1/5. Recurrent acute rheumatic fever: a forgotten diagnosis?The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/5. recurrence of Sydenham chorea: implications for pathogenesis.BACKGROUND: Sydenham chorea (SC), a major sign of rheumatic fever (RF), is related to systemic streptococcal infection and is treated with antibiotics. recurrence usually occurs within a short interval following the initial event and is considered part of RF. OBJECTIVE: To evaluate the rate, nature, and course of recurrent SC during an extended follow-up period. DESIGN: Prospective assessment of a cohort of patients with SC who were admitted between 1985 and 2002. SETTING: General community hospital. methods: diagnosis of RF was based on the revised Jones criteria. Other causes of chorea were excluded. recurrence was defined as the development of new signs, lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. patients were observed from 1 to 14 years following the initial SC episode and for at least 1 year after recurrence. At recurrence, patients were assessed for RF clinical and laboratory activity, including change in cardiac involvement. RESULTS: Twenty-four patients had SC. In 19 patients (79%), the chorea was associated with other RF signs, and 5 suffered from pure chorea. Ten patients (42%, 7 women) developed 11 recurrent episodes of chorea 3 months to 10 years after the initial episode. association of recurrent chorea with RF could be suspected in only 6 episodes: cessation of prophylactic antibiotic treatment or poor compliance in 4 patients and rise in antistreptolysin O titers in 2. In an 18-year-old woman, chorea recurred during her first pregnancy. At recurrence, chorea was the sole rheumatic sign in all 9 patients who had 1 recurrent episode. In the patient with 2 recurrent episodes, mitral regurgitation developed into mitral stenosis. No statistical differences in previous RF activity and rheumatic cardiac involvement between patients with recurrent SC and patients with a single episode could be found. CONCLUSIONS: In a significant subgroup of patients, SC recurrence might not be a true relapse of rheumatic fever. It might represent either a primary underlying abnormality that renders patients susceptible to developing such a movement disorder or the outcome of permanent subclinical damage to the basal ganglia following the initial SC episode.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/5. Acute rheumatic fever below the age of five years: a prospective study of the clinical profile.The clinical profile of acute rheumatic fever below the age of five years was studied prospectively in 53 children seen over a period of seven years. The majority presented with pain in the joints, manifested as arthritis in 81% and arthralgia in 15%. Four per cent presented with congestive heart failure. Carditis developed in 42%, with a high incidence of pericarditis (6%) and congestive heart failure (15%) and a mortality of 2%. The incidence of erythema marginatum was 2%, while chorea and subcutaneous nodules were not seen. Data from this prospective study, when compared with those of other prospective studies of acute rheumatic fever throughout childhood, clearly show a similar incidence of arthritis and carditis with a slightly more aggressive nature of carditis in children under five years. These findings are in marked contrast to recent reports describing the clinical profile of acute rheumatic fever in this age group.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/5. Acute rheumatic fever in adults: a resurgence in the Hasidic Jewish community.OBJECTIVE: To describe a series of adults diagnosed with acute rheumatic fever (ARF). methods: Retrospective chart review of 14 patients age > 18 years with suspected ARF between 1990 and 1994 in a private rheumatology practice setting. Four additional patients treated at our medical center were included in the study. RESULTS: Twelve patients met Jones criteria for rheumatic fever and were included in the study. Of these, only 3 had a childhood history of rheumatic fever. All had recent onset of arthritis and a history of antecedent sore throat. Only 4 patients, however, had throat cultures positive for B-hemolytic streptococcus. Nine patients were Hasidic jews. Four patients had carditis. One patient had erythema marginatum, while chorea and subcutaneous nodules were not seen. Nine patients improved taking nonsteroidal antiinflammatory drugs or acetylsalicylic acid; 3 required steroid treatment to control severe arthritis. CONCLUSION: Our clinical experience suggests that ARF occurs frequently, especially among Hasidic Jewish adults. Due to the disabling nature of the arthritis and the significant incidence (33%) of carditis, strict adherence to penicillin prophylaxis guidelines is indicated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/5. Rheumatic brain disease: a disease in its own right.In many cases of patients who had rheumatic fever--at times undiagnosed--there is a chronic involvement of the brain as a result of disseminated recurrent obliterating arteritis or emboli in the small blood vessels, especially in the brain membranes or the cortex. As a result, disseminated, unstable, and transient neurological and psychiatric symptoms appear. The nature of these symptoms depends upon the age of the patient and the time of onset of the disease. It is suggested that the term "rheumatic brain disease" or "rheumatic encephalopathy" be used, and introduced into the nomenclature of the American Rheumatic association.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |