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PubMed2006

The history of bacteriologic concepts of rheumatic fever and rheumatoid arthritis.

OBJECTIVES: Review of the development of etiologic and pathogenetic concepts of rheumatic fever (RF) and rheumatoid arthritis (RA) from the beginning of clinical bacteriology to the discovery of antibiotics. METHOD: Analysis of English and German language publications pertaining to bacteriology and "rheumatism" between the 1870s and 1940s. RESULTS: Early in the 20th century there was a widely held belief that a microbial cause would eventually be found for most diseases. This encouraged pursuit of the intermittent findings of positive blood and synovial fluid cultures in cases of RF and RA. Development of a streptococcal agglutination test supported the erroneous belief that RA is a streptococcal infection, while the simultaneous development of other immunologic tests for streptococci suggested that a hemolytic streptococcus was etiologic in RF. Table 1 provides a chronology of major events supporting and retarding resolutions. CONCLUSIONS: Much of the conflicting data and inferences regarding the etiology of RF and RA can be attributed to the absence or inadequacy of controls in observations of clinical cohorts and laboratory experiments.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Serum penicillin concentrations after intramuscular administration of benzathine penicillin G in children with rheumatic fever and controls.

Serum and urine penicillin levels were determined in 11 children with rheumatic fever (RF) who were receiving benzathine penicillin G (BPG) prophylactically every 3 weeks and in 10 children without RF who received the drug for the treatment of other infections. The dose given was 600,000 units for children weighing less than 25 kg and 1,200,000 units for those with a weight above 25 kg. Blood and urine samples were collected from both groups before and on days 7, 14 and 21 after BPG administration. Our results showed that: minimum inhibitory concentrations (MICs) of BPG for group A beta-hemolytic streptococci were 0.02 IU/ml or 0.0125 microgram/ml; intramuscular BPG did not give adequate serum levels to block the growth of group A beta-hemolytic streptococci in approximately 24 and 62% of children included in the study on days 14 and 21 after its administration, respectively; BPG metabolism was similar in both groups and did not depend on the underlying disease; serum and urine levels did not vary according to sex and weight; and there was a small correlation between serum and urine levels.

Adolescent↗
PubMed2002

Characterization of two novel pyrogenic toxin superantigens made by an acute rheumatic fever clone of Streptococcus pyogenes associated with multiple disease outbreaks.

The pathogenesis of acute rheumatic fever (ARF) is poorly understood. We identified two contiguous bacteriophage genes, designated speL and speM, encoding novel inferred superantigens in the genome sequence of an ARF strain of serotype M18 group A streptococcus (GAS). speL and speM were located at the same genomic site in 33 serotype M18 isolates, and no nucleotide sequence diversity was observed in the 33 strains analyzed. Furthermore, the genes were absent in 13 non-M18 strains tested. These data indicate a recent acquisition event by a distinct clone of serotype M18 GAS. speL and speM were transcribed in vitro and upregulated in the exponential phase of growth. Purified SpeL and SpeM were pyrogenic and mitogenic for rabbit splenocytes and human peripheral blood mononuclear cells in picogram amounts. SpeL preferentially expanded human T cells expressing T-cell receptors Vbeta1, Vbeta5.1, and Vbeta23, and SpeM had specificity for Vbeta1 and Vbeta23 subsets, indicating that both proteins had superantigen activity. SpeL was lethal in two animal models of streptococcal toxic shock, and SpeM was lethal in one model. Serologic studies indicated that ARF patients were exposed to serotype M18 GAS, SpeL, and SpeM. The data demonstrate that SpeL and SpeM are pyrogenic toxin superantigens and suggest that they may participate in the host-pathogen interactions in some ARF patients.

Acute Disease↗
PubMedDate not supplied

[Subclinical carditis during an initial attack of acute rheumatic fever: contribution of colored Doppler echocardiography and therapeutic advantages].

OBJECTIVES: To determine and to evaluate valvular involvement, in particular subclinical, as confirmed by colored Doppler echocardiography (CDE) during an initial attack of acute rheumatic fever (ARF). Means of diagnosis and therapeutic implications. MATERIALS AND METHODS: Over a 7-year period, from January 1994 to December 2000, 49 patients (27 females and 22 males), with a mean age of 9.2 years (range 5-14 years), who presented with a first attack of ARF, were diagnosed on the basis of clinical data (history, physical findings, specific laboratory data, EKG, and CDE) to determine the major and minor criteria of acute rheumatic fever. All patients were reinvestigated and controlled clinically and by echocardiography two weeks to three months after the first investigation. RESULTS: Reported clinical major criteria were: Arthritis, 46 cases (94%); carditis, 27 cases (55%); erythema marginatum, 3 cases (6%); subcutaneous nodules, 3 cases (6%) and chorea, 3 cases (6%). CDE abnormalities were identified in 37 cases with cardiac involvement (75% of patients), 10 of them had subclinical evidence of valvular involvement: 6 cases with mild to moderate mitral regurgitation (MR), 2 cases with moderate aortic regurgitation (AR), and 2 cases had both mild to moderate MR and moderate AR. All patients with subclinical disease and evidence of inflammatory process (7 cases) were treated by salicylates. Repeated echocardiography for control showed disappearance of valvular insufficiency in 8 patients with subclinical valvulopathy, and aggravation was observed in 2 other patients. CONCLUSION: CDE is recommended in patients with suspicion of ARF, even in normal cardiac auscultation in order to detect an acute cardiac involvement leading to an early diagnosis. The confirmation of subclinical valvular disease should be considered as major criteria for ARF. Isolated and subclinical mitral and/or aortic regurgitations, with evidence of inflammatory process, should receive corticosteroids and be followed-up regularly, clinically and non-invasively by CDE.

Acute Disease↗
PubMed1990

First attack of rheumatic fever in an adult: the case for greater awareness.

A 40 year old white woman presenting with rash, fever, and migratory polyarthralgia developed a symmetrical polyarthropathy and remained unwell for 10 weeks. Fulfilment of the revised Jones criteria reinforced the clinical diagnosis of rheumatic fever. Antistreptococcal antibodies peaked four to six weeks into the illness and declined thereafter.

Acute-Phase Reaction↗