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PubMed1996

[Clinicopathological analysis of rheumatic heart disease].

Autopsy cases of rheumatic heart disease which took natural courses without surgery were clinicopathologically analyzed. The patients had pancarditis (2 patients), mitral stenosis (MS; 12), mitral regurgitation (MR; 8), aortic stenosis and regurgitation (ASR; 5) and combined valvular disease (CVD; 30). The patients with pancarditis (mean age 15 years) showed high rheumatic activity, short clinical course, enlargement of the heart, edematous swelling and inflammation of the valves, myocardium and pericardium with multiple Aschoff nodules. Patients with MS (mean age 42 years) showed low rheumatic activity, enlarged left atrium and right ventricle, thickening and calcification of the valve edge which was categorized into oval shape and slit shape ostial narrowing, and fibromuscular thickening of the small coronary artery wall. Patients with MR (mean age 32 years) showed moderate rheumatic activity, enlarged left ventricle, left atrium and right ventricle, diffuse thickening of the valve, contraction of the posterior leaflet and healing Aschoff nodules. Patients with ASR (mean age 36 years) showed moderate rheumatic activity, elongated enlargement of the left ventricle, adhesion of the commissures, thickening with contraction and calcification of the cusps, hypertrophy and fibrosis of the myocardium. Patients with CVD were divided into the left-sided double stenosis group (CVD-S; 16 patients) and double regurgitation or triple valve disease group (CVD-R; 14). The CVD-S group (mean age 51 years) showed low rheumatic activity, female predominance and similar morphology to MS. The CVD-R group (mean age 32 years) showed moderate rheumatic activity, relatively short clinical course, male predominance and similar pathology to pancarditis and/or MR. The valvular pathology in rheumatic fever was modified by connective tissue matrix of the valves, especially of acid-mucopolysaccharides.

Adolescent↗
PubMed1997

Preferential recognition of human myocardial antigens by T lymphocytes from rheumatic heart disease patients.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune sequelae of upper respiratory infections with group A streptococci (GAS). To gain a better understanding of the pathogenesis of these diseases, we examined the in vitro proliferative responses of peripheral blood mononuclear cells (PBMC) from RHD patients to human myocardial proteins in a T-cell Western assay. A number of myocardial proteins fractionated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis were recognized by PBMC from both patients and controls. However, PBMC from a significant percentage of RHD patients (40%) responded to a discrete band of myocardial proteins migrating with an apparent molecular mass of 50 to 54 kDa while none of the control subject PBMC responded to this protein band (P < or = 0.0001). To further investigate the link between infections with GAS and autoimmune carditis, we studied the proliferative responses of PBMC from patients and controls to myocardial proteins before and after in vitro stimulation of the cells with opsonized GAS isolated from ARF patients. Priming of PBMC with rheumatogenic GAS caused the percentage of RHD patients responding to the 50- to 54-kDa myocardial proteins to increase from 43 to 90% (P < or = 0.0284). By contrast, PBMC from control subjects failed to recognize the 50- to 54-kDa myocardial proteins even after stimulation with the opsonized streptococci (P < or = 0.0001). The assay sensitivity was increased from 40 to 90% after priming of a patient's cells with opsonized GAS, but the positive predictive value was 100% in both unprimed and primed cultures. Antibodies generated to partially purified 50- to 54-kDa myocardial proteins did not cross-react with either streptococcal homogenates, purified M protein, myosin, laminin, or vimentin, suggesting a lack of cross-reactivity at the humoral level. This study suggests that the 50- to 54-kDa myocardial proteins contain a putative antigen that is preferentially recognized by T cells from RHD patients and demonstrates that exposure to streptococcal antigens enhances the ability of patients to recognize these proteins.

Animals↗
PubMed1982

HLA antigens in black South African children with rheumatic heart disease.

The high incidence of rheumatic heart disease (RHD) in black South African children has been attributed mainly to poor socio-economic status and over-crowding. In order to elucidate whether other factors, in particular genetic, were responsible, the HLA-status of 61 black children with rheumatic heart disease was compared with that of 1165 normal controls. Overall, no differences were found, except a higher incidence of HLA-B25 and BW51 in the group with rheumatic heart disease, when the difference was not of statistical significance. Moreover, when the patients were considered in two groups, viz. (a) a "surgical" group which required cardiac surgery and (b) a "non-surgical" group in which cardiac failure was absent or could be easily controlled by medical therapy, the difference between the two groups was also not of statistical significance, though there was a higher incidence of HLA-A10 (which includes HLA-A25 and A26) in the "non-surgical" group. These data appear to agree with the results of other studies which found no significant association between HLA-status and RHD.

Black People↗
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↗
PubMed1975

Antimyocardial antibodies in heart diseases. II. Immunofluorescent patterns in rheumatic fever and rheumatic heart disease.

Antibodies against rat myocardium were studied by means of histoimmunfluorescence (indirect technique) in 32 rheumatic fever patients. Antibodies were found in 54% of the cases without carditis or active rheumatic valvulitis and in 83% of those with carditis. The fluorescent patterns observed were : sarcolemmal, sarcoplasmic (intermyofibrillar) and smooth muscle of vessels. The sarcolemmal pattern was more frequently observed in rheumatic carditis while the intermyofibrillar one was more common in rheumatic fever without evidence of carditis as well as rheumatic valvulitis. The serum factors involved in the sarcolemmal fluorescence were inhibitied by the insoluble saline myocardium extract.

Adult↗
PubMed1990

Role of oxygen free radicals generated by blood monocytes and neutrophils in the pathogenesis of rheumatic fever and rheumatic heart disease.

The generation of oxygen free radicals by peripheral blood monocytes and neutrophils of patients with rheumatic fever and rheumatic heart disease has been studied using luminol enhanced chemiluminescence technique. Five groups of patients; acute rheumatic fever, recurrence of rheumatic activity, chronic rheumatic heart disease, acute pharyngitis and normal controls were studied. In all groups except the controls, measurements were made on 0, 15, 90 and 180 days. The chemiluminescence was measured in response to streptococcal membrane antigen, carbohydrate antigen and latex as triggering agents. Chemiluminescent response of monocytes, as well as, neutrophils was significantly higher (P less than 0.01) in acute rheumatic fever and recurrence of rheumatic heart disease as compared to patients with acute pharyngitis and chronic rheumatic heart disease through the study period and with all the triggering agents. A significant decline (P less than 0.001) in chemiluminescence was observed from day 0 to day 180 in the acute rheumatic fever, recurrence of rheumatic heart disease and pharyngitis patients while no such change, was observed in the chronic rheumatic heart disease group. This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may have a role in the pathogenesis of cardiac disease seen in patients with rheumatic heart disease, through the generation of oxygen free radicals.

Acute Disease↗
PubMed1989

Antibodies to a streptococcal cell wall adjuvant structure persist in patient with chronic rheumatic heart disease.

Sera from 50 patients with chronic rheumatic heart disease were analysed by an enzyme linked immunosorbent assay for the presence of antibodies to the streptococcal minimal adjuvant moiety, muramyl dipeptide (MDP). The T-cell responsiveness to this structure was also studied in vitro, using the lymphocyte transformation test. Fifty four percent of the patients possessed anti-MDP antibodies in their sera when examined 5 to 25 years after the initial rheumatic attack. Such antibodies were found only in 5 to 6% of sera from healthy controls or from patients with cardiac disease of non-rheumatic origin. There was neither antigenic nor mitogenic stimulation by MDP of the T-cells from peripheral blood of chronic rheumatic heart disease patients or controls. The results point to a lifetime persistence of anti-MDP antibodies in rheumatic fever and rheumatic heart disease. Possible mechanisms by which detectable levels of such antibodies are maintained in rheumatic heart disease are discussed.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1978

Dermatoglyphic studies in rheumatic heart disease.

62 patients suffering from rheumatic heart disease were taken from Institute of Child Health, Niloufer Hospital, Hyderabad, for the present dermatoglyphic investigation. The finger, palm and toe prints were analysed to see if there was an association between rheumatic heart disease and any of the dermatoglyphic traits. The parameters which were significantly different from the controls are: (1) reduced frequency of arches on the finger tips in males and increased frequency of whorls in females; (2) increased frequency of patterns in the III interdigital area in males; (3) decreased d-t ridge count in females, and (4) higher incidence of multiple axial triradii in females.

Adult↗