Manifestation Of Acute Rheumatic Fever Research Articles

Monoarthritis as the initial presentation of acute rheumatic fever in Iran: A single-center retrospective cross-sectional study.

In Iran, there is a lack of information and studies on acute rheumatic fever (ARF), a global health issue. The limited understanding of ARF's prevalence and primary clinical symptoms has led to confusion. This research investigates the characteristics of children aged 3-17 years who experience ARF with monoarthritis as their initial symptom. A retrospective evaluation of medical records of children diagnosed with ARF was conducted. The study aimed to determine the prevalence of monoarthritis as the first manifestation of ARF and its association with age, gender, family history, and cardiac involvement. Categorical variables were analyzed using the chi-square test with a significance level of < 0.05 and a confidence interval of 95%, using SPSS software (Version 23). The study included 62 patients with ARF, comprising 41 (66.1%) boys with an average age of 8.48±3.27 years. Among these patients, 12 exhibited cardiac involvement according to the revised Jones criteria, with 5 clinical carditis and 7 cases of subclinical carditis. Monoarthritis was the initial symptom in seven patients (11.29%); five (71.4%) also had carditis. There was a significant association (p<0.001) between monoarthritis and carditis. The study concludes that monoarthritis may be an early sign of ARF in children and correlates significantly with cardiac involvement. However, more extensive research with more significant participant numbers is necessary to understand ARF in Iran comprehensively. A thorough cardiac examination is also crucial for patients with ARF and monoarthritis.

Sydenham Chorea in Sudan; Presentation Panorama.

Sydenham's chorea (SC) is the most common form of acquired chorea in childhood, it is considered a neurological complication of streptococcal pharyngitis. In this study, we aimed to determine the clinical pattern, association of Sydenham's chorea with other manifestations of acute rheumatic fever, and the laboratory findings of Sydenham's chorea among Sudanese patients. A prospective cross-sectional study involving fifty patients of various ages diagnosed with Sydenham's chorea and followed up at The National Center for Neurological Sciences from January 2017 to November 2019. Data were obtained after patients' consent through personal interviews or personal review of patients' records via a structured questionnaire composed of demographic data, symptoms, co-morbid illness, risk factors, physical examination, and related investigations. About 50 patient was enrolled in this study with a median age of 13.7 years. Females were (n=35) (70%) and (30%) (n=15) s were males. Generalized chorea was seen in 33 (66%) and hemichorea in 17 (34%) patients. Weakness (38%) and hypotonia (46%) were common, such as behavior change (44%), dysarthria (70%), gait change (18%), and deterioration of handwriting (12%). Arthritis occurred in (36%), carditis in 30 (60%), both arthritis and carditis in 18 (36%), and pure chorea in 14 (28%). Erythema marginatum and subcutaneous nodules were not observed in our patients. Only 13 patients (26%) gave a history of pharyngitis. Sydenham chorea is more common in young female Sudanese, with a familial predominance and a tendency towards mitral valve disease. All pediatric Patients with chorea should be screened for Sydenham's chorea.

A nationwide study on Sydenham's chorea: Clinical features, treatment and prognostic factors

Sydenham's Chorea (SC) is a neuropsychiatric disorder and a major manifestation of acute rheumatic fever. The erroneous assumption that SC is a benign and self-limiting disease, has led to a lack of high-quality scientific evidence of the therapeutical and prognostic features of SC.We retrospectively analyzed the medical records of patients <18-years old with SC in 17 Italian pediatric centers. Recorded data included clinical, instrumental and laboratory parameters. Prognostic risk factors including treatment regimens were assessed with univariate and multivariate sub-analysis.We included 171 patients with SC. 66% had generalized chorea, and 34% hemichorea. 81% had carditis (subclinical in 65%). Additional neurological symptoms were reported in 60% of the patients, mainly dysarthria and dysgraphia. 51% had neuropsychiatric symptoms at onset, which persisted after 12 months in 10%. Among psychiatric manifestations, the most common was anxiety disorder/depression (77%). Neurological remission was reached by 93% of the patients at 6 months; 9% relapsed. Patients were treated as follows: 11% penicillin alone, 37% immunomodulatory therapy, 16% symptomatic drugs (i.e. anti-seizure medication, dopamine antagonists) and 37% both symptomatic and immunomodulatory treatment. Neurological outcome did not differ between groups. Patients receiving symptomatic drugs had a higher risk of relapse on multivariate analysis (p = 0.045).Treatment of SC was largely heterogeneous. Based on our results, immunomodulatory therapy did not show higher efficacy at medium term, although it was associated to a slightly lower risk of relapse compared to symptomatic therapy. Longitudinal studies are needed to assess specific risk factors and best treatment options.

Acute Rheumatic Fever.

The incidence of acute rheumatic fever (ARF) is 8 to 51 per 100,000 people worldwide. It most commonly affects children 5 to 15 years of age after a group A streptococcal infection. Overcrowding and poor socioeconomic conditions are directly proportional to the incidence of ARF. Rheumatic carditis is a manifestation of ARF that may lead to rheumatic heart disease (RHD). Timely treatment of group A streptococcal infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Prevention of recurrent ARF is the most effective way to prevent RHD. ARF is diagnosed using the 2015 modified Jones criteria. There is no gold standard laboratory test. Therefore, clinicians need to be aware of the clinical signs and symptoms of ARF to include in their differential diagnosis when seeing such patients. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is key to RHD control. Clinicians need to understand the implications of secondary prophylaxis for ARF. There is also a need to improve ARF diagnosis, to find novel therapies to reduce the incidence of ARF, and to reduce the prevalence of RHD. RHD research is neglected and underfunded. Thus, there is also a need for RHD advocacy and public health awareness to increase research on RHD.

Antistreptolysin O titer and C-reactive protein levels in pediatric patients of acute rheumatic fever.

Objectives: To determine serum levels of antistreptolysin O titre (ASOT) and C-reactive protein (CRP) and their association with clinical manifestations of Acute rheumatic fever (ARF). Study Design: Descriptive study. Setting: Department of Diagnostic Immunology and Serology, Children’s Hospital and Institute of Child Health, Lahore. Period: Jan 2015 to Jan 2016. Material &amp; Methods: Fifty clinically confirmed patients of ARF were included in this descriptive study. The samples were taken from Children hospital and Institute of child health Lahore after written informed consent. The sampling technique was convenient sampling. Results: Out of 50 enrolled patients, males were 32(64%) and women 18(36%). Only 5(10%) patients had normal ASOT levels, 20(40%) patients were with borderline ASOT, and 25(50%) patients had titres above 200 IU/ml. There was no significant association of ASOT with gender, age and arthralgia with p-value = 0.060, 0.875 and 0.473, respectively. However, a significant association was found in ASOT with carditis and C-reactive protein (p-value = 0.028 and 0.014, respectively). Only 3 (6%) patients had CRP levels below 6mg/l, whereas 43 (86%) patients were with CRP levels above 6. Only 4(8%) patients had borderline value of CRP titer. There was no significant association between C-reactive protein with gender, age and arthralgia (p-value = 0.148, 0.184 and 0.574, respectively). Moreover, there was a significant association between C-reactive protein with carditis and AOST (p-value = 0.020 and 0.014, respectively). Conclusion: ASOT and CRP are important laboratory parameters reflecting undergoing infection (mainly caused by Streptococcus pyogenes A) and inflammation in patients of ARF. Rising levels of ASOT and CRP in ARF patients might be used as an indicator of involvement of heart tissues and therefore can be used to monitor transition of rheumatic carditis into Rheumatic heart disease.

Sydenham chorea in a12- year old Saudi girl

Sydenham chorea (SC) is the most common acquired cause of chorea in children.(SC) is the neurological manifestation of rheumatic fever. Rheumatic fever is still reported in Saudi Arabia, although less frequently. According to modified Jones criteria, carditis and arthritis are the major manifestations of acute rheumatic fever (ARF) in children.SC is often seen in isolated form; however, it can occur in association with other clinical manifestations of ARF like carditis. It has been reported that silent, mild valvular regurgitation has been found in patients with pure chorea.SC is characterized by abnormal body movement, associated with behavioral changes. It is an autoimmune disease that occurs following an infection with Group A beta-haemolytic streptococcal infection that is prevalent in Saudi Arabia.Despite recent advances in child health care services, RF continues to occur in Saudi Arabia. We describe a 12-year-old Saudi girl with SC and clinically inaudible, but echocardiographically significant mild valvular regurgitation.The diagnosis of Sydenham chorea should be considered in young children with choreiform movements. Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of penicillin prophylaxis.

DETECTION OF STREPTOCOCCAL BACTERIAL DNA WITH POLYMERASE CHAIN REACTION IN EXCISED VALVULAR TISSUE OF RHEUMATIC HEART DISEASE PATIENTS

Manifestations of acute rheumatic fever (ARF) are considered due to antibody cross-reactivity (molecular mimicry). However, the pathogenesis of chronic sequelae of rheumatic heart disease (RHD) after resolution of ARF is not completely understood. We proposed that there might be persistence of

Beyond first-degree heart block in the diagnosis of acute rheumatic fever.

First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility. Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed. A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG. This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.

Evaluation of Neutrophil Gelatinase-Associated Lipocalin in Children with Sydenham's Chorea Accompanying Valvular Regurgitation

Background Acute rheumatic fever (ARF) is a nonsuppurative complications of Group A β-hemolytic streptococcal (GABHS) infection due to a delayed immune response. Sydenham's chorea (SC) is an important neurological manifestation of ARF, and heart involvement is seen in a large proportion of patients with SC. The immune system has a crucial role in initiating and spreading inflammation, which causes tissue damage in ARF. Aim The purpose of this study was to investigate urine neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for kidney injury in children with rheumatic chorea accompanying valvular involvement. Materials and Methods Twenty-eight consecutive children with SC accompanying evidence of valvular involvement, and 30 nonrheumatic, age- and sex-matched healthy children were included in the study. Cardiac evaluations were performed, and urinary NGAL, micro-total protein and creatinine levels were measured in all participants. Results Age, gender, weight, and height were similar in the patients and controls. Twenty-three patients had isolated mitral regurgitation, and five patients had mitral and aortic regurgitation. While there was no statistically significant difference between the urine creatinine and micro-total protein levels in patients and controls, the patient group demonstrated a significantly higher mean urine NGAL level (18.01 ± 7.9 vs. 3.22 ± 1.4, p = 0.002) and mean urine NGAL/creatinine ratio (2.80 ± 1.9 vs. 0.33 ± 0.1, p = 0.008). However, there were no correlations between severity of chorea and urinary NGAL or urinary NGAL/creatinine ratio, there were significant positive correlations between severity of valvular regurgitation and urinary NGAL (r = 0.751, p &lt; 0.001) and urinary NGAL/creatinine ratio (r = 0.694, p &lt; 0.001). Conclusion The present study revealed that urinary NGAL level and urinary NGAL/creatinine ratio were higher in patients with SC accompanying valvular involvement. The results obtained from this study suggest that ARF may cause subclinical renal injury in patients with intense and prolonged cellular immune response leading to chorea and carditis.

Should We Taper or not: A Short Glance to a Dilemma

The treatment of the acute inflammatory manifestations of acute rheumatic fever (ARF) refers to the utilization of anti-inflammatory agents. Based upon clinical experience, acetylsalicylic acid (ASA) has been traditionally accepted as the first-line therapy for arthritis. However, various scientific sources indicate different schedules for the administration of ASA treatment and such differences may cause misunderstandings. This student study aims to investigate the approaches for the ASA treatment that have been adopted by the pediatric cardiologists in the treatment of ARF arthritis by means of a pre-designed questionnaire.

IN-HOSPITAL OUTCOMES AND HOSPITALIZATIONS FOR ACUTE RHEUMATIC HEART DISEASE: A UNITED STATES NATIONAL STUDY

Background: Acute rheumatic heart disease (ARHD) is a serious manifestation of acute rheumatic fever (ARF) and can result in long-term cardiac complications. Literature suggests that the incidence of ARF is declining in the United States (US). However, the secular variation of ARHD has not been

Клиническая и лабораторно-инструментальная характеристика ревматической хореи у детей

Sydenham's chorea (SC) is a major clinical criterion in acute rheumatic fever (RF). SC is a late neurological manifestation of acute rheumatic fever which occurs 1 to 6 months after pharyngeal infection with group A betahemolytic streptococci. SC is characterized by clinical symptoms: involuntary hyperkinetic movements, muscular hypotonia, hyperreflexia, gait disturbance, emotional lability. Objective: The aim of the study was to identify frequency, clinical manifestations and the treatment of SC. The study included 56 children 4-17 years old, who were hospitalized in the Morozovskaya children’s clinical city hospital in 2001-2015 with RF. Clinical history, laboratory and instrumental methods (electrocardiography, transthoracic echocardiogram, cranial computed tomography scan and/or magnetic resonance imaging, electroencephalography, electroneuromyography). The study revealed frequent errors (66%) in RF diagnosis before hospitalization. Besides chorea, the clinical manifestations of RF were: carditis (89,3%), arthritis (46,4%), erythema marginatum (10,7%), subcutaneous nodule (1,8%). The peculiarity of our study washighfrequency of chorea (42,9%). Isolated chorea wasseen in 12,5%, mixed chorea - in 30,4% of SC. The clinical manifestations of chorea were typical. The nervous system lesion most often occured in children with a neurological history (p < 0,05). The clinical or laboratory evidence of streptococcal infection were seldom found (p = 0,02) in patients withchorea (45,8%) compared with patients without chorea symptoms (69%). RF issue requires attention from the medical community. SC, especially isolated chorea (29%), is the most challenging manifestation of RF for the differential diagnosis.Chronic rheumatic heart disease can be developed even in patients with isolated chorea (12,5%). In the treatment of SC in addition antibiotics and drugs which affect domamine and GABA metabolism, glucocorticoids (Prednisolone) are needed.

Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association.

Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever. To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria. This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.

Sydenham Chorea and PANDAS in South Africa: Review of Evidence and Recommendations for Management in Resource-Poor Countries.

In South Africa, and worldwide, rheumatic fever represents a public health problem. Improved diagnosis and management of Sydenham chorea, a major manifestation of acute rheumatic fever is key to prevention of rheumatic heart disease. This article reviews Sydenham chorea from its original description to current opinions. Recommendations are founded on expert opinion as class 1 data is lacking. This South African perspective is relevant to resource-poor settings globally insofar as it provides diagnosis and management recommendations for primary- and secondary-level healthcare professionals who care for patients in such environments. Four basic tenets of care are recommended, namely, elimination of the streptococcal infection, symptomatic treatment, immunological treatment, and nonpharmacologic interventions. A user-friendly outcome measurement tool, viable for use in low-resource settings is presented. Introduction of this tool may lead to increased awareness of the neuropsychiatric manifestations of poststreptococcal movement disorders in Africa, where reports are limited.

The incidence of acute rheumatic fever and chronic rheumatic heart disease in the Russian population (2011–2012)

The problems of acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD) are discussed. Carditis, polyarthritis, erythema annulare, subcutaneous nodules, and chorea minor are the main clinical manifestations of ARF caused by β-hemolytic streptococcus A. Cardiac failures emerge in 60–65% of patients after the first ARF episode. Repeated ARF attacks promote CRHD. The aim of the study is to evaluate the prevalence of rheumatic heart disease in different age groups in the regions of Russian Federation in 2011–2012. Materials and Methods. Analysis of the Ministry of Healthcare of the Russian Federation reports on population morbidity in 2011–2012 (Form N12). Results. The highest ARF prevalence was observed in 15–17-year-old teenagers, while the lowest, in adults over 18-year-old. The lowest CRHD figures were registered in juniors, while the highest ones, in adults. No ARF cases in 0–14-year-old children were registered in 31 entities of the Russian Federation; single cases, in 17 entities; no ARF cases in 15–17-year-old teenagers was registered in 37 entities, and 1–2 ARF cases were registered in 23 entities. Only in 10 entities, no ARF cases were registered in adults, and single cases were registered in 22 entities. Extremely unfavorable situations were found in the Chechen Republic (140 ARF cases in 0–14-year-old children) and in the Dagestan Republic (140 cases). High morbidity among 15–17-year-old teenagers was registered in tje Kaliningrad region (83 cases) and the Chechen Republic (100). ARF cases in adults were most frequent in St. Petersburg (124 cases), the Chechen Republic (154), and the Moscow region (161). The article lists the ARF and CRHD preventive measures.

PM127 Major manifestations of Acute Rheumatic Fever in Nepalese patients

PM127 Major manifestations of Acute Rheumatic Fever in Nepalese patients

Presyncope Due to a Complete Atrioventricular Block Revealing a Rheumatic Heart Disease

First degree Atrio Ventricular (AV) block is a common manifestation of acute Rheumatic Fever (RF) and is included in the Jones criteria but Wenckebacks phenomena and complete heart block are rarely described in the RF. Presyncope occurring in RF was rarely reported. We report the case of a young 14 years old boy with rheumatic heart disease revealed by presyncope due to an third degree AV block. Rapid improvement was obtained under corticosteroids.

Acute-Onset Choreiform Movements in a Previously Healthy 4-Year-Old Patient

We report the case of 4-year-old male with sinus venous thrombosis leading to bilateral thalamic and basal ganglia strokes presenting as generalized choreiform movements. Acute-onset chorea in the pediatric population is most commonly associated with Sydenham chorea, which is a manifestation of acute rheumatic fever. Chorea is a much less commonly noted sign of stroke, and when it occurs, it typically presents as hemichorea. Given the unlikely presentation, rapid and appropriate imaging was the key to diagnosis.

Complete heart block in Acute Rheumatic fever

Rheumatic fever can cause a variety of cardiac conduction disturbances. First-degree heart block is a common electrocardiographic manifestation of acute rheumatic fever and is included in Jones’ diagnostic criteria. Other electrocardiographic changes such as sinus tachycardia, bundle branch blocks, nonspecific ST-T wave changes, atrial and ventricular premature complexes have been reported with variable frequency. However, complete heart block is an exceptionally rare manifestation of acute rheumatic fever. We report a 15 years female who developed Complete heart Block during an episode of acute rheumatic carditis. The patient was successfully treated with conventional treatment and Temporary Pacemaker. DOI: http://dx.doi.org/10.3126/njh.v9i1.8351 Nepalese Heart Journal Vol.9(1) 2012 pp.56-58

Prevalence of Sydenham’s chorea in patients with Acute Rheumatic fever in Nepal

Background Sydenham’s Chorea (SC) is a major manifestation of acute rheumatic fever (ARF) and is the only evidence of ARF in approximately 20% of cases. There are no published reports on prevalence of SC in patients with ARF in Nepal. Objectives This retrospective study was done to find out the prevalence of SC in patients with ARF in Nepal. Methods Four years data of 672 patients with ARF from the RF/RHD registry of National RF/RHD prevention &amp; control programme launched by Ministry of Health and Population &amp; Nepal Heart Foundation in 32 hospitals throughout Nepal were analyzed. Results Prevalence of SC as a major manifestation of ARF in Nepalese patients was found to be 3.87%. Females were mostly affected with a female-to-male ratio of 3:1. Patients of age group 10-15 years were affected the most. SC was the third most common manifestation of ARF after Arthritis and Carditis. DOI: http://dx.doi.org/10.3126/njh.v9i1.8345 Nepalese Heart Journal Vol.9(1) 2012 pp.30-32