Cases Of Acute Rheumatic Fever Research Articles

Review of 222 cases of acute rheumatic fever in southern Israel (1974-1983).

Review of 222 cases of acute rheumatic fever in southern Israel (1974-1983).

Evaluation of an Alaskan streptococcal control program: Importance of the program's intensity and duration

Prospective follow-up information from the throat culturing results of 1,653 Eskimo children in 12 Alaskan villages was used to evaluate the effect of duration and intensity of a streptococcal control program begun in 1971 while controlling for several other risk factors related to streptococcal colonization. Relative risks of colonization for each of the subsequent study years relative to the first year indicate that the risk of colonization decreased over the duration of the study by 42% in Year 2 to 55% in Year 4 ( P < 0.0001). Cost-cutting measures such as lengthening the time interval between routine throat cultures led to a 37% increase in the risk of colonization ( P = 0.0002). A comparison of the number of cases of acute rheumatic fever during the 5-year period before the streptococcal control program with the number of cases during the 5-year program period showed that cases in villages with the program decreased from 11 to 0. In a similar group of comparison villages without the program, the number of cases decreased from 7 to 4. A benefit-cost study of the program indicates that benefit exceeds cost. These findings and the changes in the carriage of streptococcal organisms during the control program underscore the importance of such long-term programs with regularly scheduled culturing in high-risk populations of children.

About five cases of acute rheumatic fever in the adult.

We describe five cases of acute rheumatic fever in adults (applying Jones's criteria and exclusion of other common causes of acute polyarthritis in adults). The polyarthritis was migratory in three patients and additive in two. Severe tenosynovitis was present in three patients. Only one patient had carditis and received corticoids. The others improved with aspirin. The disease subsided after a time period varying from one week to two months and did not relapse.

Acute rheumatic fever in north Florida.

Because of the declining incidence and severity of acute rheumatic fever reported in the United States and Europe, we reviewed our clinical experiences with 128 cases of acute rheumatic fever. No decline in the rate of admissions for patients with rheumatic fever was found in our hospital. The most common major manifestation of rheumatic fever in our patients was carditis, followed by arthritis. Chorea, erythema marginatum, and subcutaneous nodules were rare. Carditis was severe in 26% of the patients, moderate in 27%, and mild in 47%. A high percentage of our patients had residual cardiac lesions, and the mortality was higher than what has been reported in the rest of the country. We conclude that primary prevention of rheumatic fever in areas like ours should be continued.

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.

Rheumatic fever in Nigerian children: a prospective study.

The initial attack of acute rheumatic fever is hardly ever diagnosed in our environment. Most cases of acute rheumatic fever are seen during recurrent illness when cardiac damage is already severe and death from cardiac failure common. In the absence of effective primary prophylaxis against rheumatic fever in the foreseeable future it is important to find every case of acute rheumatic fever at the first attack, as on this would depend effective secondary prophylaxis and, hopefully, reduction of the morbidity and mortality rates. A prospective study was set up to achieve this aim. All cases suspected of having rheumatic fever among children seen at the Lagos University Teaching Hospital over a period of five years were subjected to the Jones' diagnostic criteria for diagnosis, and grouped into "Initial illness" and "Recurrent illness" groups. Twenty-one cases of acute rheumatic fever were diagnosed during the period, out of which ten (47.6%) were in the initial stage of the illness. There was a direct relationship between the severity of cardiac involvement and delay in recognition of the condition. It was concluded that efforts aimed at prompt recognition of the initial illness would be rewarding in minimising cardiac morbidity and mortality.

Radionuclide Joint Imaging: Acute Rheumatic Fever Simulating Septic Arthritis

Technetium (Tc-99m) diphosphonate skeletal imaging is a sensitive modality for the detection of joint disease.1 Recently, the combined use of Tc-99m diphosphonate and gallium (Ga-67) citrate has been advocated for the evaluation of inflammatory joint disease and in particular the differentiation of septic arthritis from adjacent osteomyelitis and cellulitis.2,3 The case of acute rheumatic fever (ARF) described here demonstrates diffuse radioactive gallium and phosphate uptake in an affected joint. The scan findings, not unexpectedly, simulated those of a septic arthritis. Differentiation of these two entities could only be made on the basis of the clinical and biochemical picture. CASE REPORT

Control of Rheumatic Fever

To the Editor.— I read with interest the editorial Control of Rheumatic Fever: How Are We Doing? (237:1720, 1977). The following statement was of interest to me: World War II an average of 2.06 cases of acute rheumatic fever occurred per 1,000 activeduty Navy personnel; during the years 1968 through 1970, this rate declined 96% to 0.08 cases per 1,000 annually. During World War II, I was a Naval Medical Officer stationed at the US Navy Training Center, Farragut, Idaho. During that time streptococcal infections were rampant at the training center. I doubt that a day went by that at least one Navy personnel was not sent to the hospital with acute rheumatic fever. The total number of Navy personnel with rheumatic fever at this particular base was really unbelievable. I suggest that Mortimer might wish to reevaluate his statistics after excluding all cases of acute rheumatic fever from

Group A Streptococcal Infections of the Skin and Pharynx

PharyngitisStreptococcal pharyngitis is a self-limited disease whose suppurative complications have been rare since the availability of antibiotics. In contrast, approximately 100,000 new cases of acute rheumatic fever occur each year.78 Rheumatic fever primarily afflicts those living in crowded cities under substandard conditions. Its infrequent occurrence in private practice is not only an inaccurate guide to its overall incidence but also an observation that preceded the discovery of penicillin.78EpidemiologyGroup A streptococci causing pharyngitis are spread by large airborne droplets. The acquisition rate in military barracks is inversely proportional to the distance between the bed . . .

Rheumatic Fever in Colorado

NOT ONLY has the incidence of rheumatic fever been decreasing since 1900, but the florid manifestations have also been decreasing. Rheumatic fever is no longer a dramatic disease, and many physicians no longer consider it of much significance. But, is it a bygone, conquered disease? Officially, rheumatic fever is apparently grossly underreported in most states. 1 For example, in Oklahoma, eight cases of acute rheumatic fever were reported in 1969, but Silberg et al 2 surveyed all the Oklahoma hospitals for that year and found an overall incidence of 4.2/100,000 persons, which does not include nonhospitalized cases. Age-specific rates in the 5- to 9- and 10- to 14-year age groups were 11.3 and 14.2/100,000, respectively. Colorado The figures are equally confusing for Colorado, which has a reputation for high rates of streptococcal disease and rheumatic fever because of the high incidence in the military camps of World War II. In

Pitfalls in the Diagnosis of Acute Rheumatic Fever

DOI: http://dx.doi.org/10.3329/cardio.v4i1.9394Cardiovasc. J. 2011; 4(1): 75-79

C-reactive protein test. A clinical evaluation of its value in rheumatic fever and rheumatic heart disease.

Results of C.R.P. test evaluation as an index of disease activity are reported in 10 cases of acute rheumatic fever, 18 cases of rheumatic heart disease and three cases, of rheumatic chorea. C.R.P. test seems to be a sensitive index of disease activity and a reliable guide to the management of cases. It faithfully reflects the activity and is not affected by drugs, a distinct advantage over E.S.R. However, being non-specific, it is not very helpful in diagnosis.

A streptococcal epidemic in an isolated civilian population with institution of mass prophylaxis

A virulent streptococcal epidemic involving two strains concurrently occurred in Eagle Butte, South Dakota, in the spring of 1965. Index cases of acute rheumatic fever and acute glomerulonephritis occurred in this isolated civilian population. Certain criteria, previously proposed, confirm streptococcal epidemicity and offer guidelines in the consideration of mass prophylaxis. A mass prophylaxis regimen was applied to this population. The epidemic was interrupted and additional cases of nonsuppurative sequelae may have been prevented.

The radiological manifestations of the initial phases of rheumatic carditis in childhood

One hundred and eighty six cases of acute rheumatic fever during the first attack were reviewed. These cases were children in the age groups from 4 to 14, hospitalized in the ‘Rambam’ Hospital, Haifa, in the period 1956–1962 inclusive. Complete x-ray examinations with contrast visualization of oesophagus at the time of admission were available in every case and also in most cases before discharge. There was clinical evidence of active carditis in 68 patients and the radiological manifestations of the initial phases of active rheumatic carditis were studied in this group. In 54%, the heart was of normal size and shape, yet 25% of these developed rheumatic valvular disease, providing that a heart of normal radiological appearance does not exclude the presence of initial active rheumatic carditis. It was shown that in cases presenting generalized enlargement of the heart silhouette of varying degrees (stage 1–3), making up 46% of the cases, the radiological appearances follow closely those seen in acute myocarditis. No radiological signs of a valvular lesion can be expected in these early stages of the disease. The changes in size and shape of the heart were demonstrated radiologically, discussed and compared with other forms of acute myocarditis. The significance of the distension of the upper lobe veins was analyzed and evaluated with attention paid to the time of its occurrence in the initial phases of the disease.

ELECTRON MICROSCOPE APPEARANCES OF A FIBRIN-STAINING COMPONENT IN AN ASCHOFF NODULE FROM ACUTE RHEUMATIC FEVER.

ELECTRON microscope investigations of ‘fibrinoid’ in Aschoff nodules from biopsy specimens of the left atrial appendage in mitral stenosis have shown that collagen fibrils are intimately related to the abnormal material and appear to take part in its formation1. In these specimens the ‘fibrinoid’ did not stain positively for fibrin. The abnormal material was periodic acid–Schiff positive and usually stained with the collagen stains. In a few cases of acute rheumatic fever a fibrin-staining component is recognized, and this is found especially in early reticular Aschoff bodies, structures described by Klinge2 as the early rheumatic ‘Fruhinfiltrat’. Death from acute rheumatic fever is extremely rare and it is virtually impossible to obtain fresh specimens for electron microscope studies. The only source of material is paraffin embedded and an attempt has been made to see if useful information could be obtained by utilizing tissue already fixed and embedded.

MICROSCOPIC READING OF THE RA TEST.

SummaryThe Hyland RA test has proved very accurate in a series of 113 cases tested. Among 31 RA patients only one gave a negative reaction, while among the non-RA patients none was reactive macroscopically. Microscopically one non-RA case was “very weakly reactive”, and it is curious that this was a case of acute rheumatic fever.

GAMMA-1 GLOBULIN LEVELS IN RHEUMATIC FEVER.

AbstractGamma‐1A serum levels were found to be elevated in 74 per cent of 31 cases of acute rheumatic fever, more frequently than in rheumatoid arthritis, acute glomerulonephritis, and non‐complicated streptococcal infections. Some patients with clinically inactive rheumatic fever also demonstrated increased gamma‐1A. This finding could not be correlated with the severity of cardiac damage nor was it associated with continuing clinically inapparent activity. Surprisingly, gamma‐ 1M increase was observed in only 13 per cent of the cases.

AN EPIDEMIOLOGICAL INVESTIGATION OF A STREPTOCOCCAL AND RHEUMATIC FEVER EPIDEMIC IN DICKINSON, NORTH DAKOTA

Data have been presented relating 11 cases of acute rheumatic fever to a high prevalence rate of Group A streptococci in a population of school children in Dickinson, North Dakota. The majority of cases of rheumatic fever did not have a clear cut antecedent streptococcal infection which came to the attention of the examining physicians. Carrier rates for beta-hemolytic streptococci approached 50 to 60% on the initial survey, and rapidly diminished over a 6-week period. Approximately 60% of the Group A streptococci were typeable, and one-third of these were Group A, Type 5. Convalescent antistreptolysin O titers obtained on a group of fifth grade school children, of two schools followed, clinically revealed significantly high titers above any described in previous civilian epidemiological studies but comparable to epidemic strains seen in the military. A virulent Group A, Type 5 streptococcus explosively spread through this community and undoubtedly was responsible for a high attack rate of rheumatic fever. Recommendation for civilian mass prophylaxis on the basis of the data obtained from this epidemic may be made for the first time.

Rheumatic fever in Hawaii.

Rheumatic fever is generally considered to be comparatively prevalent in the temperate zone and uncommon in subtropical or tropical climates. 1 The purpose of this seminar is to report on a 5-year experience with acute rheumatic fever at the Kauikeolani Children's Hospital in Honolulu in order to emphasize the relative frequency of this disease in Hawaii. During the years 1955 through 1959, ninety-one cases of acute rheumatic fever were seen during the first attack of the disease at Children's Hospital. Although the incidence had been approximately 0.6% of the total medical admissions for the years 1955 through 1959, there was a fourfold increase in 1959 to 2.3%. The cases from 1955 through 1958 were reviewed mainly from the charts, while those of 1959 were seen personally by me. Since the exact pathogenesis of rheumatic fever is not fully understood and since climatologic factors may play a role in precipitating or

Studies on Acute Rheumatic Fever in the Adult

The cases of acute rheumatic fever admitted to the Department of Internal Medicine of Toho University Hospital, were 42 patients in the period 1958 to 1960. The ratios of these patients to the total admitted patients in each year, were 2% respectively. Considering an adult as 20 years old or over, such cases were found to be about half in number. Furthermore, in this clinic, the incidence of rheumatic fever was much higher than that of other classical collagen diseases, with the exception of rheumatoid arthritis. Thus this disease seemed to have a great importance among collagen diseases in the field of internal medicine. Consequently, studies were made on several clinical and laboratory findings of adult rheumatic fever from the angle of collagen diseases. The rheumatic fever studied in this paper was limited to systemic non-supprative inflammatory disease of protean manifestations, and fulfilled the Jones' modified criteria1).