DOCSLIB.ORG

Acute Rheumatic Fever and Rheumatic Heart Disease in Resource-Limited Settings

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Acute Rheumatic Fever and Rheumatic Heart Disease in Resource-Limited Settings Downloaded from http://adc.bmj.com/ on April 28, 2017 - Published by group.bmj.com Global child health Acute rheumatic fever and rheumatic heart disease in resource-limited settings Gabriella Watson,1 Bintou Jallow,1 Kirsty Le Doare,1,2 Kuberan Pushparajah,3 Suzanne T Anderson1 ▸ Additional material is ABSTRACT working in resource-limited settings in their diag- published online only. To view Poststreptococcal complications, such as acute rheumatic nosis and management, and approaches for over- please visit the journal online fi (http://dx.doi.org/10.1136/ fever (ARF) and rheumatic heart disease (RHD), are coming some of these dif culties. archdischild-2014-307938). common in resource-limited settings, with RHD recognised as the most common cause of paediatric ACUTE RHEUMATIC FEVER 1Gambia Unit, Medical Research Council, Fajara, heart disease worldwide. Managing these conditions in Case vignette The Gambia resource-limited settings can be challenging. We review A 12-year-old Gambian girl presented to a health 2Wellcome Centre for Global the investigation and treatment options for ARF and centre complaining of lethargy, arthralgia and inter- Health Research, Imperial RHD and, most importantly, prevention methods in an mittent fever. She was diagnosed with clinical College, London, UK 3Department of Congenital African setting. malaria and treated accordingly. Heart Disease, Evelina London Four months later she presented to clinic with Children’s Hospital, Guy’s&St similar symptoms. On examination she looked Thomas’ NHS Foundation INTRODUCTION acutely unwell with a soft systolic murmur in the Trust, London, UK Infections caused by Group A streptococcus (GAS) mitral area. Blood tests showed leukocytosis and a fi Correspondence to were identi ed as the ninth leading cause of global raised erythrocyte sedimentation rate (ESR) of Dr Gabriella Watson, Gambia mortality from an individual pathogen in the 2004 130 mm/h. Chest radiograph (CXR) showed car- Unit, Medical Research World Health Report.1 The WHO reported 18.1 diomegaly (figure 1A). ECG showed prolonged PR Council, PO Box 273 Fajara, million people living with serious GAS disease interval, and ECHO demonstrated a moderately The Gambia; [email protected] (acute rheumatic fever (ARF), rheumatic heart dilated left ventricle and left atrium with moderate disease (RHD), RHD-related stroke or infective mitral regurgitation (see figure 1B and online sup- Received 26 December 2014 endocarditis and invasive GAS diseases (iGAS)) and plementary video). A throat swab grew GAS. She Revised 2 February 2015 5 170 000 deaths in 2005. The majority of deaths was diagnosed with ARF and admitted for inpatient Accepted 3 February 2015 were attributable to RHD complications, iGAS or treatment; bed rest with mobilisation as symptoms acute poststreptococcal glomerular nephritis allowed, intramuscular benzathine penicillin (APSGN). Close living conditions, overcrowding 900 mg, aspirin 50 mg/kg/day in five divided doses, and poor hygiene promote transmission, while lisinopril 10 mg once daily and frusemide 40 mg poor public health infrastructure prevents early rec- twice daily. Her symptoms improved, and she was ognition, prompt treatment and appropriate pre- discharged 7 days later on monthly intramuscular vention measures.2 While ARF is debilitating, it is benzathine penicillin, regular frusemide, lisinopril the long-term sequelae of RHD that are the most and 3 months of aspirin. Outpatient follow-up was devastating; young children and adolescents pre- arranged 2 weeks later for repeat ESR and to senting with limited exercise capacity and young monitor progress. women presenting in pregnancy or post childbirth She missed her initial follow-up appointment in congestive cardiac failure (CCF). Data from the due to financial constraints, but presented paediatric cardiac clinic at the Medical Research 2 months later complaining of worsening exercise Council Gambia Unit have demonstrated a median tolerance since her medications finished. On exam- age of presentation with symptomatic RHD of ination she had a raised jugular venous pressure, 11 years (work in preparation, Watson et al). A sys- pedal oedema, hepatomegaly of 6 cm and bilateral tematic review by Carapetis et al3 of GAS diseases basal crackles on chest auscultation. Repeat ECHO estimated 1.88 million existing cases of ARF glo- revealed worsening mitral regurgitation. She was bally and 180 000 new cases annually. diagnosed with RHD with CCF and admitted for RHD is the most common cause of paediatric treatment with intravenous frusemide 1 mg/kg heart disease worldwide.4 The estimated prevalence twice a day, lisinopril 10 mg once daily, intramuscu- among 5 year olds to 14 year olds in Sub-Saharan lar benzathine penicillin 900 mg and restarted on Africa is 5.7/1000 compared with 0.3/1000 in aspirin 50 mg/kg/day in five dived doses. Her symp- developed countries.3 More recent echocardio- toms gradually improved, and she was discharged graphic (ECHO) screening programmes in to home 6 days later on her previous medications Mozambique and Uganda have shown prevalence and the importance of regular outpatient follow-up rates of RHD in schoolchildren of 30.4/1000 and emphasised. 14.8/1000, respectively.56With RHD accounting for 5.9 million disability-adjusted life-years lost in Diagnosing acute rheumatic fever: are the Jones fi To cite: Watson G, 2002, this poses a signi cant medical and socio- criteria appropriate for high-prevalence Jallow B, Le Doare K, et al. economic burden on populations.1 In this article, settings? Arch Dis Child we review the cardiac complications of iGAS ARF is a short-lived, multisystem, autoimmune – 2015;100:370 375. disease, the challenges faced by the clinician disease that progresses to RHD in up to 80% of 370 Watson G, et al. Arch Dis Child 2015;100:370–375. doi:10.1136/archdischild-2014-307938 Downloaded from http://adc.bmj.com/ on April 28, 2017 - Published by group.bmj.com Global child health What investigations are required to diagnose ARF? All patients should be admitted ensuring appropriate investiga- tions, management and education. Box 1 outlines the investiga- tions recommended—these may have to be adapted depending on diagnostic facilities available. In particular, absence of cardi- ologists, appropriate ultrasound equipment or staff skilled in completing and interpreting findings may make cardiac ECHO unfeasible. How do you manage a patient with ARF? Patients with carditis and heart failure should be put on bed rest. The initial use of salicylates, corticosteroids or non- steroidal anti-inflammatories should be avoided until clinical diagnosis is established as diagnostic symptoms can be masked.8 Table 2 illustrates treatment options summarised from the WHO and Australian guidelines for the management of ARF. RHEUMATIC HEART DISEASE Composite case vignette A 15-year-old boy presented to our clinic with fever, cough, leg swelling and poor exercise tolerance for 4 months. On examin- ation he was wasted, weight of 35 kg, short of breath at rest, had a soft systolic murmur and an irregular heart rate. He was admitted for investigation and treatment. CXR showed massive cardiomegaly and pulmonary plethora. ECHO demonstrated significantly thickened and regurgitant aortic and mitral valves (MV) resulting in a hugely dilated left atrium and ventricle. The tricuspid valve was similarly affected. Ventricular function was preserved, with an ejection fraction of 70%. He had an ESR of 50 mm/h without lymphocytosis and three negative blood cul- tures. Throat swab showed no growth. He was diagnosed with multivalvular RHD and CCF and managed with intravenous frusemide, lisinopril, penicillin prophylaxis and discharged 6 days later. In the following year, he had eight further admissions with decompensated heart failure. Given the limited medical and sur- Figure 1 (A) A plain chest radiograph demonstrating an enlarged gical resources for patients with RHD in The Gambia, definitive cardiothoracic ratio due to cardiomegaly. The carina is also splayed due surgical treatment (mitral and tricuspid annuloplasty and mech- to the marked enlargement of the left atrium (LA). There is coexisting anical aortic valve (AV) replacement) was performed overseas, evidence of pulmonary congestion. (B) A parasternal long-axis funded by a charitable organisation. He made a rapid post- echocardiographic view demonstrating a markedly dilated LA. The operative recovery and is currently managed on intramuscular mitral valve (MV) leaflets appear thickened and have restricted Benzathine Penicillin, lisinopril, bisoprolol and warfarin adjusted movement with a typical ‘hockey stick’ appearance of the anterior MV leaflet. This view is shown as a moving image in online supplementary according to monthly international normalised ratio (INR) mea- fi video. LV, left ventricle. surements. He has good exercise tolerance and signi cantly improved nutritional status. cases. There is no specific laboratory test for ARF and diag- How do you diagnose RHD in low-resource settings? nosis remains a clinical one, based on major and minor cri- ECHO is the most sensitive and specific diagnostic tool for teria first outlined by Jones in 1944. Changes have been RHD,9 and standardised ECHO criteria for diagnosing asymp- made to increase specificity at the expense of sensitivity, tomatic RHD exist.10 The most commonly affected valves are primarily for resource-rich countries. However, in areas the MV and AV. Morphological features of MV disease in RHD where the risk of underdiagnosis may outweigh
Load more

Recommended publications
  • Rheumatic Fever and Rheumatic Heart Disease
    SEVENTY-FIRST WORLD HEALTH ASSEMBLY A71/25 Provisional agenda item 12.8 12 April 2018 Rheumatic fever and rheumatic heart disease Report by the Director-General 1. In May 2017, the Executive Board, at its 141st session, noted an earlier version of this report1 and adopted resolution EB141.R1 on rheumatic fever and rheumatic heart disease. Paragraphs 15 and 18 in this report contain new text in response to comments from Member States. WHERE DO WE STAND TODAY? 2. Rheumatic heart disease is a preventable yet serious public health problem in low- and middle-income countries and in marginalized communities in high-income countries, including indigenous populations. 3. The disease results from damage to heart valves caused by one or several episodes of rheumatic fever, an autoimmune inflammatory reaction to throat infection caused by group A streptococci (streptococcal pharyngitis). It most commonly occurs in childhood, and can lead to death or life-long disability. Effective early intervention can prevent premature mortality from rheumatic heart disease. 4. Some 30 million people are currently thought to be affected by rheumatic heart disease globally,2 and in 2015 rheumatic heart disease was estimated to have been responsible for 305 000 deaths and 11.5 million disability-adjusted life years lost. Of these deaths 60% occurred prematurely (that is, before the age of 70 years), although these figures are very uncertain owing to incomplete data in many countries. Despite the availability of effective measures for prevention and treatment, there has been little change in the contribution of rheumatic heart disease to overall global mortality between 2000 and 2015.3 5.
    [Show full text]
  • Valvular Heart Disease Acute Rheumatic Fever
    Valvular heart disease Acute rheumatic fever Rheumatic fever • It typically occurs several weeks after streptococcal pharyngitis. • The most common pathogen is group A beta-hemolytic streptococci (GABHS) • Streptococcus cross-react with proteins in cardiac valves. • Time from acute streptococcal infection to onset of symptomatic rheumatic fever (RF) is usually 3–4 weeks. • RF is thought to complicate up to 3% of untreated streptococcal sore throats. • Previous episodes of RF predispose to recurrences. Diagnostic criteria for rheumatic fever (Jones criteria) • Evidence of group A streptococcal pharyngitis • Either a positive throat culture or rapid streptococcal antigen test, or an elevated or rising streptococcal antibody titer (samples taken 2 weeks apart). • Plus two major or one major and two minor Jones criteria: Major criteria Minor criteria • Polyarthritis • Fever • Carditis • Arthralgia • Chorea • Prolonged PR interval • Erythema marginatum • Elevated ESR and CRP • Subcutaneous nodules Joints • Migratory large-joint polyarthritis starting in the lower limbs in 75% of cases. Duration is <4 weeks at each site. There is severe pain and tenderness in contrast to a mild degree of joint swelling. Heart • Pancarditis occurs in 50% of cases with features of acute heart failure, mitral and aortic regurgitation, and pericarditis. • Endocarditis • affects the mitral valve (65%–70%), aortic valve (25%), and tricuspid valve (10%, never in isolation), causing acute regurgitation and heart failure but chronic stenosis. • Pericarditis • Pain • Friction rub • rarely causes hemodynamic instability/tamponade or constriction. Heart Myocarditis • Acute heart failure • Arrhythmias • Most common reason of death Skin • Erythema marginatum is an evanescent rash with serpiginous outlines and central clearings on the trunk and proximal limbs.
    [Show full text]
  • Rheumatic Fever and Rheumatic Heart Disease in Children Below the Age of 5 Years in the Tropics
    Ann Rheum Dis: first published as 10.1136/ard.24.4.389 on 1 July 1965. Downloaded from Ann. rheumn. Dis. (1965). 24, 389. RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN CHILDREN BELOW THE AGE OF 5 YEARS IN THE TROPICS BY ZAHIRA H. ABDIN AND A. EISSA From the Rheumatic and Heart Unit, Children's Hospital, Cairo University, Egypt Rheumatic fever and particularly rheumatic heart months. The history and main clinical finding in disease have always been regarded as rare conditions these four cases is given in the footnote below.* below the age of 5 years and as very rare below 3 years The sex distribution was 42 females to 26 males, (Holt and McIntosh, 1953). Reported cases are i.e. 2-4:1 compared to a general incidence of 1 7:1 few and no account of the clinical pattern of the (Table I). disease in the small child has been found in the TABLE I literature. SEX RATIO AND FAMILIAL TENDENCY In the Rheumatic and Heart Clinic, in Cairo Rto Positive Familial University Hospital, we have had the opportunity Group No. of Sex Ratio History* of examining large numbers of children referred with Cases Female:Male (per cent.) rheumatic fever and rheumatic heart disease in the 1. Children below 5 last 4 years. It was thus possible to collect a fairly years .. 68 2-4:1 20-5 copyright. large group of younger children with the disease and II. Children of all ages 1.7:11,000 3 - 5 we were able to examine the incidence as well as the special features of rheumatic fever and rheumatic * X2 82-5.
    [Show full text]
  • Rheumatic Heart Disease
    put together by Alex Yartsev: Sorry if i used your images or data and forgot to reference you. Tell me who you are. [email protected] Rheumatic Heart Disease History of Presenting Illness - Dyspnoea on exertion or at rest - Nocturnal dyspnoea - Orthopnoea - Swollen ankles4 - “mitral facies” - Palpitations - Chest pain Differential Diagnoses Aortic Stenosis, Valvar Human Immunodeficiency Virus Infection Aortic Valve Insufficiency Kawasaki Disease Aortic Valve, Bicuspid Mitral Stenosis, Congenital Appendicitis Mitral Valve Insufficiency Arthritis, Septic Mitral Valve Prolapse Cardiac Tumors Myocarditis, Viral Cardiomyopathy, Dilated Pericardial Effusion, Malignant Carnitine Deficiency Pericarditis, Bacterial Coccidioidomycosis Pericarditis, Viral Endocarditis, Bacterial Sarcoidosis Heart Failure, Congestive Systemic Lupus Erythematosus Histoplasmosis Transient Synovitis How is this diagnosis made? The Jones criteria require the presence of 2 major or 1 major and 2 minor criteria major diagnostic criteria minor diagnostic criteria - Carditis - fever - Polyarthritis - arthralgia - Chorea - prolonged PR interval on ECG - subcutaneous nodules - elevated ESR or CRP - erythema marginatum - leukocytosis Additional evidence of previous group A streptococcal pharyngitis is required - Positive throat culture or rapid streptococcal antigen test - Elevated or rising streptococcal antibody titer - History of previous rheumatic fever or rheumatic heart disease Pertinent Findings on History - PAST HISTORY OF RHEUMATIC HEART DISEASE: most important. - CHILDHOOD STREP THROAT: school age (peak 5-15years) Findings on Examination CARDIAC MANIFESTATIONS: Rapid irregular pulse!! AF - Pancarditis is the most serious and second most common complication of rheumatic fever (50%). In advanced cases, patients may complain of dyspnea, mild-to-moderate chest discomfort, pleuritic chest pain, edema, cough, or orthopnea. - carditis is most commonly detected by a new murmur and tachycardia out of proportion to fever.
    [Show full text]
  • Rheumatic Fever and Rheumatic Heart Disease 2
    2 Rheumatic fever and rheumatic heart disease from RHD CYAN MAGENTA YELLOW BLACK Deaths from rheumatic heart disease ICELAND 2 Rheumatic fever and FINLAND Number of deaths SWEDEN NORWAY 2002 rheumatic heart disease ESTONIA RUSSIAN 10 000 and above 500–999 0–9 UNITED LATVIA FED. KINGDOM Rheumatic fever usually follows DENMARK LITHUANIA 5000–9999 100–499 no data an untreated beta-haemolytic IRELAND NETH. BELARUS POLAND streptococcal throat infection in BELGIUM GERMANY 1000–4999 10–99 CZECH UKRAINE REPUBLIC SLOVAKIA children. It can affect many parts LUX. REP. HUNGARY MOLDOVA AUSTRIA ROMANIA of the body, and may result in FRANCE SWITZ. SLOVENIA BOSNIA & S. MARINO HERZEGOVINA rheumatic heart disease, in which CANADA CROATIA SERBIA & BULGARIA RUSSIAN FEDERATION MONTENEGRO ANDORRA MONACO ITALY the heart valves are permanently If treated, ALBANIA PORTUGAL FYR MACEDONIA damaged, and which may progress 75% of people SPAIN to heart failure, atrial fibrillation, with rheumatic GREECE fever recover KAZAKHSTAN and embolic stroke. MALTA MONGOLIA completely. Nowadays, rheumatic fever U S A DPR GEORGIA UZBEKISTAN KYRGYZSTAN KOREA JAPAN ARMENIAAZERBAIJAN mostly affects children in TURKEY TURKMENISTAN REP. TAJIKISTAN KOREA developing countries, especially CYPRUS SYRIAN ARAB TUNISIA REPUBLIC CHINA MOROCCO LEBANON AFGHANISTAN where poverty is widespread. Up ISRAEL IRAQ ISL. REP. JORDAN IRAN MARSHALL ISLANDS to 1% of all schoolchildren in KUWAIT PAKISTAN BHUTAN KIRIBATI BAHAMAS ALGERIA LIBYAN NEPAL CUBA ARAB BAHRAIN QATAR Africa, Asia, the Eastern MEXICO JAMAHIRIYA NAURU EGYPT UAE BANGLADESH TUVALU Mediterranean region and Latin DOMINICAN SAUDI ARABIA INDIA JAMAICA REP. MYANMAR LAO BELIZE HAITI PDR SAMOA COOK MAURITANIA OMAN VIET NAM America show signs of the ST KITTS & NEVIS ANTIGUA & BARBUDA ISLANDS GUATEMALA HONDURAS MALI FIJI DOMINICA CAPE VERDE NIGER THAILAND VANUATU EL SALVADOR ST VINCENT & GRENADINES SENEGAL ERITREA YEMEN disease.
    [Show full text]
  • What About My Child and Rheumatic Fever? (PDF)
    ANSWERS Cardiovascular Conditions by heart What About My Child and Rheumatic Fever? Rheumatic fever is an inflammatory reaction that can occur after a streptococcal infection of the throat (“strep throat”). Most strep throat infections don’t lead to rheumatic fever. When they do, the time between the strep throat and rheumatic fever is about two to four weeks. Rheumatic fever is not contagious; however, the strep infection that comes before it is. If a strep throat infection is treated, rheumatic fever can almost always be prevented. Anyone can get rheumatic fever, but those who do are often 5 to 15 years old. What are the common symptoms of strep Symptoms can vary widely, but may include: throat? • Fever Symptoms of strep throat include (but are not limited to): • Painful, tender, red, swollen joints • Sudden onset of a sore throat • Shortness of breath • Pain on swallowing • Skin rashes, especially on the chest or abdomen • Fever (usually 101-104°F) • Bumps under the skin • Headache • Abdominal pain, nausea, and vomiting, especially in Does it always affect the heart? children No. When it does, the damage may either disappear or remain. When rheumatic fever causes permanent heart The symptoms may be mild in some children. If your damage, it’s called rheumatic heart disease. child has a sore throat, you can’t know for sure if it’s strep throat unless you take him or her to a doctor. Is there a cure for it? How does rheumatic fever affect the body? There’s no “miracle drug” to cure it. An attack of rheumatic fever usually subsides within a few weeks to It may affect many parts of the body.
    [Show full text]
  • Rheumatic Heart Disease Lakshmi Vasudha*
    Short Communication 2020 iMedPub Journals www.imedpub.com DOI: 10.36648/2471-8157.6.4.e104 Rheumatic Heart Disease Lakshmi Vasudha* Department of Microbiology, Andhra University, Vishakhapatnam, India. Received: November 15, 2020; Accepted: November 23, 2020; Published: November 28, 2020 *Corresponding author: Dr. Lakshmi Vasudha Abstract [email protected] Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. Rheumatic Department of Microbiology, Andhra fever is an inflammatory disease that can affect many connective University, Vishakhapatnam, India. tissues, especially in the heart. Untreated or under-treated strep infections put a person at increased risk. Citation: Vasudha L (2020) Scope of What causes rheumatic heart disease? Rheumatic heart disease Interventional Cardiology Journal. Interv is caused by rheumatic fever, an inflammatory disease that can Cardiol J Vol.6 No.4:e104 affect many connective tissues, especially in the heart, joints, skin, or brain. The heart valves can be inflamed and become scarred over time Rheumatic fever, an inflammatory disease, can affect many Key words: Rheumatic, Heart Disease connective tissues, especially in the heart, joints, skin, or brain. INTRODUCTION The infection often causes heart damage, particularly scarring of the heart valves, forcing the heart to work harder to pump blood. The relative survival was 96.9% (95% CI 96.1–97.5%) at one year It is not clear why some people who are infected with group A and 81.2% (95% CI 79.2–83.0%) at five years (S3 Fig). The risk of Streptococcus bacteria go on to develop rheumatic fever, while death among RHD/ARF patients increased with age over and above background rates; there was also increased risk for both others do not; however, it appears that some families may have male and intake patients.
    [Show full text]
  • Rheumatic Endocarditis
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1938 Rheumatic endocarditis Roy F. Pierson University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Pierson, Roy F., "Rheumatic endocarditis" (1938). MD Theses. 690. https://digitalcommons.unmc.edu/mdtheses/690 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. .RHEUKATIC ENDOCARDITIS Boy :r. Pieraon SENIOR THESIS PRESENTED TO - THE UNIVERSITY OF NEBR. COLLEGE OF llmDICINE Olt:AHA, 1938 INDEX· DEFINITION 1 I NT RODUCTI ON 2 HISTORY 3 INCIDENCE 15 ETIOLOGY 26 PATHOLOGY 36 SYMPTOMS AND DIAGNOSIS 59 TREATMENT 70 BIBLIOGRAPHY 80 480967 DEFINITION Bbeumatic Endocarditis is an inflammat­ ory disease of the endoeardium associated with :Rheumatic Fever. The disease process is charact­ erized by its indefinitely prolonged febrile course, a tendeney toward relapses, arthritic and nervous manifestations, •ubcutaneous nodules and changes in the endoeardium and myoeardium which are dependent upon the extensiveness of involvement. -l- .......... INTRODUCTION Rb.eumatie Endoearditia and its innocent counterpart, Hleuma.tic Fever have been associated since Piteairn first described this condition in 1788. Since that time they have been a most consp­ icuous thorn in the palm of the medical hand. For to this day, their origin has been concealed from the most discriminating minds of the profession.
    [Show full text]
  • CVDY Rheumatic Fever, Endocarditis and Kawasaki Disease Committee
    COMMISSION Rheumatic Fever, Endocarditis and Kawasaki Disease Committee Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) NUMBER OF MEMBERS: 15 members. METHOD OF APPOINTMENT: The Council Chair, in consultation with the Committee Chair and Nominating Committee, shall appoint Committee members. The Committee shall be made up of a Chair and 8-10 members drawn from the Council (1-2 members from the Council on Clinical Cardiology (CLCD)), as well as external Liaisons from the AAP, IDSA, and ADA. TERM OF OFFICE: Members shall serve two-year terms beginning July 1st and ending June 30th and shall be staggered for continuity. FREQUENCY OF MEETINGS: The Committee shall meet face-to-face twice per year, in the Fall in conjunction with AHA Scientific Sessions, and in the Spring in conjunction with ACC. The time commitment will vary, but should not exceed 1-3 hours per month. RESPONSIBILITIES: Committee Responsibilities: • Review and evaluate new medical/scientific knowledge in the field of cardiac infectious diseases – particularly rheumatic fever, infective endocarditis, and Kawasaki disease; • Prepare scientific statements on the prevention and treatment of infective endocarditis in both children and adults; • Prepare scientific statements on the treatment of streptococcal pharyngitis and prevention of rheumatic fever; and update the Jones criteria at regular intervals; • Prepare scientific statements on the diagnosis and acute and long-term management of patients with Kawasaki disease; • Stimulate development and accumulation of further knowledge in the field; • Develop scientific conferences related to these infectious diseases; • Furnish guidance for educational matters related to these diseases; • Participate in AHA scientific conferences, and/or prepare booklets, pamphlets, and other material for the public.
    [Show full text]
  • A Sore Throat Can Hurt Your Heart Pay Close Attention to a Sore Throat
    A SOre THROat CAN HURT YOUR HEART Pay close attention to a sore throat. A dangerous disease with devastating effects on the heart could be at work. By Carine Visagie ost people accept the occasional sore HOW RHEUMATIC FEVER CAN LEAD throat as a normal part of life. After all, it’s TO RHEUMATIC HEART DISEASE one of those bothersome symptoms that often A link between a sore throat and heart disease may seem accompany a harmless cold. But if a sore throat unlikely, but it all comes down to inflammation in the body is caused by a specific group of bacteria, heart and an ongoing, damaging immune response. OCK T S Mdamage may follow. When a sore throat caused by group A streptococcus I S, Rheumatic fever, the inflammatory disease that may bacteria is left untreated, the ongoing inflammation can set E G A M develop after so-called ‘strep throat’, can cause rheumatic off an ‘immune cascade’ in the body, explains Dr Liesl Zühlke, I heart disease – a deadly condition that kills more than 1 000 paediatric cardiologist at the Red Cross War Memorial LLO A people worldwide every day. In South Africa, it’s the leading Children’s Hospital in Cape Town. Your antibodies start Y/G cause of acquired heart disease in children and young adults, to repeatedly attack other organs and tissues, and the heart, ett and the sixth highest cause of death due to heart disease. joints, skin and central nervous system may be affected. This G Could you or your child be at risk? Brush up on the facts.
    [Show full text]
  • Case Report and Review of the Literature
    Relato de Caso Miocardite Clinicamente Manifesta em Surto Agudo de Febre Reumática Clinically Manifested Myocarditis in Acute Rheumatic Fever José L. Xavier Jr.1, Alexandre de Matos Soeiro1, Antonio S. S. A. Lopes2, Guilherme S. Spina2, Carlos V. Serrano Jr.1, Múcio T. Oliveira Jr.1 Unidade Clínica de Emergência - Instituto do Coração (InCor) - HCFMUSP1; Unidade Clínica de Valvopatias - Instituto do Coração (InCor) - HCFMUSP2, São Paulo, SP - Brasil Introdução realizou cintilografia miocárdica pré-operatória com gálio-67, O desenvolvimento de miocardite aguda em período que resultou negativa para processo inflamatório miocárdico. pós-operatório de cirurgia cardíaca é um desafio para o médico A cirurgia decorreu sem complicações, e o ecocardiograma que cuida desse tipo de paciente. Na maioria das vezes, a transtorácico pós-operatório mostrava átrio esquerdo (AE) de miocardite pode ser apenas consequência da inflamação 50 mm de diâmetro, ventrículo esquerdo (VE) de 56 × 39 mm, relacionada ao procedimento. No entanto, diagnósticos fração de ejeção (FE) de 57% e prótese biológica mitral sem diferenciais devem ser observados. Dentre eles, a febre reumática alterações estruturais. Recebeu alta em uso das medicações entra como importante mecanismo. Apesar de sua manifestação citadas anteriormente. cardíaca predominante relacionar-se ao acometimento do Ao exame físico, apresentava-se em regular estado geral, afebril, aparato valvar, seu diagnóstico é essencialmente clínico, e ela taquicárdica (frequência cardíaca = 180 batimentos por minuto), pode comprometer agudamente o miocárdio. Nesse contexto, a pressão arterial de 90 × 60 mmHg, taquidispneica (frequência ocorrência de miocardite reumática aguda é rara e de tratamento respiratória = 25 incursões por minuto), com saturação arterial de imunossupressor ainda incerto.
    [Show full text]
  • Emergence of Rheumatic Fever in the Nineteenth Century
    Emergence of Rheumatic Fever in the Nineteenth Century PETER C. ENGLISH Duke University he c h il d s u f f e r in g c o n g e s t i v e h e a r t f a ilu r e from rheumatic heart disease, so common a century ago, is fortunately now quite rare. To the medical students I teach, Trheumatic fever is a disease o f history. They still memorize T. Duckett Jones’s 1944 criteria for diagnosis (as they do Robert Koch’s postu­ lates), but nearly all await the opportunity to apply them— that is, until the last several months when the unexpected and unpredicted return of rheumatic fever in several isolated epidemics surprised pe­ diatricians and epidemiologists alike. So complete seemed the demise of rheumatic fever that pediatrician- epidemiologist Leon Gordis’s 1985 T. Duckett Jones Lecture before the American Heart Association was entitled, “The Virtual Disap­ pearance of Rheumatic Fever in the United States: Lessons on the Rise and Fall of Disease.’’ That same year Milton Markowitz (1985) delivered the Lewis W Wannamaker Memorial Lecture that he titled, “The Decline of Rheumatic Fever: Role of Medical Intervention.’’ In 1986, the 86th Ross Conference was dedicated to the clinical problem of “Management of Pharyngitis in an Era of Declining Rheumatic Fever.’’ Clinicians over the age of fifty will recall that as late as the 1950s and 1960s rheumatic fever was a major health problem that touched in a central way many o f the basic sciences (bacteriology, immunology, pathology, epidemiology, genetics, endocrinology, pharmacology), most of the clinical services (internal medicine, pe- The Milbank Quarterly, Vol.
    [Show full text]