Acute Rheumatic Fever: A Disease of the Past?

Introduction. Acute rheumatic fever (ARF) is a manifestation of the nonsuppurative sequelae of Streptococcus pyogenes infection. Herein, two cases of ARF are presented to highlight that this disease is present in urban cities, can be diagnosed in otherwise healthy children, and that its diagnosis may be challenging, or marred with confounders, leading to delays in diagnosis. Case Report. Two unrelated children, age 7 and 9, presented to an urban hospital in Canada with unique manifestations of ARF. Diagnosis of ARF in the first patient was interrupted by a course of steroids which masked symptoms leading to therapeutic delays. The second patient presented with facial droop and symptoms thought to be viral, thus leading to misdiagnosis as Bell’s palsy. Discussion/Conclusion. ARF is more common in underserviced and marginalized populations, which may lead clinicians in urban centers to overlook signs or symptoms suggestive of ARF because they no longer see this condition routinely, or they believe it is a disease of the past.

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Bacterial Aetiology of Pharyngotonsillitis in Paediatric Age Group in a Tertiary Care Hospital in Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/624 ◽

2021 ◽

Vol 8 (39) ◽

pp. 3441-3447

Author(s):

Thushara Ushakumari Bhuvanendran ◽

Beena V.G.

Keyword(s):

Staphylococcus Aureus ◽

Streptococcus Pneumoniae ◽

Rheumatic Fever ◽

Streptococcus Pyogenes ◽

Acute Rheumatic Fever ◽

Bacterial Pathogens ◽

Antibiotic Sensitivity ◽

Acute Glomerulonephritis ◽

Age Group ◽

Common Organism

BACKGROUND Pharyngotonsillitis is defined as a spectrum of conditions ranging from inflammation primarily confined to the tonsils to pharyngitis implying generalized inflammation of the whole of pharynx. Children are more prone to get several episodes of pharyngotonsillitis per year during their school years. Pharyngitis caused by Streptococcus pyogenes can cause two non-suppurative complications, acute rheumatic fever and acute glomerulonephritis which is responsible for significant morbidity and mortality. The present study was conducted to identify the prevalence of bacterial pathogens causing pharyngotonsillitis and to study their antibiotic sensitivity pattern that would indicate the optimum line of treatment. METHOD A total of 200 children at the age group of 2 - 12 years who had clinical features of pharyngotonsillitis according to the inclusion criteria were recruited for this study over a period of one year. With the help of a disposable wooden spatula, pus from the pharyngo tonsillar region was collected and processed. Predominant isolates obtained were identified and antibiotic sensitivity was done. RESULTS Bacteria was isolated from 70 samples. Pharyngotonsillitis was found most prevalent at the age group of 8 – 10 years. Intake of cold food stuffs and passive smoking at home was found to have statistically significant association as risk factor for pharyngotonsillitis. Staphylococcus aureus was the most common organism isolated followed by Streptococcus pyogenes. The other organisms isolated were group G and C streptococci, Streptococcus pneumoniae, Pseudomonas aeruginosa and Klebsiella pneumonia sub species (spp) aerogenes. CONCLUSIONS Staphylococcus aureus was the most common organism isolated, followed by Streptococcus pyogenes. All the isolates of beta haemolytic streptococci were found to be sensitive to penicillin. There was increased incidence of resistance to macrolides among the gram-positive isolates except Streptococcus pneumoniae and it may be due to the wide spread use of macrolides injudiciously. All the bacterial pharyngotonsillitis cases were cured with the antibiotic given according to the sensitivity except one case. KEYWORDS Pharyngotonsillitis, Acute Rheumatic Fever, Acute Glomerulonephritis, Bacterial Pathogens, Antibiogram

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QT dispersion in acute rheumatic fever

Cardiology in the Young ◽

10.1017/s1047951106000060 ◽

2006 ◽

Vol 16 (2) ◽

pp. 141-146 ◽

Cited By ~ 7

Author(s):

Tugcin Bora Polat ◽

Yalim Yalcin ◽

Celal Akdeniz ◽

Cenap Zeybek ◽

Abdullah Erdem ◽

...

Keyword(s):

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Qt Dispersion ◽

Control Group ◽

Healthy Children ◽

Rheumatic Carditis ◽

Normal Children ◽

A Value ◽

The Mean

Background:Disturbances of conduction are well known in the setting of acute rheumatic fever. The aim of this study is to investigate the QT dispersion as seen in the surface electrocardiogram of children with acute rheumatic fever.Methods:QT dispersion was quantitatively evaluated in 88 children with acute rheumatic fever. Patients were divided into two groups based on the absence or presence of carditis. As a control group, we studied 36 healthy children free of any disease, and matched for age with both groups. Repeat echocardiographic examinations were routinely scheduled in all patients at 3 months after the initial attack to study the evolution of valvar lesions.Results:The mean QT dispersion was significantly higher in children with rheumatic carditis. But there was no statistical difference between children without carditis and normal children. Among the children with carditis, the mean dispersion was higher in those with significant valvar regurgitation. Dispersion of greater than 55 milliseconds had a sensitivity of 85%, and specificity of 70%, in predicting rheumatic carditis, while a value of 65 milliseconds or greater had sensitivity of 81% specificity of 85% in predicting severe valvar lesions in acute rheumatic carditis. At follow-up examination, a clear reduction on the QT dispersion was the main finding, reflecting an electrophysiological improvement.Conclusions:These observations suggest that QT dispersion is increased in association with cardiac involvement in children with acute rheumatic fever.

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Does it make sense to detect Streptococcus pyogenes during tonsillitis in Europe to prevent acute rheumatic fever?

Clinical Microbiology and Infection ◽

10.1111/1469-0691.12802 ◽

2014 ◽

Vol 20 (12) ◽

pp. O981-O982 ◽

Cited By ~ 2

Author(s):

S. Edouard ◽

A. Michel-Lepage ◽

D. Raoult

Keyword(s):

Rheumatic Fever ◽

Streptococcus Pyogenes ◽

Acute Rheumatic Fever

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Poststreptococcal Reactive Arthritis

Journal of the American Podiatric Medical Association ◽

10.7547/0960362 ◽

2006 ◽

Vol 96 (4) ◽

pp. 362-366 ◽

Cited By ~ 5

Author(s):

Daniel Logan ◽

Patrick J. McKee

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Lower Extremity ◽

Rheumatic Fever ◽

Reactive Arthritis ◽

Acute Rheumatic Fever ◽

Streptococcal Infection ◽

Treatment Options ◽

Review Of The Literature ◽

Poststreptococcal Reactive Arthritis

Acute rheumatic fever is a delayed inflammatory disease that follows streptococcal infection of the throat. Poststreptococcal reactive arthritis is a sterile arthritis associated with antecedent streptococcal infection in patients not fulfilling the Jones criteria for acute rheumatic fever. Poststreptococcal reactive arthritis has been reported to have lower-extremity predominance and, therefore, should be included in the differential diagnosis of patients with lower-extremity arthritis. A review of the literature, distinguishing poststreptococcal reactive arthritis from acute rheumatic fever, and treatment options are discussed here. A case report is also presented. (J Am Podiatr Med Assoc 96(4): 362–366, 2006)

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Accelerated junctional rhythm in children with acute rheumatic fever: is it specific to the disease?

Cardiology in the Young ◽

10.1017/s1047951113000620 ◽

2013 ◽

Vol 24 (3) ◽

pp. 464-468 ◽

Cited By ~ 5

Author(s):

Naci Ceviz ◽

Velat Celik ◽

Hasim Olgun ◽

Mehmet Karacan

Keyword(s):

Rheumatic Fever ◽

Atrioventricular Block ◽

Acute Rheumatic Fever ◽

Healthy Children ◽

Upper Respiratory Tract ◽

Junctional Rhythm ◽

Recent Group ◽

Group 2 ◽

Heart Group ◽

Group 1

AbstractObjective:During the course of acute rheumatic fever, some electrocardiographic changes are seen. First-degree atrioventricular block is the most common electrocardiographic abnormality. Second- and third-degree atrioventricular block, ventricular tachycardia, and junctional acceleration are also seen. In the present study, the specificity of accelerated junctional rhythm to acute rheumatic fever was investigated.Methods:The study included patients with acute rheumatic fever (Group 1), healthy children who had suffered from recent group A β-haemolytic streptococcal upper respiratory tract infection but did not develop acute rheumatic fever (Group 2), and patients who had other diseases that may affect the joints and/or heart (Group 3).Results:Accelerated junctional rhythm was detected in 10 patients in Group 1, but in none of the patients from Group 2 or 3. Specificity of accelerated junctional rhythm for acute rheumatic fever was 100% and the positive predictive value was 100%.Conclusion:Accelerated junctional rhythm is specific to acute rheumatic fever. Although its frequency is low, it seems that it can be used in the differential diagnosis of acute rheumatic fever, especially in patients with isolated polyarthritis.

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Erythema marginatum: an uncommon presentation of acute rheumatic fever in a Nigerian adolescent girl—a case report

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00068-w ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Barakat Adeola Animasahun ◽

Faith O. Lawani ◽

Moriam Omolola Lamina

Keyword(s):

Case Report ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Skin Lesions ◽

Secondary Prophylaxis ◽

Pulmonary Artery Hypertension ◽

Mitral Valves ◽

Reticular Pattern ◽

Uncommon Presentation ◽

The Face

Abstract Background Erythema marginatum is an uncommon presentation in children with acute rheumatic fever and it is one of the major criteria needed to make a diagnosis. It is seen in less than 10% of cases. It is also reported to be difficult to detect in black-skinned children. This is the first and only patient to present with the above since the inception of the unit about 14 years ago and also the first to be reported in Nigeria as far as the authors are aware, after a careful literature search; hence, we report this case based on the rarity of this symptom of acute rheumatic fever. Case presentation This is a case report of O.E, a 12-year-old Nigerian girl who presented with features of acute rheumatic fever, and these features included the rare manifestation of erythema marginatum. She presented with generalized skin eruptions on the trunk and extremities, sparing the face, migratory polyarthritis, features of congestive heart failure and high grade continuous fever. The skin lesions consisted of papules, patches, plaques and polycycles with a reticular pattern having serpiginous and raised borders. Diagnostic investigations revealed elevated erythrocyte sedimentation rate of 83mm/h, anti-streptolysin O titer of 2020IU/L and echocardiography which showed thickened mitral valves with grade II mitral regurgitation and a mild pulmonary artery hypertension. The patient was treated with anti-inflammatory and anti-failure drugs and commenced secondary prophylaxis with benzathine penicillin. Skin eruptions resolved within 3 weeks of management and are currently on follow up. Conclusions We present the above to increase awareness on the possibility of acute rheumatic fever presenting with erythema marginatum in our region, to encourage early diagnosis of acute rheumatic fever to reduce morbidity and mortality from its sequel, rheumatic heart disease.

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The role of interleukin-9 and interleukin-17 in myocarditis with different etiologies

Turkish Journal of Biochemistry ◽

10.1515/tjb-2018-0491 ◽

2019 ◽

Vol 44 (6) ◽

pp. 797-802

Author(s):

Tuğba Kandemir Gülmez ◽

Can Acipayam ◽

Metin Kilinç ◽

Nurten Seringeç Akkeçeci

Keyword(s):

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Troponin I ◽

Control Group ◽

Interleukin 17 ◽

Healthy Children ◽

Serum Samples ◽

History Of ◽

And Gender ◽

Interleukin 9

Abstract Objective Myocarditis is an inflammatory disease of the cardiac muscle. Prognosis is most often good but, in some patients, the disease can be fulminant. Our aim with this study was to determine interleukin-9 (IL-9) and interleukin-17 (IL-17) levels in myocarditis cases with different etiologies. Materials and methods Thirty one patients with myocarditis and 30 healthy controls of similar age and gender without a history of chronic disease were included in the study. All 31 patients were clinically myocarditis. In some of these patients, the cause of myocarditis is acute rheumatic fever or Kawasaki disease. Serum samples of the patients were taken during diagnosis in order to analyze serum IL-9 and IL-17 levels and sedimentation rate, CRP, ASO, pro-BNP, CK-MB, and Troponin-I tests were performed. Results It was found that IL-17 levels were statistically significant in all acute rheumatic fever, Myocarditis and Kawasaki patients compared to the control group (p = 0.001) and that cut-off was 4.30 pg/mL. This value was determined to be 71% sensitive and 67% specific for IL-17 (AUC = 0.761). Conclusions Both of the mean and median levels of IL-17 were significantly higher in pediatric patients with myocarditis than in healthy children. Our study made us think that complications of myocarditis and associated morbidity can be prevented by IL17 inhibitors. The high levels of IL17 found in our study may be a reference for future study.

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