groups showed normal spontaneous and chemotactic movement. Phagocytosis of yeast particles was significantly reduced in groups II (P less than 0.0005), III (P less than 0.025) and IV (P less than 0.005). The opsonic activity of disease sera was low in all 4 groups (P less than 0.0005). The intracellular metabolic activity was moderately elevated in Group III. Phagocytosis and opsonic activity were thus persistently low in all the groups including the remission and quiescent group.

Adolescent↗
PubMed1989

Enzyme immunoassay (ELISA) for the detection of anticarbohydrate antibodies in rheumatic fever and rheumatic heart disease.

Antibodies to group A streptococcal polysaccharide were estimated in the following groups of patients: (I) Patients with uncomplicated streptococcal pharyngitis: 10 patients, followed up for 3 months. (II) Patients with acute rheumatic fever: 8 patients with first attack followed up for one year. (III) Patients with reactivated rheumatic heart disease: 10 patients, followed up for one year. (IV) Patients with chronic rheumatic heart disease: followed up for one year. (V) normal controls without any history of sore throat/fever/vaccination/rheumatic disease: 10 patients followed up for one year. Group (I) patients did not show any significant elevation in anticarbohydrate antibodies by both ELISA and RIA. In the case of (III) and (IV), antibody levels were significantly higher as compared to group (V) and remained so till one year of follow up. In group (II) patients there was no significant rise in antibody levels. There was a good correlation between the ELISA and RIA used to detect the antibody levels. These findings suggest that the use of ELISA to detect anticarbohydrate antibody can be of help in diagnosing cases of rheumatic heart disease (both acute and chronic RHD).

Enzyme-Linked Immunosorbent Assay↗
PubMed2006

[Rheumatic fever and rheumatic heart disease].

Rheumatic heart disease, the sequel of acute rheumatic fever, is a very common cause of cardiovascular mortality and morbidity all over the world, and is the predominant indication for cardiac surgery in the industrialized countries. Diagnosis of rheumatic chronic carditis may sometimes be difficult because valvular regurgitation may not always be detected by routine clinical auscultation. A recent report from the World Health Organization Expert Committee recognizes the usefulness of echocardiography Doppler in providing supporting evidence for diagnosis of rheumatic carditis in the presence of equivocally pathological murmur, and recommends that patients with subclinical carditis should be managed as rheumatic heart disease until proven otherwise, because the disease still represents a major health problem. The aim of this review is to give an update on the disease by underlining changes made by the World Health Organization on disease diagnosis and patient management.

Adolescent↗
PubMed1984

Rheumatic fever and rheumatic heart disease in the Hamilton health district: II. Long term follow-up and secondary prophylaxis.

An analysis is made of follow-up and prophylaxis of 289 first attacks of acute rheumatic fever occurring over a ten year period in under 30 year olds in the Hamilton health district, New Zealand. Hospital clinics originally undertook to follow 84.4% of patients but after ten years, regular contact was maintained with 45% of this group while general practitioners maintained contact with 32% of their group. Fifty percent of all cases (and 77% of cases occurring in the past five years) are on regular benzathine penicillin usually administered by the district nursing service. Co-ordination with extramural services and the use of the computer based register as means of improving follow-up and prophylaxis are advocated, with more attention being given to defaulters.

Acute Disease↗