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PubMedDate not supplied

Rheumatic fever, rheumatic heart disease, and the streptococcal connection: the role of streptococcal antigens cross-reactive with heart tissue.

The role of streptococcal infections in initiating the diverse clinical and pathological manifestations of rheumatic fever and rheumatic heart disease is considered in relation to the multiple cross-reactive relations of group A Streptococcus and tissue antigens. Autoantibodies to the following shared antigens have been demonstrated in sera of patients wit rheumatic fever: (1) cardiac, skeletal, and smooth muscle; (2) heart valve fibroblasts; (3) neurons in basal ganglia; and (4) a group A carbohydrate-related determinant in connective tissues. Circulating autoantibodies to these different antigens were present in higher titer or occurred more frequently in patients with rheumatic fever than in those with uncomplicated streptococcal infections. A direct correlation of the presence of these autoantibodies with carditis could not be established. The pathogenetic mechanisms that link streptococcal infection to rheumatic fever and rheumatic heart disease are not yet clear. Among the possibilities to be considered within the above frame of reference are combined cell-mediated and humoral autoimmune mechanisms directed to one or more cross-reactive antigens in the tissues, selective binding of streptococci to tissues, role of circulating immune complexes, and linkage with histocompatibility antigens.

Antibodies, Bacterial↗
PubMed1977

HLA phenotypes in patients with rheumatic fever, rheumatic heart disease, and Yersinia arthritis.

HLA phenotypes were determined in 109 patients with rheumatic fever (RF), 48 patients with Yersinia arthritis (YA), 86 patients with chronic rheumatic heart disease (RHD), and 326 controls. There was an increased frequency of Bw35 in RF as compared to controls (Pc less than 0.01), while B18 was more common in patients with acute carditis than in those without (P less than 0.02). HLA frequencies in RHD did not differ significantly from those in controls. A significant correlation between B27 and YA was observed (Pc less than 0.001). Carditis or iritis occurred in 10 of 31 B27 positive YA patients but in none of 17 B27 negative patients. Eleven of 31 B27 carriers had signs of urological inflammation vs one of 17 B27 negative patients. In the B27 positive YA group, there were three men with previous ankylosing spondylitis and one with Reiter's syndrome (RS). Also, four patients developed RS during Yersinia infection. This simultaneous occurrence of three B27 positive rheumatic diseases suggests that a patient with one "B27 positive rheumatic disease" is more susceptible to other diseases or symptoms known to be associated with the B27 antigen.

Adult↗
PubMed1991

Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. International Rheumatic Fever Study Group.

1790 patients from 11 countries were enrolled in a prospective international study to determine the incidence of allergic reactions to monthly intramuscular benzathine penicillin (penicillin G benzathine) injections to prevent recurrences of rheumatic fever. After 32,430 injections during 2736 patient years of observation, 57 of the 1790 patients (3.2%) had an allergic reaction. 4 had anaphylaxis, an incidence of 0.2% (1.2/10,000 injections), all in patients over 12 years of age, and 1 patient died, a fatality incidence of 0.05% (0.31/10,000 injections). These rates are similar to those described for patients without rheumatic fever who receive short-term treatment with parenteral penicillin. Rheumatic fever recurred in 8 of 1790 patients (0.45%) who received benzathine penicillin prophylaxis compared with 11 of 96 (11.5%) who did not comply with treatment. Life-threatening allergic reactions are rare in patients on long-term parenteral benzathine penicillin to prevent recurrences of rheumatic fever; the long-term benefits of such prophylaxis by far outweigh the risk of a serious allergic reaction.

Adolescent↗
PubMed1992

An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa Town, Sudan.

STUDY OBJECTIVE: The aim was to determine the prevalence of rheumatic fever and rheumatic heart disease and to initiate a programme of secondary prophylaxis in Sahafa Town, Sudan. DESIGN: The study was a prospective case finding survey, carried out by a specially trained team headed by a cardiologist. SETTING: The study involved high risk school children (5-15 years of age) from Sahafa Town in the period 1986-1989. SUBJECTS: A total of 13,332 children on the school registers (7892 boys and 5430 girls) were examined generally and specifically for evidence of rheumatic fever or rheumatic heart disease. MAIN RESULTS: Out of the 13,322 children screened 351 were suspected cases and 146 were confirmed cases of rheumatic fever or rheumatic heart disease. The prevalence rates for all ages were 10/1000 for boys and 14/1000 for girls. The overall prevalence rate of the whole programme area was 11/1000, prevalence of rheumatic fever was 8/1000, and prevalence of rheumatic heart disease was 3/1000. The prevalence rate was significantly increased among the inner town inhabitants (15/1000) compared to the outer town inhabitants 4/1000 (p < 0.001). Monthly prophylactic benzathine penicillin in a dose of 1,200,000 IU was given to both suspected and confirmed cases. Penicillin coverage rate was 72%. CONCLUSIONS: Rheumatic fever continues to be a serious health problem. With economic pressures causing impending change in socioeconomic conditions in most Third World countries in the immediate future, rheumatic fever will continue to have a high prevalence rate and rheumatic fever and rheumatic heart disease prevention programmes will remain a central goal.

Adolescent↗
PubMed1991

Association of human leukocyte class II antigens with rheumatic fever or rheumatic heart disease in a Brazilian population.

BACKGROUND: The incidence of rheumatic heart disease is great in Brazil. We analyzed the distribution of human leukocyte (HLA) antigens in a Brazilian population sample with rheumatic fever or rheumatic heart disease, with the aim of better understanding the mechanisms involved. METHODS AND RESULTS: HLA class I (A, B, and C) and class II (DR and DQ) antigen distribution was studied in 40 patients with diagnosis of rheumatic fever or rheumatic heart disease and compared with a control group of 617 healthy individuals for class I typing, from which 118 were drawn for class II typing. A strong correlation between rheumatic fever and rheumatic heart disease and HLA-DRw53 (72.9% in the disease group versus 39% in the control group: p = 0.00061, relative risk, 4.2; etiologic fraction, 0.43) was found. We also found an increase in the frequency of HLA-DR7 (57.5% in the disease group versus 26.3% in control group: p = 0.00715; relative risk, 3.8; etiologic fraction, 0.56). HLA class I and HLA-DQ typing did not point to any association with these diseases. CONCLUSIONS: HLA-DR7 and HLA-DRw53 are markers for susceptibility to rheumatic fever and rheumatic heart disease in Brazil. These results could be explained by genetic differences resulting from racial or geographical diversity.

Adolescent↗
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

An association between Gc (vitamin D-binding protein) alleles and susceptibility to rheumatic fever.

Rheumatic fever is associated with exaggerated activity of B cells with massive production of antibody to the Group A streptococcus. Gc (vitamin D-binding protein) is constitutively expressed on B-cell membranes in association with membrane immunoglobulin, and could be involved in cell activation. We therefore looked for associations between the three major Gc alleles and susceptibility to rheumatic fever in a homogeneous Arab population. Patients with tuberculosis or rheumatoid arthritis and control donors, were studied in parallel. Allele frequencies in the controls, rheumatoid and tuberculosis patients were identical to those found in a previous study of normal Arab donors. However, there was a striking association between Gc2 and rheumatic fever. This allele was twice as common in these patients as in controls (p = 0.0024), and was present in 56.4% of all rheumatic fever patients.

Alleles↗
PubMed1991

[Clinical evaluation of anti-DNAse B test in rheumatic fever and rheumatic heart disease].

Anti-DNAse B test was performed with microtechnique in 160 subjects including patients with acute streptococcal pharyngitis, rheumatic fever and rheumatic heart disease as well as normal controls. It was shown that the antibody titer varied with age, stage of rheumatic fever and rheumatic heart disease as well as the frequency of benthazine penicillin injections. It was also shown in this study that the school children group had considerably higher geometric mean antibody titer than the adult group. The upper normal limit of anti-DNAse B titer was 240 units in the school children group and 160 units in the adult group. The anti-DNAse B test shows a higher positive detection rate for streptococcal infection than ASO, especially when these two tests are used in combination. In patients with manifestations of acute rheumatic fever without elevation of ASO titer, anti-DNAse B test will be of great diagnostic value.

Adolescent↗
PubMed1990

Acute rheumatic fever and rheumatic heart disease in a rural central Australian aboriginal community.

A retrospective study of clinical case records was conducted at the health centre of a rural central Australian Aboriginal community to determine the frequency of acute rheumatic fever and of rheumatic heart disease between 1978 and 1987. The case records of 976 residents over 5 years of age were examined for evidence of the clinical indicators of acute rheumatic fever or rheumatic heart disease; together they contributed 8015 person-years of study. During the 10-year study period, 18 patients developed acute rheumatic fever and 12 patients had rheumatic heart disease. The annual incidence of acute rheumatic fever (first and recurrent attacks) for children aged 5-14 years was 815 per 100,000 person-years. For the residents aged 5 years and over, the point prevalence for rheumatic heart disease at the end of 1987 was between 7.9 and 12.3 per 1000 persons, according to health clinic records and the official population census, respectively. These rates are similar to those reported for Third World countries. Preventive measures must include efforts by health professionals to help to alleviate the adverse living conditions in Aboriginal communities.

Acute Disease↗
PubMed1992

Adherence of Streptococcus pyogenes M type 5 to pharyngeal and buccal cells of patients with rheumatic fever and rheumatic heart disease during a one-year follow-up.

In vitro adherence of Streptococcus pyogenes M type 5 to isolated pharyngeal and buccal epithelial cells was studied in patients with acute recurrent rheumatic fever (n = 21), chronic rheumatic heart disease (n = 33), streptococcal pharyngitis (n = 12), and in normal controls. Patients were investigated at admission and one, six and 12 months later. Streptococci adhered significantly more to the pharyngeal cells of patients with rheumatic fever and rheumatic heart disease than to the pharyngeal cells of controls. Adherence of streptococci to pharyngeal cells of patients with pharyngitis was not different from age-matched controls. The adherence of streptococci to the pharyngeal cells of patients with acute rheumatic fever fell during follow-up but even after one year remained significantly higher than in the control group. These findings suggest that host factor(s) controlling streptococcal adhesion and colonization at the pharyngeal mucosa may be important in the pathogenesis of acute rheumatic fever.

Acute Disease↗
PubMed1987

Resurgence of acute rheumatic fever.

Rheumatic fever has been disappearing in the United States, especially during the past two decades. In the past two years, however, there have been 40 patients seen at the Columbus (Ohio) Children's Hospital diagnosed as having acute rheumatic fever. In marked contrast to the infrequency during the preceding ten years. Twenty of the 40 patients had carditis. Five of these patients were suffering from heart failure, and there was one death. The cause for this outbreak has not yet been found, but some possible causes are discussed. A possible nationwide resurgence of this disease may be heralded by our experience and that of others.

Acute Disease↗
PubMed1985

Estimation of antistreptococcal esterase in rheumatic fever and rheumatic heart disease.

In hemolytic streptococcal infection, a high ASE value in the absence of a rise in ASO has shown to occasionally occur. The relationship between ASO and ASE titers in rheumatic fever and rheumatic heart disease and the significance of these values was therefore studied. ASE values were measured by ASE Kit "Marupi" in 8 patients during the acute stage of rheumatic fever and in 9 patients with rheumatic heart disease, and then compared with the corresponding ASO values. Among the patients with rheumatic fever, a rise of ASO only was seen in 1 patient and a rise of ASE only was seen in another. In the remaining 6 patients, both ASE and ASO were elevated. Only in 1 patient with rheumatic heart disease was ASE found to be elevated.

Adolescent↗
PubMedDate not supplied

Awareness about sore-throat, rheumatic fever and rheumatic heart disease in a rural community.

This I.C.M.R. study was conducted in 74 villages of Chiraigaon block, Varanasi, U.P., during the period March 1983 and December 1986. Before and after health education awareness survey about sore throat, rheumatic fever and rheumatic heart disease was carried out by interviewing 315 persons by stratified random sampling. The study shows that there is significant increase in the knowledge about most of the symptoms, causes, consequences and preventive measures of sore throat, rheumatic fever and rheumatic heart disease. This paper highlights the importance of health education as a vital component of rheumatic heart disease control programme.

Awareness↗
PubMedDate not supplied

Rheumatic fever and rheumatic heart disease at the Department of Child Health, School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital, Medan (1983-1985).

A retrospective study on rheumatic fever and rheumatic heart disease in children was conducted at the Department of Child Health, Dr. Pirngadi Hospital Medan, during 1983-1985. The patients consisted of 43 females and 30 males. Most of the patients were over 12 years of age. Of the 73 patients there were 60 patients (82.19%) accompanied by valvular disorders. The most frequent major criteria of Jones found in this study were carditis and polyarthritis. Thirty one patients (42.46%) had functional status (NYHA) of grade II-IV, and 43 patients (58.90%) had cardiomegaly. The major ECG findings were enlargement of the atria or ventricles and first degree AV block. Compliance was only achieved in 25 (34.24%) cases. Rheumatic fever and rheumatic heart disease still remain a challenge for the medical professionals to cope with in the region.

Child↗