Resurgence Of Acute Rheumatic Fever Research Articles

Resurgence of acute rheumatic fever: Diligent history taking

Acute rheumatic fever (ARF) is still one of the most common cause of acquired heart disease in school age group children. Though there has been a decline in the past few decades, resurgence of ARF cases have been noted in developing countries. We are hereby reporting a 7 year old male child who presented to us with ARF without any cardiac complications and absence of any serological evidence of recent streptococcal infection. The child however had a history of throat infection prior to joint involvement with this case we want to emphasize the importance of history taking and the fact that even if there is no serological evidence of streptococcal infection, the case has to be treated as ARF with the fulfilment of major and minor criteria to prevent mortality due to cardiac complications.

Adult-Onset Acute Rheumatic Fever

By the late 1980s, acute rheumatic fever (ARF) had become a rare disease in Taiwan. The low prevalence rate in this area is attributed to a better economic status, which has led to improved public health and adequate medical services. The increasing number of patients with adult-onset ARF in the United States described in the literature prompted us to evaluate the cases diagnosed in our medical center. A retrospective chart review was performed for patients with arthritis from July 1988 to October 2004. To be included, patients had to meet revised Jones criteria. Three adult patients with ARF have been diagnosed since June 2001, with no childhood ARF being diagnosed. All cases presented with migratory polyarthritis, whereas 1 had erythema marginatum and transient carditis. These patients responded well to treatment with antibiotics and nonsteroidal antiinflammatory drugs. Clinicians must provide careful assessment and treatment to patients presenting with acute pharyngitis. A possible resurgence of ARF can be eradicated by primary prevention of streptococcal pharyngitis.

The diagnosis of rheumatic fever.

1. Laura Mirkinson, MD 1. 2. *Department of General Pediatrics Children’s National Medical Center Washington, DC 1. Acute Rheumatic Fever . Wald E. Curr Probl Pediatr . 1993;23:264-270 [OpenUrl][1][CrossRef][2][PubMed][3] 2. Rheumatic Fever: Keeping up with the Jones Criteria . Forster J. Contemp Pediatr . 1993;10:51-60 3. Treatment of Acute Streptococcal Pharyngitis and Prevention of Rheumatic Fever: A Statement for Health Professionals . Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S, and American Academy of Pediatrics Committee on Infectious Diseases and the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Pediatrics . 1995;96:758-764 [OpenUrl][4][Abstract/FREE Full Text][5] Acute rheumatic fever (ARF) was recognized initially in the late 19th century and followed a declining pattern of incidence in the United States until the mid-1980s. It remains one of the primary causes of acquired heart disease worldwide. A resurgence of ARF since 1984 prompted the medical community to review the early signs and symptoms of an illness that was considered to be uncommon. Traditionally, ARF was thought to be a disease of the inner-city poor and military recruits, but in recent resurgences, rural and suburban communities have been affected as well. The most common clinical manifestations of ARF in recent outbreaks in the United States were arthritis and carditis. During these outbreaks the majority of patients showed one major manifestation, but two major manifestations (carditis and arthritis or carditis and chorea) also were seen frequently. Many of the patients diagnosed as having ARF during these epidemics had no recognizable prodrome that would have brought them to medical attention. A history of symptomatic pharyngitis often was absent. It is important to remember that the throat culture frequently is negative by the time rheumatic fever develops. These facts emphasize the need to consider ARF in the appropriate clinical setting and use the streptococcal … [1]: {openurl}?query=rft.jtitle%253DCurrent%2Bproblems%2Bin%2Bpediatrics%26rft.stitle%253DCurr%2BProbl%2BPediatr%26rft.aulast%253DWald%26rft.auinit1%253DE.%2BR.%26rft.volume%253D23%26rft.issue%253D7%26rft.spage%253D264%26rft.epage%253D270%26rft.atitle%253DAcute%2Brheumatic%2Bfever.%26rft_id%253Dinfo%253Adoi%252F10.1016%252F0097-3165%252893%252990018-4%26rft_id%253Dinfo%253Apmid%252F8404011%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/0097-3165(93)90018-4&link_type=DOI [3]: /lookup/external-ref?access_num=8404011&link_type=MED&atom=%2Fpedsinreview%2F19%2F9%2F310.atom [4]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DDajani%26rft.auinit1%253DA.%26rft.volume%253D96%26rft.issue%253D4%26rft.spage%253D758%26rft.epage%253D764%26rft.atitle%253DTreatment%2Bof%2BAcute%2BStreptococcal%2BPharyngitis%2Band%2BPrevention%2Bof%2BRheumatic%2BFever%253A%2BA%2BStatement%2Bfor%2BHealth%2BProfessionals%26rft_id%253Dinfo%253Apmid%252F7567345%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=96/4/758&atom=%2Fpedsinreview%2F19%2F9%2F310.atom

Poststreptococcal Reactive Arthritis and Silent Carditis: A Case Report and Review of the Literature

Between 1984 and 1988, a resurgence of acute rheumatic fever (ARF) was reported in several pediatric centers.1-3 During the same time, pediatric cases,4-6 and, recently, adult cases6 of poststreptococcal reactive arthritis (PSRA) have been reported. Although several of these patients had or developed multisystemic manifestations,4,5 none of these cases fully adhered to the guidelines of the revised Jones criteria.7 Thus, these individuals were given the diagnosis of PSRA or poststreptococcal rheumatic syndrome (PSRS) rather than ARF.4-6,8-10 One of the leading causes of acquired pediatric heart disease in North America is carditis of ARF,3 and severe cases can result in congestive heart failure, the need for valve replacement, or death.11

Gram-positive Organisms and Sepsis

In recent years, the importance of gram-negative organisms in the genesis of sepsis has been emphasized. However, this emphasis may no longer be correct; recent studies show an increasing incidence of gram-positive sources of sepsis, and its is possible that these cases may predominate in the coming years. This increase results from more than just a greater prevalence of infection--it appears that gram-positive organisms may also be more virulent in fomenting the disease, as can be evidenced by the emergence of streptococcal toxic shock syndrome and the resurgence of acute rheumatic fever. This may result from the ability of gram-positive organisms to produce more inflammation-causing cell wall constituents, as well as unbound exotoxins. Despite the recent emphasis on gram-negative causes, sepsis resulting from gram-positive sources is increasingly common. Research on these causes of sepsis should be encouraged.

Persistence of acute rheumatic fever in the intermountain area of the United States

We report our 8-year experience with the resurgence of acute rheumatic fever during the years 1985 through 1992. The records of 274 confirmed cases referred to Primary Children's Medical Center were reviewed. The clinical features including the presence of the Jones criteria, demographic data, preceding streptococcal infection, and the use of echocardiographic studies were tabulated and assessed. Patients came predominantly (84%) from middle-class families with access to medical care. Only 46 patients (17%) sought medical attention for a preceding sore throat. Carditis evident by auscultation was the dominant major manifestation in 68% of the cases. Echocardiography demonstrated mitral regurgitation that was not audible in 15 (47%) of 32 patients who had only polyarthritis at onset and in 30 (57%) of the 53 who had pure chorea. The incidence of acute rheumatic fever has been declining since the peak of the outbreak in 1985 but is continuing in the intermountain area at rates comparable to those of the 1960s. (J P EDIATR 1994;124:9-16)

The resurgence of acute rheumatic fever in the United States.

Several areas in the United States have experienced significant outbreaks of acute rheumatic fever. Reasons for the reappearance of acute rheumatic fever are incompletely understood but may relate to changes in the organism. Fortunately, however, GABHS has remained exquisitely susceptible to penicillin. Given the resurgence in cases of acute rheumatic fever, the practicing physician needs to be vigilant in diagnosing and ensuring adequate treatment of acute streptococcal pharyngitis. In addition, acute rheumatic fever must be considered in a patient who presents with a new onset murmur, a migratory polyarthritis, chorea, or a rash suggestive of erythema marginatum.

Resurgence of acute rheumatic fever in west Alabama.

This study was done to ascertain whether there was an increased incidence of acute rheumatic fever (ARF) in west Alabama, similar to that reported elsewhere within the United States. Hospital records for the previous 10 years were reviewed and 5-year intervals were compared (1980 through 1984 vs 1985 through 1989). A sevenfold increase was noted in the later period. Possible explanations for this increase are discussed. Close surveillance, appropriate testing, and adequate complete treatment must be continued to eradicate streptococcal disease leading to acute rheumatic fever.

Pediatric rheumatology

Much of the information concerning pediatric rheumatologic diseases reported during the past year dealt with therapeutic and toxic effects of medications. Ibuprofen, the nonsteroidal anti-inflammatory drug most recently approved for use in children in the United States, was shown to be safe and effective in juvenile rheumatoid arthritis. Pilot studies of intravenous gammaglobulin in systemic juvenile rheumatoid arthritis, sulfasalazine in pauciarticular juvenile rheumatoid arthritis, and methotrexate in all juvenile arthritides also yielded promising results. On the other hand, little-recognized toxicities of nonsteroidal anti-inflammatory drugs, including nephrotic syndrome and a photodermatitis, were also highlighted. New demographic data were published concerning the resurgence of acute rheumatic fever, as well as the continuing severe morbidity suffered by children with systemic lupus erythematosus. Description of the first transgenic animal model of a human inflammatory disease, however, holds out the possibility of an entirely new approach to the rheumatic diseases.

A resurgence of acute rheumatic fever in a mid-south children's hosptial: Leggiadro R, Birnbaum S, Chase N, Myers L. South Med J. 1990; 83: 1418–1820

A resurgence of acute rheumatic fever in a mid-south children's hosptial: Leggiadro R, Birnbaum S, Chase N, Myers L. South Med J. 1990; 83: 1418–1820

A Resurgence of Acute Rheumatic Fever in a Mid-South Childrenʼs Hospital

A resurgence of acute rheumatic fever (ARF) has been reported in many areas of the United States in recent years. We retrospectively reviewed the medical records of inpatients with a new diagnosis of ARF from 1982 through 1988 at a children's hospital that serves a six-state referral area in the mid-South. Thirty patients were identified, 21 of whom were seen in 1987 (13) and 1988 (8). The rate of new cases of ARF per 1000 hospital discharges (0.7) was significantly greater for 1987 and 1988 than it was (0.15) from 1982 through 1986. Patients with recently diagnosed ARF were predominantly from nonurban areas, and polyarthritis was the most common recent major manifestation. Reasons for the resurgence of ARF in the US, including the mid-South, are unclear, but our experience serves to support recently published guidelines for the diagnosis and management of streptococcal pharyngitis in light of this resurgence of ARF.

The Resurgence of Acute Rheumatic Fever in the United States

The incidence of acute rheumatic fever (ARF) had been declining in the United States for decades, and by the late 1970s ARF had become a rare disease in most areas of the country. The mid-1980s saw a resurgence of ARF, with reported outbreaks in Utah, Ohio, Pennsylvania, and military recruit camps in Missouri and California, as well as sporadic cases in many other communities. This review summarizes salient epidemiologic data related to the resurgence, explores some possible explanations for its occurrence, and discusses strategies for prevention of rheumatic fever now and in the future.

The Resurgence Of Acute Rheumatic Fever In The United States

CD40 is a cell-surface member of the TNF (tumor necrosis factor) receptor superfamily. Upon activation, CD40 can license dendritic cells to promote antitumor T cell activation and re-educate macrophages to destroy tumor stroma. Numerous agonist CD40 ...Read More

Resurgence of Acute Rheumatic Fever

Between February 1987 and September 1988, there were eight published reports of outbreaks or increases of acute rheumatic fever cases in civilian as well as in military populations in the United States. This is a change from the past decade. Because rheumatic fever is no longer a reportable disease to local or state health departments, we thought it important to attempt to ascertain the extent of this middle 1980s resurgence. We contacted 56 physicians by telephone, all of them pediatric cardiologists. Essentially, all practice in large referral medical centers.

Occurrence of mucoid M-18 Streptococcus pyogenes in a central Ohio pediatric population.

During a 1-year period from October 1986 through September 1987, we recovered 116 mucoid, hemolytic Streptococcus pyogenes isolates from clinical specimens collected from patients seen at our pediatric institution. A total of 102 isolates were from throat cultures (101 for pharyngitis, 1 for acute rheumatic fever), 13 were from other superficial body sites, and 1 was from pleural fluid. All of 40 mucoid isolates tested to date were determined to be M-type 18 strains. A direct latex agglutination test for group A carbohydrate antigen in throat swab specimens was equally sensitive in detecting M-18 mucoid and nonmucoid strains (45 of 77 [58%] and 795 of 1,186 [67%], respectively; not significant, P greater than 0.05). Antimicrobial susceptibility tests performed with 40 mucoid and 40 nonmucoid isolates against penicillin and nine other antimicrobial agents showed all strains to be susceptible, with no difference in MICs. All isolates tested were also considered fully susceptible to the bactericidal activity of penicillin. Further studies are needed to establish the relative virulence of M-18 strains and their possible association with the resurgence of acute rheumatic fever in central Ohio and other areas of the United States.

Streptococcal pharyngitis. What's new.

Group A beta-hemolytic streptococcal pharyngitis continues to be a major problem and accounts for a large number of physician visits. The recent resurgence of acute rheumatic fever in several areas in the United States underlines the need to accurately diagnose and correctly treat streptococcal pharyngitis. Appropriate treatment with antibiotics effectively prevents rheumatic fever. Early institution of treatment also leads to prompt alleviation of symptoms. The "gold standard" for diagnosing group A streptococcal pharyngitis is the throat culture. Newer rapid diagnostic tests may be used, but the clinician must recognize that there are a substantial number of false-negative tests (low sensitivity). Therefore, patients with negative rapid tests should have standard throat cultures as well. Patients with positive rapid tests should be treated with appropriate antibiotics, as should patients with positive throat cultures. Patients with signs and symptoms that are highly suggestive of streptococcal pharyngitis can also be treated, pending throat culture results. Penicillin continues to be the drug of choice for treatment, and American Heart Association guidelines suggest the use of oral penicillin V for ten days or intramuscular benzathine penicillin G. Alternative antibiotics commonly used include erythromycin and various cephalosporins. Throat cultures need not be obtained from most patients after therapy. However, some patients may seem to be having frequent streptococcal infections or may be recognized as asymptomatic carriers. Carriers may be considered for therapy with intramuscular benzathine penicillin G plus oral rifampin.

Resurgence of acute rheumatic fever

Resurgence of acute rheumatic fever

Resurgence of acute rheumatic fever

Resurgence of acute rheumatic fever

Resurgence of acute rheumatic fever in the intermountain area of the United States: Veasy LG, Wiedmeir SE, Orsmond GS, et al. N Engl J Med 1987; 316:421–427

Resurgence of acute rheumatic fever in the intermountain area of the United States: Veasy LG, Wiedmeir SE, Orsmond GS, et al. N Engl J Med 1987; 316:421–427

Resurgence of Acute Rheumatic Fever

Resurgence of Acute Rheumatic Fever