scholarly journals Atypical presentation of rheumatic fever

2021 ◽  
pp. 412-415
Author(s):  
Sushil Yewale ◽  
Keya Lahiri ◽  
Fehmida Najmuddin ◽  
Anand Sude
Keyword(s):  
Young Children ◽  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Aortic Regurgitation ◽  
Acute Rheumatic Fever ◽  
Adverse Reactions ◽  
Atypical Presentation ◽  
Sydenham Chorea ◽  
Psychosocial Disability ◽  
Shed Light

Sydenham Chorea (St. Vitus dance) occurs in about 10-15% of children with acute rheumatic fever. Herein, we present the case of a 5-year-old male child with hemichorea and arthralgia. The child also presented with mild mitral regurgitation and mild aortic regurgitation. Appropriate management is essential to prevent mortality, morbidity, and psychosocial disability in such cases. We would also like to shed light on the challenges faced in the management of chorea in young children with key emphasis on the anticipation of adverse reactions to commonly used medications.

Valvular heart disease

2012 ◽  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Rheumatic Fever ◽  
Aortic Regurgitation ◽  
Valvular Heart Disease ◽  
Mitral Valve Prolapse ◽  
Mitral Stenosis ◽  
Acute Rheumatic Fever

General considerations 144Acute rheumatic fever 146Mitral stenosis: clinical features 150Mitral stenosis: investigations 152Mitral stenosis guidelines 156Mitral regurgitation 158Mitral regurgitation guidelines 161Mitral valve prolapse 162Aortic stenosis 164Management of aortic stenosis 168Aortic regurgitation 170Aortic regurgitation guidelines ...

Evaluation of subclinical valvar disease in patients with rheumatic fever

2003 ◽  
Vol 13 (6) ◽  
pp. 495-499 ◽  
Author(s):  
Suheyla Ozkutlu ◽  
Olgu Hallioglu ◽  
Canan Ayabakan
Keyword(s):  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Aortic Regurgitation ◽  
Doppler Echocardiography ◽  
Acute Rheumatic Fever ◽  
Disease Treatment ◽  
Permanent Disability ◽  
Subclinical Disease ◽  
Diagnostic Criterion ◽  
Adequate Evidence

Carditis is the only manifestation of acute rheumatic fever that leads to permanent disability. Hence, its diagnosis is of paramount importance. Recently, it has been reported that Doppler echocardiography has disclosed subclinical valvar regurgitation in some patients with acute rheumatic fever manifested as isolated arthritis or pure chorea. The prognosis of such patients with acute rheumatic fever and subclinical valvitis is not clear. We aimed, therefore, prospectively to investigate the potential to diagnose patients with subclinical carditis. We examined 40 patients, aged from 7 to 16 years, with Doppler evidence of mitral and aortic regurgitation, but in the absence of any pathologic murmur. The major findings satisfying the Jones criterions were arthritis in 29 patients, chorea in 10 patients, and arthritis and erythema marginatum in one patient. Of the patients, 33 had mitral regurgitation, 6 patients had combined mitral and aortic regurgitation, and one patient had aortic regurgitation. The patients were followed over a mean period of 18.1 ± 13.9 months, the valvar regurgitation disappearing in 23 (57.5%). No significant differences were observed in the resolution of the valvitis between those treated with acetylsalicylic acid, steroids, or those receiving no treatment. It is noteworthy, nonetheless, that patients treated with steroids were the fastest to recover from valvitis (p < 0.05).Based on our study, we suggest that subclinical valvitis demonstrated by echocardiography should now be accepted as adequate evidence for the diagnosis of carditis, and become a major diagnostic criterion for acute rheumatic fever. When managing this group of patients with subclinical disease, treatment with steroids seems to have a role in promoting early resolution of the valvitis.

scholarly journals Clinical profile of acute rheumatic fever patients attending a tertiary care hospital in eastern Bihar, India

2017 ◽  
Vol 4 (5) ◽  
pp. 1218
Author(s):  
Shanker Suman ◽  
Rakesh Kumar ◽  
Divya Jyoti ◽  
Pramod Kumar Agrawal ◽  
Vishal Parmar
Keyword(s):  
Heart Disease ◽  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Aortic Regurgitation ◽  
Rheumatic Heart Disease ◽  
Joint Pain ◽  
Acute Rheumatic Fever ◽  
Care Hospital ◽  
Autoimmune Reaction ◽  
Rheumatic Heart

Background: Acute rheumatic fever (ARF) is a multisystem disease resulting from an autoimmune reaction to infection with group A beta haemolytic streptococcus. Acute rheumatic fever commonly occurs between 5-14 years of age.1 The major concern relating to acute rheumatic fever is often not the episode itself but the long-term consequences of damage to heart valves (Rheumatic heart disease (RHD) that often results from recurrent episodes of acute rheumatic fever. Rheumatic heart disease (RHD) continues to be a major public health problem and a common cause of morbidity and mortality in many parts of India.2Methods: 50 consecutive patients admitted with the diagnosis of acute rheumatic fever in Medicine Department, Katihar Medical College and Hospital, Bihar, India were studied. A detailed clinical history of these patients including presenting symptoms were noted. Physical examination of all systems was done and a diagnosis of acte rheumatic fever was made according to WHO Criteria (2002-2003) for the diagnosis of rheumatic fever and rheumatic heart disease (Based on the Revised Jones Criteria). Echocardiography of all 50 patients were done.Results: Mean age of patients diagnosed with ARF was 14.20±7.02 years. Out of 50 patients, 32 (64%) were female and 18 (36%) were male. Joint pain was the commonest presenting complain, 35 (70%) patients, followed by fever in 21 (42%) patients. Among Jones major manifestations 36 (72%) cases had carditis, 32 (64%) had arthritis, 6 (12%) had subcutaneous nodules, 5 (10%) had erythema marginatum and5(10%) had Sydenham’s chorea. In patients with carditis, 25 (69.44%) had mitral regurgitation (MR) only while 10 (27.77%) had MR with aortic regurgitation (AR) and 1 (2.77%) patient had organic tricuspid regurgitation (TR) with mitral regurgitation and aortic regurgitation. Out of 36 patients with carditis, 10 (27.77%) patients did not have any clinical evidence of carditis and were detected by echocardiography only.Conclusions: Commonest complain in patients with rheumatic fever was joint pain followed by fever. In patients with carditis, all had mitral regurgitation(MR), with 1/3rd of these patients having associated aortic regurgitation(AR). 1/3rd of patients with carditis were detected by echo only and therefore, echo should be included in diagnostic criteria for acute rheumatic fever. None of the patients who developed rheumatic fever was on penicillin prophylaxis.

Criteria for judging the improvement in subclinical rheumatic valvitis

2003 ◽  
Vol 13 (6) ◽  
pp. 500-505 ◽  
Author(s):  
Sevim Karaaslan ◽  
Saadet Demirören ◽  
Bülent Oran ◽  
Tamer Baysal ◽  
Osman Başpinar ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Aortic Regurgitation ◽  
Short Duration ◽  
Acute Rheumatic Fever ◽  
Aortic Valves ◽  
Cross Sectional

Recent technical improvements in cross-sectional echocardiography have made it possible to detect even mild organic regurgitation of the mitral and aortic valves in patients with acute rheumatic fever. To determine the prevalence and prognosis of subclinical valvitis, we have analyzed 104 patients with acute rheumatic fever referred to our institution. Of 53 patients who had no murmur, 22 of them with polyarthritis, 29 with chorea, and 2 with polyarthritis and chorea, 23 (43.4%) had subclinical valvitis. Isolated mitral regurgitation was the most common valvar lesion, seen in 82.6% of the patients. Isolated aortic regurgitation was detected in 4.4% of the cases, and combined mitral and aortic regurgitation in the remaining 13%. During follow-up, the degree of mitral regurgitation improved in 59.1%, decreased in 18.2%, and increased or remained unchanged in 22.7% according to the length of colour jet. According to criterions of velocity, mitral regurgitation improved in 86.4% of the patients, and increased or unchanged in the remaining 13.6%. Mitral regurgitation disappeared completely in 6 of the patients (27.3%) as judged according to both the length of colour jet and the velocity of regurgitation. Aortic regurgitation improved in all the patients with this problem, disappearing completely in two of the four.Based on this experience, we suggest that not only the disappearance of regurgitation, but also improvements in the echocardiographic diagnostic criterions of regurgitation, such as the length of the colour jet less than 1 cm, or velocity less than 2.5 m/s, or indicative of regurgitation that is either intermittent or of short duration, should also be considered as criterions indicating improvement in valvar regurgitation in patients with subclinical rheumatic valvitis.

Suspected acute rheumatic fever in a young man in England

2021 ◽  
Vol 14 (11) ◽  
pp. e244469
Author(s):  
Zak Michael Wilson ◽  
Katie Craster
Keyword(s):  
Chest Pain ◽  
General Practitioner ◽  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Supportive Therapy ◽  
Acute Hospital ◽  
Shortness Of Breath ◽  
Pleural Effusions ◽  
Pericardial Thickening

A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.

Are all recurrences of “pure” Sydenham chorea true recurrences of acute rheumatic fever?

1985 ◽  
Vol 107 (6) ◽  
pp. 867-872 ◽  
Author(s):  
X. Berrios ◽  
F. Quesney ◽  
A. Morales ◽  
J. Blazquez ◽  
A.L. Bisno
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Sydenham Chorea

Subclinical rheumatic valvitis: a long-term follow-up

2003 ◽  
Vol 13 (5) ◽  
pp. 431-438 ◽  
Author(s):  
Cristina Costa Duarte Lanna ◽  
Edward Tonelli ◽  
Marcio Vinicius Lins Barros ◽  
Eugenio Marcos Andrade Goulart ◽  
Cleonice Carvalho Coelho Mota
Keyword(s):  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Aortic Regurgitation ◽  
Confidence Intervals ◽  
Doppler Echocardiography ◽  
The Other ◽  
Control Group ◽  
Healthy Children ◽  
Long Term Follow Up

In order prospectively to investigate the frequency and evolution of subclinical valvitis, we selected 40 consecutive patients suffering their initial attack of rheumatic fever, seen in our clinic from 1992 to 1994, and followed-up until 2001, with a mean period of follow-up of 8.1 years, and a standard deviation of 0.6 year. We also assembled a matched control group of 37 healthy children and adolescents. We discovered a murmur of mitral regurgitation in 28 (70.0%) of the patients. In 3 (7.5%) of these patients, there was also a murmur of aortic regurgitation. In the group of 28 symptomatic patients, Doppler echocardiography showed mitral regurgitation in all, and aortic regurgitation in 17. In the group of 12 patients without clinical evidence of cardiac involvement, Doppler echocardiography identified mitral regurgitation in 2, isolated in one and associated with aortic regurgitation in the other. Thus, the frequency of subclinical valvitis was 16.7%. In patients with subclinical valvitis only the aortic regurgitation regressed during the period of follow-up. In the group of 28 symptomatic patients, mitral regurgitation disappeared in 6 (21.4%), aortic regurgitation in 7 of the 17 having this feature (41.2%), while 2 patients (7.1%) developed mitral stenosis. The sensitivity and specificity of cardiac auscultation were, respectively, 93.3%, with 95% confidence intervals between 72.3% and 97.4%, and 100%, with 95% confidence intervals between 65.5% and 100%, for the diagnosis of mitral regurgitation, and 16.7%, with 95% confidence intervals between 4.4% and 42.3%, and 100%, with 95% confidence intervals between 81.5% and 100%, for that of aortic regurgitation. We conclude that the Doppler echocardiogram is an important means of diagnosing and assessing the evolution of subclinical rheumatic valvar lesions, which are not always transient. We suggest that Doppler echocardiography should be performed in all patients with acute rheumatic fever. Subclinical valvitis should be considered as mild carditis, provided that strict criterions are observed in the differential diagnosis from physiological regurgitation, and Doppler echocardiographic findings are analyzed in the context of the other manifestations of the disease.

A case of acute rheumatic fever: Echocardiographic findings for mitral regurgitation in acute rheumatic carditis.

1987 ◽  
Vol 51 (12) ◽  
pp. 1393-1396 ◽  
Author(s):  
YASUHISA KAJINO ◽  
HAJIME IWAYANI ◽  
NORIYUKI HANEDA ◽  
MASAKAZU SAITO ◽  
TOSHIKAZU NISHIO ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Rheumatic Carditis ◽  
Echocardiographic Findings

Penicillin and Acute Rheumatic Fever

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 506-507
Author(s):  
Bernard Boxerbaum
Keyword(s):  
Heart Disease ◽  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Acute Rheumatic Fever ◽  
Secondary Prophylaxis ◽  
Benzathine Penicillin ◽  
Childrens Hospital ◽  
Rheumatic Heart

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4

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