RHEUMATIC FEVER: DIET AS A PREDISPOSING FACTOR

Rheumatic heart disease (RHD), a debilitating complication from rheumatic fever, remains a problem in low- and middle-income countries. This study describes the incidence, prevalence, modifiable risk factors for severe RHD and immediate outcome of pediatric RHD. This population-based and observational cohort study reviewed pediatric RHD patients (0-18 years) from the Sabah Pediatric Rheumatic Heart Registry from 2015 till 2018. A total of 188 RHD were reviewed with 120 new cases. The incidence of RHD is 2.19 [95% confidence interval (CI): 1.83-2.61] per 100 000 population, with a rising trend over time. Meanwhile, the prevalence of RHD was 13.78 (95% CI: 11.92-15.86) per 100 000 pediatric population. The majority of patients were from indigenous groups (59.0%), male (56.4%) with a mean age of 14.3 (3.31) years. About 77.9% had the lowest household income, and a significant proportion lived in overcrowded conditions. At diagnosis, 59% were diagnosed with severe RHD. There is heightened risk but no statistical significance between modifiable factors (low weight and height percentile at diagnosis, lowest income group, renting a house, overcrowding and healthcare access of more than 5 km) with severe RHD. Severe RHD is significantly associated with risk for intervention (p = 0.016). Sixteen (13.8%) patients required surgical intervention. About 97.6% of patients were on intramuscular benzathine penicillin G with 84.5% compliance. The rising prevalence and incidence of pediatric RHD in Sabah, with the most being severe RHD at diagnosis, necessitates the development of an echocardiographic screening and a comprehensive national disease program.

Article1 August 1943THE INCIDENCE OF ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS IN RHEUMATIC HEART DISEASERAYMOND GELFMAN, M.D.RAYMOND GELFMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-19-2-253 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIt is well known that the possibility of developing acute or subacute bacterial endocarditis constitutes a decided threat to the patient with rheumatic disease.1, 2, 3, 4, 5, 6, 7 Fully 20 to 25 per cent of all patients whose hearts have been the site of preëxisting rheumatic activity are said to fall prey to the ravages of infectious endocarditis. Moreover, 90 per cent or more of all bacterial endocarditis is found in hearts that have been previously damaged by the rheumatic infection.5Believing that it might prove profitable to inquire once again into the incidence of superimposed infectious processes...Bibliography1. BLUMER G: Subacute bacterial endocarditis, Medicine, 1923, ii, 105. CrossrefGoogle Scholar2. FULTONLEVINE MNSA: Subacute bacterial endocarditis, with special reference to valvular lesions and previous history, Am. Jr. Med. Sci., 1932, clxxxiii, 60. CrossrefGoogle Scholar3. DAVISWEISS DS: The relation of subacute and acute bacterial endocarditis to rheumatic endocarditis, New England Jr. Med., 1933, xii, 619. CrossrefGoogle Scholar4. KEEFER C: The pathogenesis of bacterial endocarditis, Am. Heart Jr., 1940, xix, 352. CrossrefGoogle Scholar5. CHRISTIAN HA: The determinative background of subacute bacterial endocarditis, Am. Jr. Med. Sci., 1941, cci, 34. Google Scholar6. LAWSLEVINE CLSA: Clinical notes on rheumatic heart disease with special reference to the cause of death, Am. Jr. Med. Sci., 1933, clxxxvi, 833. CrossrefGoogle Scholar7. HEDLEY OF: Rheumatic heart disease in Philadelphia hospitals, Pub. Health Rep., 1940, lv, 1707. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Received for publication March 12, 1942.From the Medical clinic of the Peter Bent Brigham Hospital, Boston. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBACTERIAL ENDOCARDITIS IN A SYDNEY HOSPITAL FROM 1960 TO 1965Infective Endocarditis in the Antibiotic EraChronic Rheumatic Valvular Heart Disease in IcelandDie Herz- und GefäßkrankheitenBACTERIAL ENDOCARDITIS IN THE AGED*JACQUES B. WALLACH, M.D., MACELLIS GLASS, B.A., LESLIE LUKASH, M.D., ALFRED A. ANGRIST, M.D.Mitral Valve Disease over the Age of 50STUDIES ON THE AGING HEART. I. THE PATTERN OF RHEUMATIC HEART DISEASE IN OLD AGE (A CLINICAL-PATHOLOGICAL STUDY)*PAUL KAUFMAN, M.D., F.A.C.P., HARVEY POLIAKOFF, M.D.Bacterial Endocarditis in the ElderlyMITRAL STENOSIS IN LATER LIFESubacute bacterial endocarditis in the aged 1 August 1943Volume 19, Issue 2Page: 253-255KeywordsBacterial diseasesBacterial physiologyCardiovascular therapyChildrenEndocarditisFallsHeartHospitalsInfantsInfectious diseases ePublished: 1 December 2008 Issue Published: 1 August 1943 PDF downloadLoading ...

Spatiotemporal trends in global burden of rheumatic heart disease and associated risk factors from 1990 to 2019

Background Rheumatic fever has a marked tendency to recur leading to high risk of chronic heart lesions or worsening lesions in patients with previous rheumatic heart disease. For secondary prevention of RF, long acting penicillin can be used. Some rheumatic heart disease patients suffer from atrial fibrillation. Cardiac rhythm may affect the response of the body to the long acting penicillin, so it would be helpful to study the effect of cardiac rhythm on serum levels of inflammatory mediators in patients with chronic rheumatic heart disease. Objectives Our study is a prospective cross-sectional controlled study that aims to study the effect of cardiac rhythm on serum levels of the inflammatory mediators; C-Reactive Protein and Interleukin-6 in patients with chronic rheumatic heart disease. Methods The study included 70 rheumatic heart disease patients on regular long acting penicillin. Patients were divided into to 2 groups: Group A; 56 patients with rheumatic heart disease who have sinus rhythm, and Group B; 14 patients with rheumatic heart disease who have atrial fibrillation (AF) and Group C; control group of 10 healthy individuals. Results There was no significant difference between sinus patients and AF patients in CRP and IL-6 levels (p = 0.3050 and 0.6758, respectively). Also, there was no significant difference between 15, 21 and 30 days regimens of penicillin in CRP and IL-6 levels (p = 0.9467and 0.0795, respectively). IL6 values were significantly correlated with CRP values (r = 0.5435, p < 0.0001). There was a significant difference in CRP and IL-6 levels between compliant and non-compliant patients (p = 0.0053 and 0.0308). Conclusion Our study results disprove that cardiac rhythm has an effect on the serum levels of the inflammatory mediators C-Reactive Protein and Interleukin-6 in chronic rheumatic heart disease. Our study also disproves the preference of any regimen of long acting penicillin (15 days, 21 days and 30 days) over each other for secondary prevention of chronic rheumatic heart disease. Our study results emphasized that chronic rheumatic heart disease is an inflammatory process mediated with some mediators as CRP and IL-6 that are strongly correlated with each other.

Background In February 2025, pediatricians alerted the Alaska Department of Health to a possible increase in cases of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). ARF/RHD are immune-mediated sequelae of group A Streptococcus (GAS) infections. ARF primarily affects school-aged children and can progress to RHD without appropriate antibiotic treatment and prophylaxis. RHD is characterized by damage to heart valves and can result in death. Early diagnosis, appropriate antibiotic treatment, and prophylaxis for people with ARF/RHD reduce the risk of ARF recurrence and RHD progression.Table 1:Demographic characteristics of patients with ARF and RHD included in medical records review, Alaska, Jan 2022–Feb 2025. (N=52)Table 2.Incidence of ARF/RHD among ages 3-17 years from medical records review, Alaska, Jan 2022–Feb 2025. Methods We calculated ARF/RHD incidence among children aged 3–17 years living in Alaska during January 2022–February 2025 using data reported by healthcare systems in response to a statewide call for cases. We conducted medical chart reviews to collect information on presenting signs and symptoms, prior GAS infections, clinical management, and outcomes. We also conducted a secondary data analysis of the Indian Health Service’s (IHS) National Patient Information Reporting System to calculate incidence of ARF/RHD during 2014–2023 among Alaska Native children aged 3–17 who received care within the Tribal Health System.Figure 1.Indian Health Service National Patient Information Reporting System trends in reported incidence of new ARF and RHD among AI/AN children aged 3–17 years, Alaska, 2014–2023Figure 2.Indian Health Service’s National Patient Information Reporting System reported average ARF incidence (3–17 years) among AI/AN people by region, Alaska, 2014–2023 Results ARF and RHD incidence among children aged 3–17 increased from 3.8 and 1.9 per 100,000 persons per year in 2022 to 5.3 and 5.3 per 100,000 persons per year, respectively, in 2024. Incidence was highest in the northern (ARF: 33.5; RHD: 33.5) and southwestern (ARF: 23.0; RHD: 41.4) regions of Alaska and among children who were Alaska Native (ARF: 11.1; RHD: 11.1) or Native Hawaiian/Pacific Islander (ARF: 27.3; RHD: 16.4). Analysis of IHS data found the average annual incidences of ARF/RHD during 2014–2023 among Alaska Native children aged 3–17 were 6.2 per 100,000 persons and 8.5 per 100,000 persons, respectively. Conclusion ARF/RHD incidence in Alaska is higher than the rest of the United States, particularly among Alaska Native and Native Hawaiian/Pacific Islander people. The observed recent increases may be linked to factors such as a rise in GAS infections. Potential opportunities to improve early diagnosis and clinical management of GAS infections and sequelae can inform public health recommendations and clinical guidance. Disclosures All Authors: No reported disclosures

Although there has been a substantial decline in its prevalence during the last twenty years, acute rheumatism remains one of the most important diseases of the rheumatic group. Infection with hæmolytic streptococci of Group A is at present the only factor in the aetiology of acute rheumatism which can be identified with confidence. Until other aetiological factors, which almost certainly exist, have been defined the prevention of acute rheumatism rests upon general measures such as diminution of overcrowding which will control the frequency, weight and variety of upper respiratory tract infections among children and young adults. Prompt detection of acute rheumatism, especially of the forms which have an insidious onset, rest in bed during the stages of acute illness and convalescence, together with special clinical arrangements for after-care extending over many years remain the only satisfactory measures for the prevention and limitation of the chronic heart disease caused by acute rheumatism. The chief responsibility for this now lies with the hospital and specialist section of the National Health Service. Research at present in progress may serve to uncover some of the hitherto unknown factors in the aetiology of acute rheumatism and hence lead to better methods for its prevention. The use of penicillin to control upper respiratory infections in rheumatic individuals and of hormones in the treatment of the initial illness which are now being investigated may prove to be valuable in the prevention of chronic rheumatic heart disease.

Rheumatic heart disease (RHD) is an inflammatory disease of the heart, and it has major cause of morbidity and mortality in developing countries. It has significant impact on the quality of life of RHD patients. Objective: To assess the Quality of life in patients with chronic Rheumatic heart disease. Materials and methods: This prospective observational study was conducted at the Safdarjung Hospital, New Delhi for a period of 18 months. Study subjects are the patients who were diagnosed with chronic rheumatic heart disease at the outpatient department. A total of 500 subjects suffering from RHD and 100 Controls without RHD were identified during the study period. SF-36 health survey questionnaire was used to interview the subjects. The scores of health survey questionnaire was analysed descriptively and ANOVA is used to find out the significant differences. SPSS version-20 was used for data analysis. Results: Out of 600 subjects, 500 were the cases and 100 were the controls. 54.4% were males and 45.8% were females. Majority of the cases were belonged to the age group 36–40 years (19%) with the mean age group 35.7±9.2 years. 80% of the subjects were identified with moderate rheumatic heart disease and 20% were severe. Physical functioning, role of limitations due to physical health and emotional problems, social functioning and health change has shown the significant difference. Conclusion: It was seen that most of the domains of SF-36 were significant from which we can conclude that there is the relation between RHD and quality of life. Considering the poor quality of life in rheumatic heart disease patients, multimodal approach (psychiatric consultation, enrolment in mental support group, and occupational help) to provide overall care to a rheumatic heart disease patient should be considered.

ABSTRACT: One hundred four patients with Chronic Rheumatic Heart Disease were investigated to find out the prevalence of bacterial endocarditis in this group and to document the causative organ jam s and their sensitivity pattern. INTRODUCTION: Since the introduction of antibiotics in the mid forties, endocarditis has been going through an evolution. The changing etiology of endocarditis has been the subject of several reports.1’2 , ‘ According to these reports, in the economically advanced countries the age has shifted from the 2nd and 4th decade to the 5th and 6th decade with a mean at about 55 years. The etiology of the disease has changed with Strep. MATERIAL AND METHODS: All patients with chronic valvular rheumatic heart disease admitted consecutively to the medical C Ward of Khyber Hospital Peshawar were included in the study. After complete clinical assessment, samples of blood were taken from each patient on three consecutive days for blood culture. RESULTS: Of the 104 patients studied 60 were males and 44 females. A positive blood culture was obtained from 23 cases. None yielded a positive result in all three blood culture samples, and only one culture each was positive in all. In 10 (43.4%) a positive culture was obtained from the first culture bottle, in 5 (21.7%) the 2nd blood sample yielded a positive culture and in 8 (34.8%) the 3rd sample was the source of a positive culture. DISCUSSION: The results of the study show that the age distribution of our cases is the same as that of the preantibiotic-era in the developed countries. 1 5 Thirty-nine per cent of our endocarditis cases were in the 2nd and 3rd decade and 56.5% in the 3rd and 4th decade. The sex ratio in our cases is similar to that reported by Lerner and Wienstein (1966) and Garvey and Neu (1973). Although in our hospital admitted cases the number of females is generally lower than that of males, however, we have taken into account the sex ratio in all cases of rheumatic heart disease and have found that in the endocarditis cases the ratio is higher. ACKNOW LEDGEMENT: The authors are grateful to Dr. Tasleem Akhtar, Research Director, PMRC Research Centre, Khyber Medical College, for help in the preparation of this report and to Miss Mubarik Begum for typing the manuscript. The study was approved and financed by the Pakistan Medical Research Council.

Valvular heart diseases are an important public health problem worldwide. They are classically related to rheumatic fever and rheumatic heart disease. Rheumatic fever and rheumatic heart disease are thought to result from an autoimmune reaction to group A streptococcal pharyngeal infection, which leads initially to valve regurgitation (mitral regurgitation more often than aortic regurgitation) and later to valve stenosis (mitral stenosis more often than aortic stenosis). Although the incidence of rheumatic heart disease has decreased markedly in economically developed countries owing to the dramatic decrease in the incidence of rheumatic fever, rheumatic heart disease persists in economically developing countries owing to the persistently high incidence of rheumatic fever.

Social and Economic Conditions and the Incidence of Rheumatic Heart Disease.

"Dally, John Frederick Halls, (died 4 Nov. 1944), Consulting Physician to Mount Vernon Hospital; Senior Physician to St Marylebone and Western General Dispensary and Director of the Children’s Supervisory Centre for Rheumatism and Rheumatic Heart Disease; Medical Supt Bromsgrove Emergency Hospital, Worcestershire; Consulting Physician to Sutton War Emergency Hospital, to Philanthropic Society’s School, Redhill and to the Shriners Hospital, Montreal; Editor, West London Journal; Vice-President Chelsea Clinical Society; Member of St Marylebone War Committee; late Chairman, Special Neurological Board of Ministry of Pensions" published on by Oxford University Press.

Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. Secondary prophylaxis with regular intramuscular injections of benzathine penicillin G (BPG) is a key component to prevent ARF and RHD recurrent. This study aimed to evaluate the secondary prophylaxis effectiveness based on the profile of clinical manifestations and blood laboratory findings. The data were collected by interviews, complete blood counts, the anti-streptolysin titer O (ASTO) analysis, the C-reactive protein Assay, electrocardiography, and echocardiography. Data were analyzed using SPSS 18, and the results were presented as the percentage frequency. The samples were 63 patients with ARF and RHD who get secondary prophylaxis, consisting of 32 males (50.8%) and 31 females (49.9%). The echocardiography examination showed that valve regurgitation was more common than valve stenosis, indicating longer P-R interval in 49 subjects (77.7%). Sixty subjects (92.2%) received secondary prophylaxis with BPG injection, and three subjects (4.8%) got Erythromycin oral. The main factor of secondary prophylaxis adherence is pain and injection disliking. How to Cite this Article Pubmed Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Web Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. http://www.sysrevpharm.org/?mno=11016 [Access: March 29, 2021]. doi:10.31838/srp.2020.9.63 AMA (American Medical Association) Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. 2020; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Vancouver/ICMJE Style DIMIATI H, SOFIA S, GANI BA. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP. (2020), [cited March 29, 2021]; 11(9): 452-457. doi:10.31838/srp.2020.9.63 Harvard Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. SRP, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Turabian Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. 2020. for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63 Chicago Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11 (2020), 452-457. doi:10.31838/srp.2020.9.63 MLA (The Modern Language Association) Style DIMIATI, HERLINA, SOFIA SOFIA, and BASRI A. GANI. Penicillin for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Children. Systematic Reviews in Pharmacy 11.9 (2020), 452-457. Print. doi:10.31838/srp.2020.9.63 APA (American Psychological Association) Style DIMIATI, H., SOFIA, . S. & GANI, . B. A. (2020) for Secondary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease in Acehnese Reviews in Pharmacy, 11 (9), 452-457. doi:10.31838/srp.2020.9.63

Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis. Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to M ay 2010. Results: We found male to female ratio 2: 1, median age 12 (5- 14yrs) with the most affected age group of 11- 12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Six ty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (M R). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (A R) in 55% of cases. Thirty-two patients (57%} had PA H in which 8 patients has severe PAH and 24 patients had mild to moderate PAH . Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%) had vegetation in echocardiography. The mortality was 11% in this study. Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever.

Cost-effectiveness of Treatment Options for Prevention of Rheumatic Heart Disease from Group A Streptococcal Pharyngitis in a Pediatric Population

Identification of patients with latent rheumatic heart disease by echocardiography presents a unique opportunity to prevent disease progression. Myocardial strain is a more sensitive indicator of cardiac performance than traditional measures of systolic function. The objective of this study was to test the hypothesis that abnormalities in myocardial strain may be present in children with latent rheumatic heart disease. Standard echocardiography images with electrocardiogram gating were obtained from Ugandan children found to have latent rheumatic heart disease as well as control subjects. Traditional echocardiography measures of systolic function were obtained, and offline global longitudinal strain analysis was performed. Comparison between groups was performed using strain as a continuous (Mann-Whitney U-test) and categorical (cut-off 5th percentile for age) variable. Our study included 14 subjects with definite rheumatic heart disease, 13 with borderline rheumatic heart disease, and 112 control subjects. None of the subjects had abnormal left ventricular size or ejection fraction. Global longitudinal strain was lower than the 5th percentile in 44% of the subjects with any rheumatic heart disease (p=0.002 versus controls) and 57% of the subjects with definite rheumatic heart disease (p=0.03). The mean absolute strain values were significantly lower when comparing subjects with any rheumatic heart disease with controls (20.4±3.95 versus 22.4±4.35, p=0.025) and subjects with definite rheumatic heart disease with controls (19.9±4.25 versus 22.4±4.35, p=0.033). Global longitudinal strain is decreased in subjects with rheumatic heart disease in the absence of abnormal systolic function. Larger studies with longer-term follow-up are required to determine whether there is a role for strain to help better understand the pathophysiology of latent rheumatic heart disease.