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Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
The diagnosis of acute rheumatic fever is based on Jones', criteria which include two major manifestations (carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules) or one major and two minor manifestations (fever, arthralgia, previous rheumatic fever or rheumatic heart disease, raised ASO titre, raised ESR, leucocytosis, C-reactive protein, prolonged P-R interval). The mitral valve is most commonly involved, and this usually presents with the murmur of mitral incompetence. As the relationship between acute rheumatic carditis and streptococcal, infection is well established, appropriate treatment consists of therapeutic dosages of penicillin followed by long-term penicillin prophylaxis. Rheumatic chorea is often accompanied by emotional lability, deterioration in school performance and poor coordination. The affected muscles are weak and the deep tendon reflexes are variable.
Diagnostic Approach to Rash and Fever in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Lee S. Engel, Charles V. Sanders, Fred A. Lopez
Carditis associated with rheumatic fever manifests as pericarditis, myocarditis, and endocarditis, most commonly involving the mitral valve, followed by the aortic valve [300,301]. Rheumatic heart disease is a late sequela of acute rheumatic fever, occurring 10–20 years after the acute attack, and is the most common cause of acquired valvular disease in the world [302]. The mitral valve is most commonly affected with resultant mitral stenosis that often requires surgical correction.
Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Meningococcal disease can induce problems of unexplained fever in the following circumstances: chronic meningococcemia (without meningitis). This clinical form is manifested initially by a prodromal episode of upper respiratory illness, or a viral exanthem. A few days or weeks after so-called recovery, the patient develops fever, weakness, headache, petechial rash, splenomegaly, arthralgia or arthritis and, in severe cases, hypotension and prostration. The pattern of fever is intermittent and the infection may last for weeks or months, with afebrile periods lasting up to 10 days. Without adequate diagnosis and treatment, severe complications may appear, e.g., carditis, nephritis and, especially, meningitis. This clinical picture must be distinguished from that of recurrent meningococcal meningitis.40
Epidemiology of infective endocarditis: novel aspects in the twenty-first century
Published in Expert Review of Cardiovascular Therapy, 2022
Verda Arshad, Khawaja M. Talha, Larry M. Baddour
A serial review of the incidence and epidemiology of a disease is critical as one considers burden of disease and strategies to invoke to hopefully reduce disease incidence based on epidemiological findings. IE is no exception. Some success has been achieved with the decades-long attack on RHD. Fortunately, multiple international agencies have accepted the challenge to rid the world of rheumatic fever. Unfortunately, much more needs to be done in low- and middle-income countries to reduce RHD incidence, and IE as a complication of it. Improving hygiene should help reduce the prevalence of underlying rheumatic carditis as a substrate for the subsequent development of IE. The availability of a Streptococcus pyogenes vaccine, which has been the focus of decades of investigation, will be a promising development in IE incidence reduction [112]. The World Health Foundation (WHF) and the World Health Organization (WHO) have set a target to have a vaccine in phase III clinical trials by 2023. If this goal is met, it can help eliminate RHD-IE.
Serum periostin levels in acute rheumatic fever: is it useful as a new biomarker?
Published in Paediatrics and International Child Health, 2020
In conclusion, recent studies have suggested that periostin may be a novel biomarker and potential therapeutic target because of its specificity and unique qualities within cardiac mesenchymal tissue. A significant increase of serum periostin levels in ARF and reduction after adequate treatment was demonstrated. This increase was independent of the severity of carditis and was most significant in the co-occurrence of carditis and arthritis. Periostin may be a new biomarker which acts as an acute phase reactant in ARF and may be a useful biomarker of disease progression once the initial diagnosis has been made. As periostin is also elevated in inflammation, allergy and cancer, further and larger studies are needed to clarify the usefulness of periostin as a potential biomarker in ARF, as well as treatment responses, and to predict permanent valvar lesions.
Association of IL17 and IL23R gene polymorphisms with rheumatic heart disease in South Indian population
Published in Immunological Investigations, 2018
Maheshkumar Poomarimuthu, Sivakumar Elango, Pravin Raj Solomon, Sambath Soundrapandian, Jayalakshmi Mariakuttikan
Rheumatic heart disease (RHD) is an autoimmune disease caused by abnormal immune response against group A β-hemolytic streptococci (GAS) infection aggravated by rheumatic fever (RF). The autoimmune reaction in RHD occurs via molecular mimicry between the GAS antigens and human cardiac proteins mediated by both cross-reactive antibodies and T cells (Carapetis et al., 2016; Cunningham, 2014; Mastrandrea, 2015). Global Burden of Disease study estimates that there are 33 million RHD patients in the world and it accounts for 275,000 annual deaths. RHD is known to cause the highest cardiovascular disease-related loss of disability-adjusted-life-years among children and young adults (10–14 years) in low- and middle-income countries (Abubakar et al., 2015). Various studies reported that there are 2–4 million RHD patients in India (Kumar and Tandon, 2013). Rheumatic carditis is an inflammatory condition characterized by cellular infiltration (mainly CD4+ T cells) of endocardium and valve tissues which results in progressive valvular damage that leads to RHD (Guilherme and Kalil, 2010; Guilherme et al., 2001; Roberts et al., 2001). Recent studies indicated the involvement of Th17 cells in the pathogenesis of RHD (Bas et al., 2014; Wen et al., 2015).