First Attack Of Rheumatic Fever Research Articles

Pulse therapy combined with oral corticosteroids in the management of severe rheumatic carditis and rebound.

The aim of the present study was to describe the clinical course, laboratory tests, and the cardiac involvement in rheumatic carditis patients in functional class III and IV, submitted to pulse therapy combined with oral prednisone. A total of 120 patients with severe carditis due to acute rheumatic fever were treatment with three cycles of pulse therapy combined with oral corticosteroids. The patients were followed up from the hospital admission until the end of the treatment and returned after 30, 60, and 90 days to control. The patients were evaluated by clinical, laboratory, and transthoracic echocardiogram. In total, 23 (19.2%) patients at first attack of rheumatic fever and 97 (80.8%) with recurrent carditis were evaluated. Cardiac surgery was performed in 8 (6.6%) patients. The patients showed improved laboratory and radiological parameters (p<0.001) and were discharged, 74 (61.7%) in functional class I and 46 (38.3%) in functional class II. Hospitalisation time ranged from 21 to 176 days, with a mean of 69.1 days. Reduction of left atrium and ventricle diameters was observed, measured by means of transthoracic echocardiography, at hospital admission and discharge (p<0.001). None of the patients experienced rebound. The pulse therapy was effective in controlling severe rheumatic carditis and the oral corticosteroid prevented rebound episodes. Prolonged hospital stay was required for the clinical stabilisation of patients and to avoid the interruption of medication.

Heart lesion after the first attack of the rheumatic Fever 22 years experience in single centre.

Background:Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years.Aims:In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting.Methods:To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography.Conclusion:In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Proceedings of the Jones Criteria workshop.

On April 8 and 9, 2000, the members of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association met with a group of international experts on rheumatic fever, rheumatic heart disease, and streptococcal infections to review guidelines for the diagnosis of acute rheumatic fever using the Jones criteria, including the 1992 statement on the “Jones Criteria Updated.”1 Formal presentations during the meeting included an historical review of the Jones criteria, beginning with the original publication in 19442 through several revisions of the guidelines, including the latest statement in 1992.1 A review of the worldwide impact of rheumatic fever and rheumatic heart disease was presented, as well as an overview of the recent resurgence of rheumatic fever in certain regions of the United States. Extensive discussion focused on the diagnostic potential of Doppler echocardiography and its possible role in the diagnosis of acute rheumatic carditis. In addition, data on “silent” rheumatic valvular disease were presented, as well as clinical dilemmas in the diagnosis of rheumatic fever, with special reference to epidemiological challenges in both developing and developed countries. The purpose of the workshop was to review the adequacy of the existing guidelines1 for the diagnosis of first attacks of rheumatic fever and to assess whether contemporary diagnostic techniques, specifically two-dimensional and Doppler echocardiography, could be added to the criteria for the diagnosis of rheumatic carditis/valvulitis. Other issues that were addressed included the diagnosis of recurrences of rheumatic fever, the adequacy of one set of guidelines (the current Jones criteria) for the diagnosis of rheumatic fever both in developed countries and in developing countries that have a much higher prevalence of rheumatic fever, and monoarticular arthritis as a possible major criterion for the diagnosis of rheumatic fever. The working group reaffirmed the validity …

Closed Mitral Commissurotomy in Archangel, Northern Russia, 1965-1993. Operative Assessment of 367 Patients Operated on for Rheumatic Mitral Stenosis

Preoperative and operative assessment of the 367 patients operated on for rheumatic mitral stenosis with closed mitral commissurotomy (CMC) at the regional hospital in Archangel, northwest Russia, between 1965 and 1993. Retrospective survey. Mean age at first attack of rheumatic fever was 15 years +/- 1.09 years. Mean age at time of surgery was 33.4 years +/- 0.92. Preoperatively, most patients (67%, n = 245) were in New York Heart Association stage III; 29% (n = 107) in stage IV. Digital commissurotomy alone was performed in 16% (n = 57) and a transventricular dilator was used in 84% (n = 310). Operative blood loss was average (384.4 ml +/- 34 ml); 20% (n = 73) developed wound infection, 21% (n = 77) pericarditis. In-hospital stay was above 50 days for both sexes. In-hospital mortality was 1.6% (n = 6). Rheumatic heart disease developed rapidly in these patients. CMC has a place as a low cost treatment of mitral stenosis when a heart lung machine is not available.

Rheumatic Fever—A Half-Century Perspective

Rheumatic Fever—A Half-Century Perspective

Beta haemolytic streptococci and reactive arthritis in adults.

There is an increasing occurrence of reactive group A beta haemolytic streptococci (BHS) phenomena. This review makes a case for considering BHS in the differential diagnosis of adult reactive arthritis. This is based on (a) published reports over the past 45 years describing first attacks of rheumatic fever in adults; (b) the longstanding observation that polyarthritis is the most commonly expressed Jones major criterion in adults; (c) the broad spectrum of clinical expression of disease following streptococcal infection, with the re-emergence of the term 'poststreptococcal reactive arthritis'. The arthritis in adult rheumatic fever is characterised by sequential involvement of large weightbearing joints. Recurrent, severe, prolonged arthritis has been a prominent feature of adult poststreptococcal reactive arthritis. Carditis has been reported in 33% of adult patients with rheumatic fever. Consequently long term antibiotic prophylaxis for adults with reactive BHS phenomena should be strongly considered, and guidelines are suggested for this in individual patients. Further areas for research are discussed, particularly the interrelations between bacteria and host in disease expression, and the possibility that BHS might play a part in chronic arthritides and vasculitides.

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.

Sequelae of the initial attack of acute rheumatic fever in children from north India. A prospective 5-year follow-up study.

We determined the outcome of acute rheumatic fever in 85 children from North India who had received regular antistreptococcal prophylaxis after their first attack. By the end of the 5-year follow-up, 33 patients had rheumatic heart disease. Mitral insufficiency, the most common valvular lesion, appeared in 91% of the patients, whereas mitral stenosis developed in only 18%. Initial carditis, congestive heart failure, cardiomegaly or moderate-to-severe mitral insufficiency significantly increased the risk of rheumatic heart disease (p less than 0.001). The recurrence rate of acute rheumatic fever in children who received continuous prophylaxis was 0.006 per patient-year. Most recurrence (92%) mimicked the first attack and produced further cardiac damage in five patients with carditis and in one patient with chorea. Cardiac status during the first attack of rheumatic fever and the continuity of prophylaxis were the major determinants of outcome. Statistical comparisons disclosed that with continuous prophylaxis, the prevalence rate, evolution and clinical spectrum of the sequelae of acute rheumatic fever in children from India do not differ significantly from those in the West.

Epidemiology of rheumatic fever in Japan.

The number of patients with the first attack of rheumatic fever reached a peak in 1960, decreased remarkably until 1968, then has remained unchanged for the last nine years. Approximately 10% of rheumatic patients still develop recurrences.

Cardiovascular Clinics, Pediatric Cardiology.

This volume about cardiovascular clinics is devoted to pediatric cardiology. Mary Allen Engle, MD, guest editor, has selected 27 contributors for this treatise. The book is dedicated to Dr. Helen B. Taussig and late Dr. Alfred E. Blalock, the mother and the father of pediatric cardiology. Taranta and Gordis discuss prevention of first attacks of rheumatic fever and recurrences. Blumenthal and Jesse state that atherosclerosis has a multifactorial causation with beginnings in childhood. Innocent murmurs are differentiated from organic murmurs by Dr. Levy. Cardiac conduction pathways in infant and child are described by Massing, Liebman, and James. Dr. William Friedman presents some neuropharmacological studies of perinatal myocardium. Supraventricular and ventricular dysrhythmias are illustrated and discussed by Dr. Ehlers. An international study of natural history of complete heart block is related by Michaelsson and Engle. The pharmacological aspects of cardioactive agents, primarily antiarrhythmic drugs are elucidated by Dr.

Studies on advanced rheumatic mitral insufficiency: clinical aspects and circulatory dynamics with special reference to their correlations.

The clinical and pathophysiological features of 41 patients with advanced pure mitral insufficiency of rheumatic origin, were investigated and statistical analysis of the hemodynamic parameters was made with special reference to their correlations. 1. A history compatible with acute rheumatic fever was obtained in 31 patients (75.6 per cent). The average age at the time of initial attack was 13.1 years and the asymptomatic intervals averaged 6.8 years. 2. Exertional dyspnea (95 per cent), palpitation (78 per cent) and excess fatigability (76 per cent) were the early and most common symptoms of the patients. 3. In addition to the loud apical pansystolic murmur constantly present, a middiastolic murmur was heard in 33 patients (.81 per cent). A third sound or diastolic gallop sound was present in over a half of the patients (56 per cent). 4. Auricular fibrillation was found in over two-thirds of the patients (68 per cent). Patients with auricular fibrillation was older and had longer duration of the disease in comparison with those of sinus rhythm. The average period since first attack of rheumatic fever or equivalents was 15 years in patients with auricular fibrillation. The majority of patients revealed electrocardiographic evidence of combined ventricular hyper-trophy (54 per cent) and right ventricular hypertrophy alone was observed in 5 per cent of patients. 5. The cardiac size as expressed by cardio-thoracic ratio ranged from 0.52 to 0.87 with an average of 0.70 and marked cardiomegaly (cardio-thoracic ratio exceeding 0.81) was noted in 7.5 per cent of the patients. Giant left atrium was present in 1 2.8 per cent of the cases. 6. The cardiac index ranged from 2.0 to 4.5 L/min/M2 BSA with an average of 3.1 and low cardiac index (less than 2.6 L/min/M2 BSA) was encountered in 37 per cent of patients. 7. The peak systolic pressure in the pulmonary artery ranged from 25 to 105 mmHg, averaging 55; the mean pressure varied from 14 to 65 with an average of 37. Moderately severe to severe pulmonary hypertension (pulmonary-systemic peak systolic ratio of over 0.7) was observed in 17 per cent of patients. The total pulmonary resistance ranged from 286 to 2, 329 dynes sec. cm-5 with an average of 81 5. The values in excess of 1, 300 dynes sec. cm-5 was noted in 17 per cent of patients. 8. The various hemodynamic parameters were analysed in relation to duration of the disease and degree of the mitral insufficiency, and factors influencing pulmonary vascular reactivity were assessed in addition. The pressure-volume relationships of the left side of the heart in rheumatic mitral insufficiency were complex. Myocardial malfunction secondary to the under-lying rheumatic process as well as to increased myocardial burden because of the presence of mitral insufficiency, size and compliance of the left atrium and presence or absence of auricular fibrillation might greatly influence and shape the total cardiac dynamics. The possible interrelationships between mitral regurgitant flow and pulmonary vascular reactivity were also discuss-ed. 9. The most reliable method for estimating the severity of mitral insufficiency was selective left ventriculography. With no exception, the severity could be graded as 3 plus or greater in a total of 30 patients in whom the diagnosis was confirmed at surgery. 10. Selected pathological findings obtained at surgery were reported and the status of rheumatic fever as well as the prevalence of cardiac involvement in this subtropical or tropical zone was sepculated.

Rheumatic Fever, Throat Cultures, and Penicillin

E. A. Mortimer, Jr., commenting on the "Role of the Pediatrician in Rheumatic Fever Control,"1 deplores the fact that first attacks of rheumatic fever have been reduced only 30% compared with the "prepenicillin" era, whereas prophylaxis has reduced recurrences by 75%. He feels that this is because (A) a significant proportion (from 34% to 56%) of initial attacks occurred in patients whose physicians either did not recognize or treated inadequately the antecedent streptococcal infection, and (B) parents failed to seek medical help for ‘pharyngitis of insufficient severity."

Preventing First Attacks of Rheumatic Fever

Preventing First Attacks of Rheumatic Fever

Carditis during Second Attacks of Rheumatic Fever

A NUMBER of studies have reported that patients without clinical evidence of carditis in their first attack of rheumatic fever or chorea usually do not acquire carditis in subsequent attacks and often escape residual rheumatic heart disease. The reports, however, differ in the percentage of such patients with normal cardiac findings on follow-up examinations.In 1937 Roth and his co-workers1 reported data on the second attack in 149 children who had had polyarthritis without clinical signs of carditis. During their second attack 51 of these 149 children (34 per cent) had carditis. In 1938 Boone and Levine2 presented 225 cases . . .

Potential preventability of first attacks of acute rheumatic fever in children.

The authors studied 110 consecutive cases of children hospitalized for a first attack of rheumatic fever. In each case a judgment was made as to the adequacy of the preceding treatment in the light of recommendations made by the American Heart Association. In 94 of the 110 cases there had been an infection within 5 weeks before the onset of rheumatic fever. The patient had been seen by a physician in 62 cases, throat cultures had been made in 17, and antibiotics had been given in 50. In only 10 patients was the preceding therapy deemed adequate. Residual cardiac involvement was noted in 54 of the 110 at the time of discharge from the hospital. It was estimated that about 84% of these cases of rheumatic fever had been preventable.

Prevention of rheumatic fever.

Elsewhere in this issue (p 985) Grossman and Stamler report a retrospective study of 110 first attacks of rheumatic fever. In essence, 85% of these attacks were preceded by an infection, which if properly recognized and adequately treated could have resulted in the prevention of the rheumatic fever in these individuals. During this century, morbidity and mortality from rheumatic fever and rheumatic heart disease have declined markedly in the United States. Nevertheless, these diseases have by no means been eradicated. They still are significant cripplers and killers of children and young adults, and today exact a sizeably greater toll than paralytic poliomyelitis. The data collected by Grossman and Stamler indicate that this need not be, and that it is in order to enhance the effort to prevent rheumatic fever. The relationship between initial attacks of rheumatic fever and antecedent Group A streptococcal infections, as well as the ability of adequate

Declining severity of first attack of rheumatic fever.

A decline in the incidence and severity of rheumatic fever has been reported from several centers in the past 2 decades. 1-11 It is the purpose of this report to document this trend as it has occurred on the Children's Cardiac Service at Bellevue Hospital over a 24-year period from 1935 through 1958. Case Material and Methods A total of 792 initial attacks of acute rheumatic fever form the basis for this study. The patients, ranging in age from 2 to 15 years, fulfill the following requirements: (1) They were hospitalized at Bellevue during their first attack, and (2) a definite diagnosis of acute rheumatic fever was made in each. Cases in which the diagnosis of acute rheumatic fever was considered to be questionable at the time of review for the study were not included. A definite diagnosis required at least one of the major criteria of Jones 12,13 (arthritis,

The pattern of symptoms, pre-treatment interval, and prognosis of acute rheumatic fever.

Article1 October 1962The Pattern of Symptoms, Pre-Treatment Interval, and Prognosis of Acute Rheumatic FeverALVAN R. FEINSTEIN, M.D., JUANITA G. ZAGALA, M.D., MARIO SPAGNUOLO, M.D.ALVAN R. FEINSTEIN, M.D.Search for more papers by this author, JUANITA G. ZAGALA, M.D.Search for more papers by this author, MARIO SPAGNUOLO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-57-4-563 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a recent re-appraisal of the clinical patterns of acute rheumatic fever (1), we decided to examine the now traditional belief that residual heart disease is prevented by early treatment. Inspected grossly, the data for first attacks of rheumatic fever showed residual heart disease in 53 (25 per cent) of 209 patients who began treatment within the first 2 weeks after onset of symptoms and in 38 (69 per cent) of 55 patients who began treatment after the first 2 weeks. This highly significant difference seemed to be a clear demonstration that early treatment was of definite value.When the...

The clinical study and morphology of the first attack of rheumatism in children below three years of age.

Skvortsov4 has repeatedly pointed out in this connection that insufficiency of blood circulation is the result of an inflammatory process in the heart muscle in the acute stage of the first attack of rheumatic fever in children, when hypotrophy of the heart muscle is out of the question. Disturbances in the blood circulation and in the pericardium are indicative of a gross severity of the rheumatic process and influence

Sore throats, streptococcal infections, and prevention of rheumatic fever

Recent advances in laboratory and clinical investigation have shown the constant association of acute rheumatic fever with Group A beta-hemolytic streptococcal infections. Attempts to prevent rheumatic fever are accordingly aimed at eradication of Streptococci. This is an elusive target because there are no routine, simple clinical or laboratory indications of streptococcal infection. Patients with streptococcal infections may have sore throats but often are asymptomatic or have non-specific upper respiratory symptoms. Tests for Streptococci in the throat can be done easily but show only that the organism is present; they do not prove it is the causing infection. Antibody measurements can detect infection, but these tests are complex, cumbersome, and often require long delays to await acquisition of the sequential specimens required for demonstrating a change in titer. In preventing first attacks of rheumatic fever, physicians must find and then eradicate asymptomatic or atypical streptococcal infections as well as those that produce sore throats. Oral or parenteral penicillin, in adequate dosage, is the agent of choice for this purpose. Sulfonamides should not be employed therapeutically; erythromycin provides a feasible alternative when the use of penicillin is precluded. The major features used in deciding whether infection is present are a sore throat, and exudate, together with laboratory evidence of streptococcal infection. In preventing recurrent attacks of rheumatic fever in susceptible patients, physicians cannot rely on attempts to find and then treat streptococcal infections because the risk of missing asymptomatic infections is too great. Therefore, prevention of rheumatic recurrences requires continuous antimicrobial prophylaxis. At present, the most effective agent is a monthly injection of long-acting parenteral benzathine penicillin. The most effective oral agent to date has been sulfadiazine, 1.0 gram daily. Although it is currently recommended that all rheumatic patients maintain prophyl-axis indefinitely, rational considerations suggest that more finite durations can be planned for some patients on the basis of age, cardiac status, and length of time elapsed since the previous rheumatic attack.