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Sample records for acute rheumatic fever

  1. [Acute rheumatic fever].

    Science.gov (United States)

    Maier, Alexander; Kommer, Vera

    2016-03-01

    We report on a young women with acute rheumatic fever. Acute rheumatic fever has become a rare disease in Germany, especially in adults. This carries the risk that it can be missed in the differential diagnostic considerations of acute rheumatic disorders and febrile status. If rheumatic fever is not diagnosed and treated correctly, there is a considerable risk for rheumatic valvular heart disease. In this article diagnosis, differential diagnosis and therapy of rheumatic fever are discussed extensively.

  2. Adult-onset acute rheumatic fever.

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    Nakashima, Dainari; Ueda, Kohei; Tsukuda, Kyozo; Utsu, Noriaki; Kohki, Shimazu; Fushimi, Hiroaki; Miyakoshi, Kazuho

    2012-01-01

    A 62-year-old man was hospitalized for acute rheumatic fever. He had previously suffered from rheumatic fever at 15 years of age. The rheumatic fever was complicated by carditis, which caused valve disease that required surgical treatment. The incidence of rheumatic fever has decreased in most developed countries with improvements in sanitary conditions. The low incidence of this disease makes a timely and accurate diagnosis difficult. Due to the fact that both the first occurrence and recurrence of acute rheumatic fever can occur in the elderly and adults, this potential disease should not be overlooked when making a differential diagnosis.

  3. Acute rheumatic fever and rheumatic heart disease in indigenous populations.

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    Steer, Andrew C; Carapetis, Jonathan R

    2009-12-01

    Acute rheumatic fever and rheumatic heart disease are diseases of socioeconomic disadvantage. These diseases are common in developing countries and in Indigenous populations in industrialized countries. Clinicians who work with Indigenous populations need to maintain a high index of suspicion for the potential diagnosis of acute rheumatic fever, particularly in patients presenting with joint pain. Inexpensive medicines, such as aspirin, are the mainstay of symptomatic treatment of rheumatic fever; however, antiinflammatory treatment has no effect on the long-term rate of progression or severity of chronic valvular disease. The current focus of global efforts at prevention of rheumatic heart disease is on secondary prevention (regular administration of penicillin to prevent recurrent rheumatic fever), although primary prevention (timely treatment of streptococcal pharyngitis to prevent rheumatic fever) is also important in populations in which it is feasible.

  4. Acute rheumatic fever and rheumatic heart disease.

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    Carapetis, Jonathan R; Beaton, Andrea; Cunningham, Madeleine W; Guilherme, Luiza; Karthikeyan, Ganesan; Mayosi, Bongani M; Sable, Craig; Steer, Andrew; Wilson, Nigel; Wyber, Rosemary; Zühlke, Liesl

    2016-01-14

    Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.

  5. Advanced heart block in acute rheumatic fever.

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    Hubail, Zakariya; Ebrahim, Ishaq M

    2016-04-01

    First degree heart block is considered a minor criterion for the diagnosis of this condition. The cases presented here demonstrate that higher degrees of heart block do occur in rheumatic fever. Children presenting with acquired heart block should be worked-up for rheumatic fever. Likewise, it is imperative to serially follow the electrocardiogram in patients already diagnosed with acute rheumatic fever, as the conduction abnormalities can change during the course of the disease.

  6. Advanced heart block in acute rheumatic fever

    OpenAIRE

    2015-01-01

    First degree heart block is considered a minor criterion for the diagnosis of this condition. The cases presented here demonstrate that higher degrees of heart block do occur in rheumatic fever. Children presenting with acquired heart block should be worked-up for rheumatic fever. Likewise, it is imperative to serially follow the electrocardiogram in patients already diagnosed with acute rheumatic fever, as the conduction abnormalities can change during the course of the disease.

  7. Diagnostic criteria of acute rheumatic fever.

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    Burke, Rebecca J; Chang, Christopher

    2014-01-01

    Acute rheumatic fever is an inflammatory sequela of Group A Streptococcal pharyngitis that affects multiple organ systems. The incidence of acute rheumatic fever has been declining even before the use of antibiotics became widespread, however the disease remains a significant cause of morbidity and mortality in children, particularly in developing countries and has been estimated to affect 19 per 100,000 children worldwide. Acute rheumatic fever is a clinical diagnosis, and therefore subject to the judgment of the clinician. Because of the variable presentation, the Jones criteria were first developed in 1944 to aid clinicians in the diagnosis of acute rheumatic fever. The Jones criteria have been modified throughout the years, most recently in 1992 to aid clinicians in the diagnosis of initial attacks of acute rheumatic fever and to minimize overdiagnosis of the disease. Diagnosis of acute rheumatic fever is based on the presence of documented preceding Group A Streptococcal infection, in addition to the presence of two major manifestations or one major and two minor manifestations of the Jones criteria. Without documentation of antecedent Group A Streptococcal infection, the diagnosis is much less likely except in a few rare scenarios. Carditis, polyarthritis and Sydenham's chorea are the most common major manifestations of acute rheumatic fever. However, despite the predominance of these major manifestations of acute rheumatic fever, there can be significant overlap with other disorders such as Lyme disease, serum sickness, drug reactions, and post-Streptococcal reactive arthritis. This overlap between disease processes has led to continued investigation of the pathophysiology as well as development of new biomarkers and laboratory studies to aid in the diagnosis of acute rheumatic fever and distinction from other disease processes.

  8. Acute rheumatic fever and rheumatic heart disease among children--American Samoa, 2011-2012.

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    Beaudoin, Amanda; Edison, Laura; Introcaso, Camille E; Goh, Lucy; Marrone, James; Mejia, Amelita; Van Beneden, Chris

    2015-05-29

    Acute rheumatic fever is a nonsuppurative, immune-mediated consequence of group A streptococcal pharyngitis (strep throat). Recurrent or severe acute rheumatic fever can cause permanent cardiac valve damage and rheumatic heart disease, which increases the risk for cardiac conditions (e.g., infective endocarditis, stroke, and congestive heart failure). Antibiotics can prevent acute rheumatic fever if administered no more than 9 days after symptom onset. Long-term benzathine penicillin G (BPG) injections are effective in preventing recurrent acute rheumatic fever attacks and are recommended to be administered every 3-4 weeks for 10 years or until age 21 years to children who receive a diagnosis of acute rheumatic fever. During August 2013, in response to anecdotal reports of increasing rates of acute rheumatic fever and rheumatic heart disease, CDC collaborated with the American Samoa Department of Health and the Lyndon B. Johnson Tropical Medical Center (the only hospital in American Samoa) to quantify the number of cases of pediatric acute rheumatic fever and rheumatic heart disease in American Samoa and to assess the potential roles of missed pharyngitis diagnosis, lack of timely prophylaxis prescription, and compliance with prescribed BPG prophylaxis. Using data from medical records, acute rheumatic fever incidence was calculated as 1.1 and 1.5 cases per 1,000 children aged ≤18 years in 2011 and 2012, respectively; 49% of those with acute rheumatic fever subsequently received a diagnosis of rheumatic heart disease. Noncompliance with recommended prophylaxis with BPG after physician-diagnosed acute rheumatic fever was noted for 22 (34%) of 65 patients. Rheumatic heart disease point prevalence was 3.2 cases per 1,000 children in August 2013. Establishment of a coordinated acute rheumatic fever and rheumatic heart disease control program in American Samoa, likely would improve diagnosis, treatment, and patient compliance with BPG prophylaxis.

  9. Mean platelet volume in acute rheumatic fever.

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    Sert, Ahmet; Aypar, Ebru; Odabas, Dursun

    2013-01-01

    Acute rheumatic fever (ARF) is still an endemic disease, especially among school-aged children in developing countries. Mean platelet volume (MPV), which is commonly used as a measure of platelet size, indicates the rate of platelet production and platelet activation. We aimed to investigate MPV in children with ARF. The study population consisted of 40 children with ARF (32 patients with carditis and 8 patients without carditis) and 40 healthy control subjects. White blood cell (WBC) and platelet counts were significantly higher and MPV values were significantly lower in patients with ARF during the acute stage when compared to controls. Erythrocyte sedimentation rate (ESR) and C-reactive protein values significantly decreased in patients with ARF after the treatment when compared to baseline, whereas MPV values increased. MPV values were negatively correlated with ESR and WBC, and platelet counts. In conclusion, during the acute stage of ARF, MPV values were lower when compared to controls.

  10. [What is happening to acute rheumatic fever?].

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    Stéphan, J L

    1994-12-01

    Rheumatic fever is an inflammatory disease of the heart, joints, central nervous system and subcutaneous tissues that develops after a nasopharyngeal infection by one of the group A beta-haemolytic streptococci. The pathogenesis remains an enigma. As the disease has been less florid and some of the more characteristic manifestations less common in developed countries, it has become more difficult to establish the diagnosis on clinical grounds. Rheumatic fever and its sequellae are still active in developing countries. Carditis is a dominant feature of this social disease. Renewed educational efforts concerning this preventable disorder are needed among both physicians and the public.

  11. Rheumatic fever reappraised

    Institute of Scientific and Technical Information of China (English)

    Ulrik Baandrup

    2005-01-01

    @@ Rheumatic fever is a complication following an episode of group A streptococcal pharyngitis. It is an acute immunologically mediated, multisystem inflammatory disorder. Acute rheumatic heart disease during the active phase of rheumatic fever sometimes progresses to chronic rheumatic heart disease. Despite its declining importance in industrialised countries rheumatic fever remains the leading cause of death from heart disease in children and young adults in less developed regions. Fifteen to twenty million new cases emerge every year in developing countries.1

  12. [Acute rheumatic fever in children, a diagnostic problem].

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    Wieringa, J W; Ramaker, C; Wolf, B H M

    2006-05-20

    Three girls of Moroccan descent, aged 9, 10 and 7 years, presented with fever, joint pain and other symptoms. After Streptococcus infection and carditis were confirmed and the Jones criteria for acute rheumatic fever were met, the patients were treated with penicillin and acetylsalicylic acid. All 3 patients recovered. However, the second girl presented 2 months later with cardiac decompensation caused by valve disorders, after which aortic and mitral valvuloplasty was performed. The third girl developed joint pain again after 3 weeks and was diagnosed with juvenile idiopathic arthritis; treatment was adjusted accordingly. The prevalence of rheumatic heart diseases is 10-20 times higher in developing countries than in industrialised nations. The diagnosis 'acute rheumatic fever' should be considered in children of school age with unexplained fever, also when the Jones criteria have not yet been met. This may apply to migrant children in particular.

  13. Acute rheumatic fever and rheumatic heart disease in resource-limited settings.

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    Watson, Gabriella; Jallow, Bintou; Le Doare, Kirsty; Pushparajah, Kuberan; Anderson, Suzanne T

    2015-04-01

    Poststreptococcal complications, such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), are common in resource-limited settings, with RHD recognised as the most common cause of paediatric heart disease worldwide. Managing these conditions in resource-limited settings can be challenging. We review the investigation and treatment options for ARF and RHD and, most importantly, prevention methods in an African setting.

  14. Acute Rheumatic Fever: Global Persistence of a Preventable Disease.

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    Bono-Neri, Francine

    2016-10-21

    The persistence of acute rheumatic fever continues to be seen globally. Once thought to be eradicated in various parts of the world, the disease came back with a vengeance secondary to a lack of diligence on the part of providers. Today, the global burden of group A streptococcal infection, the culprit of the numerous sequelae manifested in acute rheumatic fever, is considerable. Although a completely preventable disease, rheumatic fever continues to exist. It is a devastating disease that involves long-term, multisystem treatment and monitoring for patients who were unsuccessful at eradicating the precipitating group A streptococcal infection. Prevention is the key to resolving the dilemma of the disease's global burden, yet the method to yield its prevention still remains unknown. Thus, meticulous attention to implementing proper treatment is the mainstay and remains a top priority.

  15. Rhythm and conduction analysis of patients with acute rheumatic fever.

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    Balli, Sevket; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Ece, Ibrahim

    2013-02-01

    Various rhythm and conduction abnormalities can develop in acute rheumatic fever. This study investigated rhythm and conduction abnormalities in children with acute rheumatic fever using a standard 12-lead electrocardiogram and 24-h rhythm Holter recordings. This multicenter retrospective study, performed between August 2011 and March 2012, enrolled 73 consecutive children with acute rheumatic fever. Standard electrocardiography was used to measure PR and corrected QT intervals. Holter recordings were evaluated for all the patients, and 52 of the patients (71.2 %) had carditis that was either isolated or together with other major criteria. A positive correlation was detected between carditis and the mean PR interval on standard electrocardiography, but this was not significant (p > 0.05). Standard electrocardiography showed a significant positive correlation between PR and corrected QT intervals (p = 0.03; r = 0.55). Standard electrocardiography showed only three patients (4.2 %) with premature contractions, whereas 24-h electrocardiography showed 26 patients (35.6 %) with premature contractions. Carditis was positively correlated with premature contractions (p rheumatic fever are more common than previously thought.

  16. Rheumatic Fever.

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    Visvanathan; Manjarez; Zabriskie

    1999-10-01

    There have been numerous reports stating that treatment of acute rheumatic fever with either aspirin or corticosteroids does not alter the long-term outcome of rheumatic heart disease. Yet, it should be emphasized that most of these studies were carried out with the first generic corticosteroids before the advent of the more active and more potent corticosteroid agents. In spite of this caveat, there is no question that all the clinical and laboratory parameters of inflammation (erythrocyte sedimentation rate, C-reactive protein) return to normal much more rapidly with corticosteroids than with aspirin alone. It is therefore our belief that steroids should be used when clinical and laboratory evidence of carditis exists, and aspirin should be reserved for cases of acute rheumatic arthritis with no evidence of carditis. The incidence of long-term valvular disease in active carditis may be decreased with steroid therapy. For example, the number of valve replacements differs markedly in centers that do use steroids and in those that do not. In Capetown, South Africa, where steroids are routinely used for carditis, valve replacement is quite rare. In contrast, in Johannesburg, where steroids are rarely used, the rate of valve replacement is quite high. The racial backgrounds of both groups of patients are similar, thus eliminating the question of racial differences. Concerning secondary prophylaxis, there is also controversy concerning the best second-line therapy. It is now well known that monthly intramuscular injections of benzathine penicillin are really effective for only 20 days. Thus, there is a window in which penicillin coverage is not adequate. To circumvent this problem, some investigators give benzathine penicillin every 3 weeks. These injections are quite painful, however, and it has been our "rule" that compliance with this treatment is inversely proportional to the ratio of the size of the child to the mother. In our own experience over 30 years with the

  17. [Rheumatic fever].

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    Cherkashin, D V; Kumchin, A N; Shchulenin, S N; Svistov, A S

    2013-01-01

    This lecture-style paper highlights all major problems pertinent to rheumatic fever Definition of acute RF and chronic rheumatic heart disease is proposed and desirability of the use of these terms in clinical practice is explained. Present-day epidemiology of RF is described with reference to marked differences in its prevalence in developed and developing countries. Modern classification of acute RF is described as adopted by the Russian Association of Rheumatologists and recommended for the use in Russian medical facilities. Discussion of etiological issues is focused on such virulence factors as beta-hemolytic streptococcus A and genetic predisposition confirming hereditary nature of RE Its clinical features are described along with laboratory and instrumental methods applied for its diagnostics. Large and small diagnostic criteria of RF are considered. Special attention is given to the treatment of RF and its complications (antibiotic, pathogenetic, and drug therapy). Its primary and secondary prophylaxis is discussed in detail, preparations for the purpose are listed (with doses and duration of application). In conclusion, criteria for the efficacy of therapy are presented along with indications for hospitalization and emergency treatment.

  18. Update on diagnosis of acute rheumatic fever: 2015 Jones criteria.

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    Eroğlu, Ayşe Güler

    2016-03-01

    In the final Jones criteria, different diagnostic criteria were established for the diagnosis of acute rheumatic fever for low risk and moderate-high risk populations. Turkey was found to be compatible with moderate-high risk populations as a result of regional screenings performed in terms of acute rheumatic fever and rheumatic heart disease. The changes in the diagnostic criteria for low-risk populations include subclinical carditis found on echocardiogram as a major criterion in addition to carditis found clinically and a body temperature of 38.5°C and above as a minor criterion. In moderate-high risk populations including Turkey, subclinical carditis found on echocardiogram in addition to clinical carditis is used as a major criterion as a new amendment. In addition, aseptic monoarthritis and polyarthralgia are used as major criteria in addition to migratory arthritis and monoarhtralgia is used as a minor criterion among joint findings. However, differentiation of subclinical carditis from physiological valve regurgitation found in healthy individuals and exclusion of other diseases involving joints when aseptic monoarthritis and polyarthralgia are used as major criteria are very important. In addition, a body temperature of 38°C and above and an erythrocyte sedimentation rate of 30 mm/h and above have been accepted as minor criteria. The diagnostic criteria for the first attack have not been changed; three minor findings have been accepted in presence of previous sterptococcal infection in addition to the old cirteria for recurrent attacks. In the final Jones criteria, it has been recommended that patients who do not fully meet the diagnostic criteria of acute rheumatic fever should be treated as acute rheumatic fever if another diagnosis is not considered and should be followed up with benzathine penicilin prophylaxis for 12 months. It has been decided that these patients be evaluated 12 months later and a decision for continuation or discontinuation of

  19. P-wave dispersion in children with acute rheumatic fever.

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    Kocaoglu, Celebi; Sert, Ahmet; Aypar, Ebru; Oran, Bulent; Odabas, Dursun; Arslan, Derya; Akin, Fatih

    2012-01-01

    As a new and simple electrocardiographic marker, P-wave dispersion is reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The current study aimed to investigate P-wave dispersion in children with acute rheumatic fever. The study population consisted of 47 children with acute rheumatic fever (29 patients with carditis and 18 patients without carditis) and 31 healthy control subjects. Maximum and minimum P-wave durations were measured from the 12-lead surface electrocardiogram. The P-wave dispersion was calculated as the difference between maximum and minimum P-wave durations. The maximum P-wave duration and the P-wave dispersion of the patients with and without carditis were significantly greater than those of the control subjects. The P-wave dispersion of the patients with carditis was significantly greater than that of the patients without carditis. In conclusion, the P-wave dispersion was higher in the children with acute rheumatic fever than in the healthy control subjects.

  20. Acute rheumatic fever: the danger for our children.

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    Casey, Georgina

    2013-06-01

    THE NEW Zealand Government's allocation of $21 million in the 2013 Budget for treatment and prevention of acute rheumatic fever (ARF) highlights the impact this disease has on the long-term health of New Zealand's marginalised communities. ARF is a disease confined largely to developing nations and is regarded in the developed world as a disease of deprivation and poverty, yet New Zealand has a high incidence, Largely within Maori and Pacific populations. ARF arises from an often mild throat infection caused by streptococcal bacteria. The mechanisms by which this microorganism triggers rheumatic fever and its cardiac sequelae are complex. Awareness of these mechanisms can help health professionals understand prevention and treatment strategies designed to reduce the burden of ARF in vulnerable communities.

  1. Sinus Node Dysfunction Presenting as Syncope in Acute Rheumatic Fever - A Case Report

    Directory of Open Access Journals (Sweden)

    Navdeep Singh Sidhu

    2015-01-01

    Full Text Available Rheumatic fever may be associated with a variety of cardiac conduction and rhythm disturbances. First-degree heart block is a common occurrence in acute rheumatic fever and is included in Jones’ criteria. Other electrocardiographic changes such as sinus tachycardia, bundle branch blocks, nonspeci c ST-T wave changes, atrial and ventricular premature complexes have been reported with variable frequency. Rarely, complete heart block may be a manifestation of acute rheumatic fever. Sinus node dysfunction has been reported as an exceptionally rare manifestation of acute rheumatic fever. We report a case of 33 year old female who developed syncope due to sinus node dysfunction during an episode of acute rheumatic carditis.

  2. Acute rheumatic fever outbreak in southern central European country.

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    Kočevar, Urška; Toplak, Nataša; Kosmač, Blaž; Kopač, Luka; Vesel, Samo; Krajnc, Natalija; Homan, Matjaž; Rus, Rina; Avčin, Tadej

    2017-01-01

    A decline in the incidence of acute rheumatic fever (ARF) in developed countries over the past century can be attributed to the improved public hygiene and to widespread use of antibiotics. ARF seemed to be a rare disease in southern central European country, Slovenia, up to 2010 when we noticed an increase in the number of patients with ARF. In order to assess the current incidence of ARF, we performed a retrospective study of all patients with ARF treated at the University Children's Hospital Ljubljana from January 2008 until the end of December 2014. In a period of 7 years, 19 patients with ARF were identified. The estimated annual incidence of ARF during the study period was 1.25 cases per 100,000 children. Carditis was present in all patients, arthritis in 37 % and Sydenham chorea in 32 %.

  3. The role of viral agents in aetiopathogenesis of acute rheumatic fever.

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    Olgunturk, Rana; Okur, Ilyas; Cirak, Meltem Y; Oguz, Ayse Deniz; Akalin, Nursel; Turet, Sevgi; Tunaoglu, Sedef

    2011-01-01

    The reason why abnormal immune response exists in acute rheumatic fever is not exactly explained. The influence of co-pathogens like certain viruses were mentioned regarding the initiation of the immunological reaction in acute rheumatic fever patients by several authors since 1970. This study was designed to find the role or effect of some viral infections in the development of rheumatic fever. In this study, 47 cases with acute rheumatic fever (acute rheumatic arthritis, acute rheumatic carditis, and chorea), 20 cases with chronic rheumatic fever, 20 cases with streptococcal pharyngitis, and 20 healthy age- and gender-matched control cases were involved. Serological and molecular tests were made including hepatitis B virus, hepatitis C virus, rubella virus, herpes simplex virus (HSV group 1), and Epstein-Barr virus (EBV). HBsAg, rubella IgM and EBV IgM positivity were not seen in any of patients with rheumatic fever. Although antiHBs seropositivity was higher in the control group, it was not statistically significant (p > 0.05). There was no difference in rubella IgG, HSV IgM seropositivity, either (p > 0.05). EBV DNA was searched by the polymerase chain reaction technique; due to the latent nature of the virus, no significant difference was found between the control group and the other groups (p > 0.05). In this study, no positive correlation could be found to support the synergism theories regarding the streptoccocus infection and viral infections in the development of acute rheumatic fever. Only EBV DNA positivity was found in all acute rheumatic fever cases but not in the control group may lead to further studies with larger series of patients.

  4. Acute rheumatic fever in adults: case report together with an analysis of 25 patients with acute rheumatic fever.

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    Kasitanon, Nuntana; Sukitawut, Waraporn; Louthrenoo, Worawit

    2009-07-01

    We reported the oldest acute rheumatic fever (ARF) patient with initial attack at the age of 90 years and experience with ARF in adults in 20 years of observation. The case files of all ARF patients treated by rheumatology unit, Chiang Mai University, were reviewed. Demographic data and clinical profile were recorded and compared between patients with initial attack and patients with recurrent attack. A total of 25 patients with ARF were included. There was no different incidence of arthritis and carditis between two groups. Initial attack patients have higher incidence of prolonged PR-interval (67 vs. 12%, P = 0.049) and longer duration of admission to diagnosis (5 vs. 2 days, P = 0.05). Thirty percent presented initial attack after 30 years of age. ARF is more common in adults than previously recognized. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patients with arthritis.

  5. Acute Rheumatic Fever: An Evidence-Based Approach To Diagnosis And Initial Management.

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    Khanna, Kajal; Liu, Deborah R

    2016-08-01

    Acute rheumatic fever is an inflammatory reaction involving the joints, heart, and nervous system that occurs after a group A streptococcal infection. It typically presents as a febrile illness with clinical manifestations that could include arthritis, carditis, skin lesions, or abnormal movements. Of these, the cardiac manifestations of acute rheumatic fever are most concerning, as children may present in acute heart failure and may go on to develop valvular insufficiency or stenosis. Because this is a rare presentation to emergency departments in developed countries, it is crucial for clinicians to keep a broad differential when presented with clinical presentations suspicious for acute rheumatic fever. This issue focuses on the clinical evaluation and treatment of patients with acute rheumatic fever by offering a thorough review of the literature on diagnosis and recommendations on appropriate treatment.

  6. A STUDY OF PROFILE AND PATTERNS OF “JOINT INVOLVEMENT” IN UNDER 15 YEARS AGE GROUP CHILDREN WITH ACUTE RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE

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    Bhavani Shankar

    2015-03-01

    Full Text Available CONTEXT (BACKGROUND: Acute Rheumatic fever / Rheumatic Heart disease is the most common acquired childhood heart disease diagnosis made in India. Poly Arthritis is one of the common manifestations of the disease and making it one among many differential diagnoses for sub - acute arthritis. AIMS & OBJECTIVES: To study the profile and patterns of joint involvement in children with Acute Rheumatic fever / Rheumatic Heart dise ase. MATERIALS & METHODS: The Study was conducted in a tertiary care hospital for 2 years period on less than 15 years children diagnosed as Acute Rheumatic fever / Rheumatic Heart disease as per Jones criteria (U pdated 1992. RESULTS: Joint involvement is one of the common manifestations of Acute Rheumatic fever / Rheumatic Heart disease. In our study Joint involvement is found in 50% cases (18 out of 36 cases i.e., 87.5% (7 out of 8cases of first attack cases and 39.28 %( 11 out 28 cases of reactivation cases. Further we found Polyarthritis is the predominant pattern of joint involvement. CONCLUSION: Basing on the results of our study we conclude that Joint involvement was observed in majority of cases, more so in first attack cases of Acute Rheumatic fever. Further Polyarthritis is the predominant pattern in our study. We found Knee Joint involvement as most common joint to be involved in children with Acute Rheumatic fever / Rheumatic Heart disease.

  7. Fibrinous Pericardial Effusion and Valvulitis Secondary to Previous Acute Rheumatic Fever: An Unusual Clinical Presentation

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    Osman Yılmaz

    2014-12-01

    Full Text Available Rheumatic heart disease, a sequela to acute rheumatic fever (ARF, is a major cause of acquired heart disease in children and young adults in developing countries. Valvular disease of variable severity, heart failure, and pericarditis has been observed in patients with rheumatic heart disease. A 12-year-old female patient presented with fever presented for 3 days, continuing for fatigue, exhaustion, and chest pain. Echocardiography revealed a pericardial effusion with a 24-mm-thick fibrin accumulation in the neighborhood of the left ventricle. Review of the patient’s medical history revealed that about 3 months earlier the patient had experienced migrating swelling, erythema, and pain of the ankles and knees that lasted for 1 week. Here, we present an ARF patient with an unusual clinical presentation who thought to have an attack of acute rheumatic fever 3 months earlier and was presented with fibrinous pericardial effusion.

  8. STUDY OF RISK FACTORS AND LABORATORY PROFILE IN UNDER 15 YEARS AGE GROUP CHILDREN WITH ACUTE RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE

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    Ramu

    2015-03-01

    Full Text Available CONTEXT : BACKGROUND : Acute Rheumatic fever / Rheumatic Heart disease is the most common acquired child hood heart disease diagnosis made in India and is consistently associated with poverty and overcrowding. There is no single symptom , sign or laboratory test that is diagnostic of Acute Rheumatic fever and carditis . Revised , edited and updated Jones criteria are guidelines to assist practitioners and are not a substitute for clinical judgment . The main concern in liberalizing these criteria in developed countries may be over diagnosis of Acute Rheumatic fever. AIMS & OBJECTIVES: To study the risk factors and laboratory profile in children with Acute Rheumatic fever / Rheumatic Heart d isease. MATERIALS & METHODS: The Study was conducted for 2 years period in a tertiary care hospital on less than 15 years children diagnosed as Acute Rheumatic fever / Rheumatic Heart disease. RESULTS: In our study all the cases (100% , 36 cases belongs to Lower socio economic status. Overcrowding is noted in all 36 cases (100% and we noticed rural predilection in 91.7% (33 cases cases. CONCLUSION: Basing on the results of our study we conclude that lower socio economic status , overcrowding (100% cases a nd rural predilection (91.7% are frequent associate risk factors of Acute Rheumatic fever / Rheumatic Heart disease. Further we found Anemia (88.89% , positive C.R.P (86.11% , and A.S.O titer more than 400 I.U/ml in (69.44% as common laboratory abnormali ties.

  9. Acute rheumatic fever: a public health concern in resource-poor settings

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    Olusegun Busari

    2013-04-01

    Full Text Available Acute rheumatic fever remains a public health concern in developing countries as well as in poorer communities and among indigenous populations in some developed nations. It poses serious economic problem at individual, communal and national levels through direct and indirect health care costs. The objective of this article is to review acute rheumatic fever in the global context with some emphasis on the continuing burden of this disease in the developing settings. The Cochrane Database of Systematic Reviews, PubMed, EMBASE and AJOL were searched with focus on epidemiology, pathogenesis, diagnosis and treatment, and control of acute rheumatic fever. The review shows that acute rheumatic fever still occurs under conditions of impoverished overcrowding and poor sanitation and where access to healthcare services is limited. Since acute rheumatic fever is a preventable disease, improved housing and sanitation, access to effective healthcare services, early diagnosis, registration of cases and follow up remain the bedrock of the control of this disease [Archives Medical Review Journal 2013; 22(2.000: 153-169

  10. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011.

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    Narin, Nazmi; Mutlu, Fatma; Argun, Mustafa; Ozyurt, Abdullah; Pamukcu, Ozge; Baykan, Ali; Baykan, Zeynep; Uzum, Kazım

    2015-04-01

    In developing countries, acute rheumatic fever is the most common cause of acquired heart disease in the paediatric and adolescent population. It is believed that vulnerability to developing acute rheumatic fever is associated with several factors such as socio-economic and living conditions. Aim Determine the incidence and clinical characteristics of acute rheumatic fever in the Central Anatolia region of Kayseri within the last 14 years, and to make a comparison of two 7-year periods. Material and methods We performed a retrospective analysis of 624 patients who were diagnosed with acute rheumatic fever at the Department of Pediatric Cardiology in the Medical Faculty of Erciyes University between January, 1998 and December, 2011. The mean age of patients was 10.9±2.7 years. The female/male ratio was 1.4. When patients were categorised according to age groups, the largest group represented 376 patients (60.3%) aged between 10 and 14 years. The estimated incidence rate of acute rheumatic fever was 7.4/100,000 in the Central Anatolia region of Kayseri. Among the major findings, the most common included carditis at 54%, arthritis at 35%, Sydenham's chorea at 25%, and subcutaneous nodules at 0.5%, respectively. No significant difference was found between the first 7-year period and second 7-year period in distributions of age, gender, and major findings. Although there has been socio-economic development in Turkey in the recent years, the incidence of acute rheumatic fever is still high in the Central Anatolia region of Kayseri.

  11. Acute Rheumatic Fever: Findings of a Hospital-Based Study and an Overview of Reported Outbreaks

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    Upton D Allen

    1990-01-01

    Full Text Available To review the characteristics of reported outbreaks of acute rheumatic fever in the United States, and to determine if there is an increase in the incidence of acute rheumatic fever in the population served by the Hospital for Sick Children, Toronto, Ontario, the authors conducted a literature search and a retrospective review of inpatients and outpatients, satisfying the revised Jones criteria for the diagnosis of acute rheumatic fever, from 1972 to 1988. Patients satisfying the revised Jones criteria for the time period 1972–88 were included in the study. There have been eight articles reporting an increase in acute rheumatic fever in the United States. In three, the majority of children were white and from middle class suburban/rural communities in different geographic locations. Mucoid strains of group A streptococci were implicated but not confirmed as being associated with the outbreaks in three. The results of the chart review at the Hospital for Sick Children revealed that 83 cases satisfied the revised Jones criteria. The number of cases per 100,000 children (aged 18 years or less per year, decreased progressively over the study period. Polyarthritis was the most frequently seen major criterion occurring in 73% of patients (61 of 83. The most frequently affected ethnic groups were Italians 23%, Afro-Canadians 19% and Orientals 8%. The reported outbreaks in the United States are multifocal and predominantly confined to white middle class children residing in suburban/rural communities. There was no evidence of an increase in the number of cases of acute rheumatic fever seen in the population served by the Hospital for Sick Children; there was a progressive decline in number of cases over the study period. The results facilitate the characterization of acute rheumatic fever within North America into three different patterns of occurrence.

  12. Incidence of acute rheumatic fever and chronic rheumatic heart disease, trends in deaths in the Tula region (1991—2011

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    Valentina Nikolayevna Sorotskaya

    2013-01-01

    Full Text Available The paper analyzes the incidence of acute rheumatic fever (ARF and chronic rheumatic heart disease (CRHD and theirs outcomes in the Tula Region in 1991 to 2011. In this period, the incidence of ARF decreased to 0.002, which was much lower than Russia's rates. That of CRHD in 2011 accounted for 1.6 per 1,000 adult population, which was comparable to the values in Russia. CRHD mortality rates showed a 2.5-fold decrease. The main causes of fatal outcomes were cardiovascular disorders.

  13. ECHOCARDIOGRAPHIC PROFILE OF VALVULAR LESIONS IN CHILDREN WITH ACUTE RHEUMATIC FEVER / RHEUMATIC HEART DISEASE IN A TERTIARY CARE HOSPITAL

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    Ramu

    2015-03-01

    Full Text Available CONTEXT (B ACKGROUND: Rheumatic Heart disease is still a leading cause of valvular disease in developing countries like India and constitutes 10 to 50% of the cardiac patients in Indian hospitals. Echocardiography is a very sensitive investigation for the diagnosis of Rheumatic Carditis and its sequalae like Mitral, Aortic and Tricuspid valve disease as well as sub clinical Carditis. AIMS & OBJECTIVES: To study the profile, severity and gender based differences of valvular lesions on the Trans Thoracic Echocardiographic records of children diagnosed as Acute Rheumatic fever/ Rheumatic Heart disease. MATERIALS & METHODS: This study was conducted during D ecember’2014 by reviewing the records of trans thoracic Echocardiographic reports of our 36 cases (childhood Acute Rheumatic fever/ Rheumatic Heart disease cases for type and degree of valvular involvement according to AHA guidelines. RESULTS: Mitral valv e was involved most often (23 cases – 63.89%. Severe Mitral regurgitation is the common type of valvular lesions both in Boys and Girls (19.44% and 25% respectively. Isolated Aortic valve/ Tricuspid valve involvement was not found in our study. Mixed les ions were seen most often than pure isolated valvular lesions. CONCLUSION: Mitral valve was most commonly affected, while Regurgitant lesions were more common than Stenotic lesions and most severe in children less than 15 years age group. Aortic Regurgitat ion (AR was found more commonly in Girls than Boys in our study. But all these cases of AR had some other valvular involvement as Mixed lesions. Therefore Echocardiography should be done routinely for patients with Rheumatic Heart Disease, focusing on you nger population to facilitate diagnosis and definitive treatment before complications set in.

  14. A Review of Acute Rheumatic Fever and Rheumatic Heart Disease Research in Malaysia.

    Science.gov (United States)

    Hung, L C; Nadia, R

    2016-06-01

    A total of 39 titles related to rheumatic fever or rheumatic heart disease in Malaysia were found with online literature search dating back to their inceptions and through 2014. Additional publications from conference journals were included. Nine papers were selected based on clinical relevance and future research implications. There were no population-based studies on the incidence or prevalence of ARF or RHD. In the 1980s, the incidence of admission due to ARF ranged from 2 to 21.1 per 100 000 paediatric admission per year. The burden of disease was significant in the adult population; 74.5% of patients with RHD were female, of which 77.1% were in the reproductive age group of 15-45 years old. Rheumatic mitral valve disease constituted almost half (46.7%) of all mitral valve repairs, ranging from 44.8 - 55.8 patients per year from 1997 - 2003. From 2010-2012, mitral valve interventions increased to 184 per year, of which 85.7% were mitral valve repair. In children with ARF, 25.4% - 41.7% had past history of rheumatic fever or RHD. In patients with rheumatic mitral valve disease undergoing surgical or medical interventions, only 6% reported history of ARF, none had history of GABHS pharyngitis or antibiotic prophylaxis. Only 44.7% of patients with RHD on follow-up were on intramuscular benzathine penicillin prophylaxis. Overall, there is scarcity of publications on ARF and RHD in Malaysia. Priority areas for research include determination of the incidence and prevalence of ARF and RHD, identification of high-risk populations, evaluation on the implementation and adherence of secondary preventive measures, identification of subclinical RHD especially amongst the high-risk population, and a surveillance system to monitor and evaluate preventive measures, disease progression and outcomes.

  15. A STUDY OF PROFILE AND PATTERNS OF “JOINT INVOLVEMENT” IN UNDER 15 YEARS AGE GROUP CHILDREN WITH ACUTE RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE

    OpenAIRE

    2015-01-01

    CONTEXT (BACKGROUND): Acute Rheumatic fever / Rheumatic Heart disease is the most common acquired childhood heart disease diagnosis made in India. Poly Arthritis is one of the common manifestations of the disease and making it one among many differential diagnoses for sub - acute arthritis. AIMS & OBJECTIVES: To study the profile and patterns ...

  16. Acute rheumatic fever - Carditis is the most common presenting manifestation in South Africa

    NARCIS (Netherlands)

    Muller, E; Huizinga, SJ; Kalis, NN; VanDerMerwe, PL

    1997-01-01

    Acute rheumatic fever (ARF) is still a major health problem in South Africa. In this retrospective, descriptive study, 100 patients with ARF were analysed to establish whether the clinical profile has changed. Carditis was found in 94% of patients and was therefore the most common of the major crite

  17. M-Protein Analysis of Streptococcus pyogenes Isolates Associated with Acute Rheumatic Fever in New Zealand.

    Science.gov (United States)

    Williamson, Deborah A; Smeesters, Pierre R; Steer, Andrew C; Steemson, John D; Ng, Adrian C H; Proft, Thomas; Fraser, John D; Baker, Michael G; Morgan, Julie; Carter, Philip E; Moreland, Nicole J

    2015-11-01

    We applied an emm cluster typing system to group A Streptococcus strains in New Zealand, including those associated with acute rheumatic fever (ARF). We observed few so-called rheumatogenic emm types but found a high proportion of emm types previously associated with pyoderma, further suggesting a role for skin infection in ARF. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  18. A Rare Heart Rhythm Problem in Acute Rheumatic Fever: Complete Atrioventricular Block

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    Ayse Kibar

    2014-03-01

    Full Text Available Rheumatic heart disease remains the most important cause of acquired heart disease in children and young adults. Different kinds of rhythm and conduction disturbances may be seen during the course of acute rheumatic fever (ARF. Long PR intervals are found commonly in rheumatic fever, but complete atrioventricular (AV block is an exceptionally rare manifestation. This case report is about a 14 year-old-female patient diagnosed as ARF based on migratory arthralgia and mild carditis who also developed complete heart block on admission. Electrocardiogram on the 3rd day of hospitalization depicts 2nd degree atrioventricular block (Mobitz I combined with PR prolongation. The ECG revealed a normal sinus rhythm with PR prolongation on the 4th day of hospitalization. Rarely, complete AV heart block can occur as a complication of ARF and may develop during the acute phase

  19. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study.

    Science.gov (United States)

    Karacan, Mehmet; Işıkay, Sedat; Olgun, Haşim; Ceviz, Naci

    2010-12-01

    Some rhythm and conduction abnormalities can occur in children with acute rheumatic fever. These abnormalities have been defined based on standard electrocardiography; however, the real prevalence of these abnormalities has not been investigated previously by the evaluation of long-term electrocardiographic recordings. In this study, we evaluated the asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever by evaluating the 24-hour electrocardiography. We evaluated the standard electrocardiography and the 24-hour electrocardiography of 64 children with acute rheumatic fever. On standard electrocardiography, the frequency of the first-degree atrioventricular block was found to be 21.9%. Electrocardiography at 24 hours detected three additional and separate patients with a long PR interval. Mobitz type I block and atypical Wenckebach periodicity were determined in one patient (1.56%) on 24-hour electrocardiography. While accelerated junctional rhythm was detected in three patients on standard electrocardiography, it was present in nine patients according to 24-hour electrocardiography. Premature contractions were present in 1.7% of standard electrocardiography, but in 29.7% of 24-hour electrocardiography. Absence of carditis was found to be related to the presence of accelerated junctional rhythm (p > 0.05), and the presence of carditis was found to be related to the presence of premature contractions (p = 0.000). In conclusion, our results suggest that in children with acute rheumatic fever, the prevalence of rhythm and conduction abnormalities may be much higher than determined on standard electrocardiography. Further studies are needed to clarify whether or not these abnormalities are specific to acute rheumatic fever.

  20. THE UTILITY OF A SINGLE ANTI STREPTOLYSIN O TITER IN THE DIAGNOSIS OF ACUTE RHEUMATIC FEVER

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    Anil

    2014-07-01

    Full Text Available BACKGROUND: Acute Rheumatic Fever still affects millions of children in the developing world, the diagnosis of rheumatic fever is based on the Jones criteria and supporting evidence of preceding streptococcal infection from a positive throat culture or elevated ASO titers. However, some clinicians have questioned the role of a single ASO titer in the diagnosis of acute rheumatic fever. AIMS AND OBJECTIVES: To determine the utility of a single ASO titer level and its correlation with Jones major criteria. MATERIAL AND METHODS: 12 children diagnosed with rheumatic fever at our hospital in the preceding two years were included. A single ASO titer done in these children using a turbidimetric immunoassay was recorded OBSERVATIONS: The ASO titer levels ranged from 185 to 1691 IU/ml. The highest levels were seen with features of acute carditis and the lowest levels in association with chorea. CONCLUSION: A single ASO titer retains its role as a useful diagnostic tool and inversely correlates with disease progression.

  1. Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Māori and Pacific children.

    Science.gov (United States)

    Thornley, Simon; Marshall, Roger J; Bach, Katie; Koopu, Pauline; Reynolds, Gary; Sundborn, Gerhard; Ei, Win Le Shwe Sin

    2017-04-01

    To determine whether dental caries, as an indicator of cumulative exposure to sugar, is associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease, in Māori and Pacific children aged 5 and 6 years at their first dental visit. A cohort study was undertaken which linked school dental service records of caries with national hospital discharge and mortality records. Cox models were used to investigate the strength of the association between dental caries and rheumatic fever incidence. A total of 20 333 children who were free of rheumatic heart disease at enrolment were available for analysis. During a mean follow-up time of 5 years, 96 children developed acute rheumatic fever or chronic rheumatic heart disease. After adjustment for potential confounders, children with five or more primary teeth affected by caries were 57% (95% CI: 20% to 106%) more likely to develop disease during follow-up, compared to children whose primary teeth were caries free. The population attributable to the risk for caries in this cohort was 22%. Dental caries is positively associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease in Māori and Pacific children. Sugar intake, an important risk factor for dental caries, is also likely to influence the aetiology of rheumatic fever. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Rheumatic Fever Programme in Samoa.

    Science.gov (United States)

    Viali, Satupaitea; Saena, Puleiala; Futi, Vailogoua

    2011-02-11

    Rheumatic fever is very common in Samoa. The following paper describes the Rheumatic Fever Programme in Samoa and looks at the incidence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). The incidence of ARF has decreased to 30 per 100,000 in 2005, 12.8 per 100,000 in 2007, 7.3 per 100,000 in 2008, and 9.5 per 100,000 in 2009. The incidence of RHD has decreased to 40.2 per 100,000 in 2007, 34 per 100,000 in 2008, and 31.8 per 100,000 in 2009. Cardiac surgery in New Zealand is expensive, but is cheaper to perform in Samoa. RHD screening with echocardiogram at schools may be the best way to reduce the burden and suffering from RHD.

  3. A cost-effective strategy for primary prevention of acute rheumatic fever and rheumatic heart disease in children with pharyngitis.

    Science.gov (United States)

    Irlam, James H; Mayosi, Bongani M; Engel, Mark E; Gaziano, Thomas A

    2013-09-03

    Primary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in children depends on prompt and effective diagnosis and treatment of pharyngitis at the primary level of care. Cost-effectiveness modeling shows that the most cost-effective strategy for primary prevention in South Africa (SA) is to use a simple symptomatic clinical decision rule (CDR) to diagnose pharyngitis in children presenting at the primary level of care and then to treat them with a single dose of intramuscular penicillin. Treat All and CDR2+ strategies are affordable and simple and miss few cases of streptococcal pharyngitis at the primary level of care. The CDR2+ strategy is the most cost-effective for primary prevention of ARF and RHD in urban SA and should complement primordial and secondary prevention efforts.

  4. Clinical significance of sialic acid in acute rheumatic fever with and without carditis

    OpenAIRE

    Maher H. Gomaa; Halah Salah Al-Din Hamza; Mamdouh M. Ali; Ahmed Abd-Allah Ali; Osama Abd Al-Motaal Mansour; Ahmed M. Ibrahim

    2012-01-01

    Objective: In Egypt, acute rheumatic fever (ARF) is the most common cause of acquired heart disease. ARF is a clinical syndrome without a specific diagnostic test or single pathognomonic feature, so the aim of this study is to investigate the utility of using serum total sialic acid (TSA) in differentiation between children suffering from ARF with and without carditis. Methods: In the present study, 62 children were divided into three groups: first group, 16 healthy children; second group, 20...

  5. Sydenham's chorea and erythema marginatum as the first clinical presentation of acute rheumatic fever

    Directory of Open Access Journals (Sweden)

    Farhang Babamahmoodi

    2009-01-01

    Full Text Available (Received 5 February, 2009 ; Accepted 13 Jan, 2010AbstractAcute rheumatic fever is an acute systemic disease due to autoimmune reaction against some of BHSA. Similarity between bacterial antigens and cardiaciovascular tissue, synovial membrane, joints and subcutaneous tissues and cerebral basal ganglions are the causes of autoimmune reactions and manifestation of the disease. Most of the ARF occur in children (5-14 years old followed by streptococcal pharyngitis and the disease is very rare in adults.Sydenham's chorea is a late manifestation of ARF and one of the John's diagnostic criteria that is usually revealed when the other criteria are absent. There is often a long latent period between clinical manifestations of the ARF and the onset of chorea as an uncommon initial presentation of acute rheumatic fever. We report the clinical findings, investigations and the course of clinical development of a seventeen-year-old girl, who presented with acute onset of abnormal involuntary movements in her right hand for two days before her admission. She had sore throat and fever three weeks before development of these new problems. Her complaints disappeared with proper treatment. The considerable findings in this case report was co-incidence of Sydenham's chorea with erythema marginatum, fever, severe mitral valve insufficiency, arthralgia in an adult patient that is a very rare case. She was discharged after a 10-day treatment regime.Key words: Acute rheumatic fever, sydenham's chorea, erythema marginatumJ Mazand Univ Med Sci 2009; 20(74: 91-97 (Persian.

  6. Macrolide treatment failure in streptococcal pharyngitis resulting in acute rheumatic fever.

    Science.gov (United States)

    Logan, Latania K; McAuley, James B; Shulman, Stanford T

    2012-03-01

    Macrolide resistance (MR) in group A Streptococcus (GAS) has been well documented in several countries and has become clinically significant since the large increases in macrolide usage during the 1970s. Macrolides are recommended as an alternative therapy for GAS pharyngitis, the most common cause of bacterial pharyngitis. Macrolide resistance has been associated with certain emm types, a sequence-based typing system of the hypervariable region of the GAS M-protein gene. Clinical failure of macrolide treatment of GAS infections can be associated with complications including acute rheumatic fever and rheumatic heart disease, the leading cause of acquired heart disease in children worldwide. Here we report 2 pediatric cases of MR and/or treatment failure in the treatment of GAS pharyngitis with the subsequent development of acute rheumatic fever. We also review the literature on worldwide MR rates, molecular classifications, and emm types, primarily associated with GAS pharyngeal isolates between the years of 2000 and 2010. The use of macrolides in the management of GAS pharyngitis should be limited to patients with significant penicillin allergy.

  7. Acute rheumatic fever and streptococci: the quintessential pathogenic trigger of autoimmunity.

    Science.gov (United States)

    Chakravarty, Soumya D; Zabriskie, John B; Gibofsky, Allan

    2014-07-01

    Acute rheumatic fever (ARF) is a non-suppurative complication of pharyngeal infection with group A streptococcus. Signs and symptoms of ARF develop 2 to 3 weeks following pharyngitis and include arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. In developing areas of the world, ARF and rheumatic heart disease are estimated to affect nearly 20 million people and remain leading causes of cardiovascular death during the first five decades of life. ARF still represents one of the quintessential examples of a pathogenic trigger culminating in autoimmune manifestations. In this review, we will focus on the pathogenesis and etiology of ARF and its complications, along with diagnostic and treatment approaches to both ameliorate and prevent long-term sequelae of this potentially debilitating disease.

  8. Is It Suitable to Diagnose Acute Rheumatic Fever with Anti-Streptolysin O?

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    Ç. Emre Çağlıyan

    2011-08-01

    Full Text Available In clinical practice, Anti-streptolizin O (ASO levels are used for diagnosis of Acute Rheumatic Fever (ARF. We investigated to evaluate the accuracy of using ASO in patients with a murmur in physical examination, in patients with a suspicious ARF history and sometimes only in routine examination. When we evaluate 52 patients' data, high ASO levels was not associated with nor valve structures, neither ARF history. Therefore, we showed that using ASO of levels only is an incorrect application for diagnosis of ARF in clinical practice.

  9. Post-streptococcal reactive arthritis in children: a distinct entity from acute rheumatic fever

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    Barash Judith

    2011-10-01

    Full Text Available Abstract There is a debate whether post-streptococcal reactive arthritis (PSRA is a separate entity or a condition on the spectrum of acute rheumatic fever (ARF. We believe that PSRA is a distinct entity and in this paper we review the substantial differences between PSRA and ARF. We show how the demographic, clinical, genetic and treatment characteristics of PSRA differ from ARF. We review diagnostic criteria and regression formulas that attempt to classify patients with PSRA as opposed to ARF. The important implication of these findings may relate to the issue of prophylactic antibiotics after PSRA. However, future trials will be necessary to conclusively answer that question.

  10. The incidence of acute rheumatic fever and chronic rheumatic heart disease in the Russian population (2011–2012

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    Rimma Mikhailovna Balabanova

    2014-03-01

    Full Text Available The problems of acute rheumatic fever (ARF and chronic rheumatic heart disease (CRHD are discussed. Carditis, polyarthritis, erythema annulare, subcutaneous nodules, and chorea minor are the main clinical manifestations of ARF caused by β-hemolytic streptococcus A. Cardiac failures emerge in 60–65% of patients after the first ARF episode. Repeated ARF attacks promote CRHD. The aim of the study is to evaluate the prevalence of rheumatic heart disease in different age groups in the regions of Russian Federation in 2011–2012. Materials and Methods. Analysis of the Ministry of Healthcare of the Russian Federation reports on population morbidity in 2011–2012 (Form N12.Results. The highest ARF prevalence was observed in 15–17-year-old teenagers, while the lowest, in adults over 18-year-old. The lowest CRHD figures were registered in juniors, while the highest ones, in adults. No ARF cases in 0–14-year-old children were registered in 31 entities of the Russian Federation; single cases, in 17 entities; no ARF cases in 15–17-year-old teenagers was registered in 37 entities, and 1–2 ARF cases were registered in 23 entities. Only in 10 entities, no ARF cases were registered in adults, and single cases were registered in 22 entities. Extremely unfavorable situations were found in the Chechen Republic (140 ARF cases in 0–14-year-old children and in the Dagestan Republic (140 cases. High morbidity among 15–17-year-old teenagers was registered in tje Kaliningrad region (83 cases and the Chechen Republic (100. ARF cases in adults were most frequent in St. Petersburg (124 cases, the Chechen Republic (154, and the Moscow region (161.The article lists the ARF and CRHD preventive measures.

  11. The incidence of acute rheumatic fever and chronic rheumatic heart disease in the Russian population (2011–2012

    Directory of Open Access Journals (Sweden)

    Rimma Mikhailovna Balabanova

    2014-01-01

    Full Text Available The problems of acute rheumatic fever (ARF and chronic rheumatic heart disease (CRHD are discussed. Carditis, polyarthritis, erythema annulare, subcutaneous nodules, and chorea minor are the main clinical manifestations of ARF caused by β-hemolytic streptococcus A. Cardiac failures emerge in 60–65% of patients after the first ARF episode. Repeated ARF attacks promote CRHD. The aim of the study is to evaluate the prevalence of rheumatic heart disease in different age groups in the regions of Russian Federation in 2011–2012. Materials and Methods. Analysis of the Ministry of Healthcare of the Russian Federation reports on population morbidity in 2011–2012 (Form N12.Results. The highest ARF prevalence was observed in 15–17-year-old teenagers, while the lowest, in adults over 18-year-old. The lowest CRHD figures were registered in juniors, while the highest ones, in adults. No ARF cases in 0–14-year-old children were registered in 31 entities of the Russian Federation; single cases, in 17 entities; no ARF cases in 15–17-year-old teenagers was registered in 37 entities, and 1–2 ARF cases were registered in 23 entities. Only in 10 entities, no ARF cases were registered in adults, and single cases were registered in 22 entities. Extremely unfavorable situations were found in the Chechen Republic (140 ARF cases in 0–14-year-old children and in the Dagestan Republic (140 cases. High morbidity among 15–17-year-old teenagers was registered in tje Kaliningrad region (83 cases and the Chechen Republic (100. ARF cases in adults were most frequent in St. Petersburg (124 cases, the Chechen Republic (154, and the Moscow region (161.The article lists the ARF and CRHD preventive measures.

  12. Understanding rheumatic fever.

    Science.gov (United States)

    Azevedo, Pedro Ming; Pereira, Rosa Rodrigues; Guilherme, Luiza

    2012-05-01

    Through a comprehensive review of the recent findings on rheumatic fever, we intend to propose a new physiopathologic model for this disease. A Medline search was performed for all articles containing the terms rheumatic fever or rheumatic heart disease in title or abstract from 1970 to 2011. Best evidence qualitative technique was used to select the most relevant. The scientific interest on rheumatic fever has notably diminished throughout the twentieth century as evidenced by the comparison of the proportion of articles in which RF was a subject in 1950 (0.26%) and today (0.03%) [Pubmed]. However, RF remains a major medical and social problem in the developing world and in the so-called hotspots, where it still causes around 500.000 deaths each year, not too different from the pre-antibiotic era. The role of genetic factors in RF susceptibility is discussed. Familiar aggregation, similarity of disease patterns between siblings, identical twin, and HLA correlation studies are evidence for a genetic influence on RF susceptibility. The suspect-involved genes fall mainly into those capable of immunologic mediation. Molecular mimicry explains the triggering of RF, but an intense and sustained inflammation is needed to cause sequels. Also, RF patients vary greatly in terms of symptoms. It is likely that a genetic background directing immune response towards a predominantly Th1 or Th2 pattern contributes to these features. The recent findings on rheumatic fever provide important insight on its physiopathology that helps understanding this prototype post-infectious autoimmune disease giving insights on other autoimmune conditions.

  13. Rheumatic fever in New Zealand.

    Science.gov (United States)

    Webb, Rachel; Wilson, Nigel

    2013-03-01

    Acute rheumatic fever and its sequel rheumatic heart disease remain major unsolved problems in New Zealand, causing significant morbidity and premature death. The disease burden affects predominantly indigenous Māori and Pacific Island children and young adults. In the past decade these ethnic disparities are even widening. Secondary prophylaxis using 28-day intramuscular penicillin has been the mainstay of disease control. In the greater Auckland region, audit shows community nurse-led penicillin delivery rates of 95% and recurrence rates of less than 5%. The true penicillin failure rate of 0.07 per 100 patient years supports 4 weekly penicillin rather than more frequent dose regimens. Landmark primary prevention research has been undertaken supporting sore throat primary prevention programmes in regions with very high rheumatic fever rates. Echocardiographic screening found 2.4% previously undiagnosed rheumatic heart disease in socially disadvantaged children. Combined with secondary prevention, echocardiography screening has the potential to reduce the prevalence of severe rheumatic heart disease.

  14. Geoepidemiological hints about Streptococcus pyogenes strains in relationship with acute rheumatic fever.

    Science.gov (United States)

    Esposito, Susanna; Bianchini, Sonia; Fastiggi, Michele; Fumagalli, Monica; Andreozzi, Laura; Rigante, Donato

    2015-07-01

    Group A Streptococcus (GAS) strains are lately classified on the basis of sequence variations in the emm gene encoding the M protein, but despite the high number of distinct emm genotypes, the spectrum of phenotypes varying from invasive suppurative to non-suppurative GAS-related disorders has still to be defined. The relationship of GAS types with the uprising of acute rheumatic fever (ARF), a multisystemic disease caused by misdirected anti-GAS response in predisposed people, is also obscure. Studies published over the last 15 years were retrieved from PubMed using the keywords: "Streptococcus pyogenes" or "group A Streptococcus" and "acute rheumatic fever": the prevalence of peculiar emm types across different countries of the world is highly variable, depending on research designs, year of observation, country involved, patients' age, and gender. Most studies revealed that a relatively small number of specific emm/M protein types can be considered "rheumatogenic", as potentially characterized by the possibility of inducing ARF, with remarkable differences between developing and developed countries. The association between emm types and post-streptococcal manifestations is challenging, however surveillance of disease-causing variants in a specific community with high rate of ARF should be reinforced with the final goal of developing a potential primary prophylaxis against GAS infections.

  15. What about My Child and Rheumatic Fever?

    Science.gov (United States)

    ... Cardiovascular Conditions What About My Child and Rheumatic Fever? Rheumatic fever is an inflammatory reaction that can occur after ... strep throat infections don’t lead to rheumatic fever. When they do, the time between the strep ...

  16. Penicillin Therapy in Children with Acute Rheumatic Fever: Side Effects, Malpractice and Anaphylactic Reactions

    Directory of Open Access Journals (Sweden)

    Murat Çiftel

    2015-04-01

    Full Text Available Acute rheumatic fever (ARF is more common in developing countries. ARF is a systemic disorder, which develops in children following group A streptococcal (GAS pharyngitis. Rheumatic valvular disease is caused by autoimmune responses. Penicillin is used in the treatment of GAS tonsillopharyngitis and in primary and secondary prophylaxis against ARF. A single intramuscular (IM injection of benzathine penicillin or oral penicillin V (phenoxymethylpenicillin is administered as primary prophylaxis for 10 days. In the presence of rheumatic valvular disease, secondary prophylaxis with the injection of benzathine penicillin is required for life, or at least until the age of 40. IM injection of penicillin may cause fear and pain in children. Lidocaine or lidocaine-prilocaine (EMLA creams can be used to decrease pain associated with IM injections. The most serious side effect of penicillin is, however, the anaphylactic reaction. This reaction can be caused by minor or major determinants of penicillin. Patients should be questioned about the past history of the penicillin allergy, and penicillin skin testing should be performed and interpreted appropriately in order to prevent anaphylactic reaction related to penicillin administration. In the presence of the suspicion of a penicillin allergy, skin testing should be avoided, and the patient should be tested by a pediatric allergy specialist using major and minor determinants to confirm a penicillin allergy. Patients who are allergic to penicillin can undergo desensitization in the absence of an alternative drug. It is a medical and legal obligation to perform and interpret the skin test appropriately, to keep the necessary equipment and drugs available for possible anaphylactic reactions, and to treat the patient appropriately in the case of an anaphylactic reaction. Penicillin is commonly used in pediatrics and pediatric cardiology.

  17. A Case of Adult-Onset Acute Rheumatic Fever With Long-Lasting Atrioventricular Block Requiring Permanent Pacemaker Implantation.

    Science.gov (United States)

    Oba, Yusuke; Watanabe, Hiroaki; Nishimura, Yoshioki; Ueno, Shuichi; Nagashima, Takao; Imai, Yasushi; Shimpo, Masahisa; Kario, Kazuomi

    2015-01-01

    A 45-year-old hypertensive Japanese woman presented with epigastric pain on inspiration, fever, complete atrioventricular block and polyarthritis. Her antistreptolysin O levels were markedly elevated. A diagnosis of rheumatic fever was made according to the modified Jones criteria. She was prescribed loxoprofen sodium, which was partially effective for her extracardiac clinical symptoms. However, she had syncope due to complete atrioventricular block with asystole longer than 10 seconds. Consequently, we implanted a permanent pacemaker. Although we prescribed prednisolone, the efficacy of which was limited for the patient's conduction disturbance, the complete atrioventricular block persisted. In our systematic review of 12 similar cases, the duration of complete heart block was always transient and there was no case requiring a permanent pacemaker. We thus encountered a very rare case of adult-onset acute rheumatic fever with persistent complete atrioventricular block necessitating permanent pacemaker implantation.

  18. Clinical significance of sialic acid in acute rheumatic fever with and without carditis

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    Maher H. Gomaa

    2012-08-01

    Full Text Available Objective: In Egypt, acute rheumatic fever (ARF is the most common cause of acquired heart disease. ARF is a clinical syndrome without a specific diagnostic test or single pathognomonic feature, so the aim of this study is to investigate the utility of using serum total sialic acid (TSA in differentiation between children suffering from ARF with and without carditis. Methods: In the present study, 62 children were divided into three groups: first group, 16 healthy children; second group, 20 patients suffering from chronic rheumatic heart disease (RHD; and third group, 26 patients suffering from ARF, subdivided into three subgroups as (A 10 patients suffering from arthritis without carditis, (B 10 patients with carditis but without congestive heart failure (CHF, and (C 6 patients with carditis and CHF. Antistreptolysin O titre (ASOT by latex agglutination test, erythrocyte sedimentation rate (ESR by Westergren method, C-reactive protein (CRP by turbidimetric immunoassay method, lactate dehydrogenase (LDH activity by kinetic method, immunoglobulin levels by radial immunodifussion assay (RID, cardiac troponin I (cTnI by ELISA test kit and TSA by diphenylamine (DPA method were performed. Results: Significant elevated values of ESR, CRP, LDH, IgG and IgA were obtained in ARF as compared to both control and RHD groups; significant values of IgM were found between B and C as compared to control and RHD groups; cTnI showed insignificant difference between all groups; values of TSA showed highly significant difference between ARF as compared to both control and RHD groups as well as between RHD and control groups; significant difference was found between B and C groups as compared to group A. Conclusion: The results of the present study point out the possibility that the levels of TSA could be of help in differentiation between ARF patients with and without carditis. [J Exp Integr Med 2012; 2(4: 305-311

  19. Rheumatic Fever in the Adult: A Forgotten Diagnosis

    Science.gov (United States)

    Berger, Brian; Swanson, Richard; Smith, Stanley

    1987-01-01

    The authors of this article present a case of acute rheumatic fever in an adult and review the diagnostic criteria for this illness. They emphasize the prevention of acute rheumatic fever by the adequate treatment of streptococcal pharyngitis with penicillin. PMID:21263778

  20. Serological Evidence of Immune Priming by Group A Streptococci in Patients with Acute Rheumatic Fever

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    Jeremy M Raynes

    2016-07-01

    Full Text Available Acute rheumatic fever (ARF is an autoimmune response to Group A Streptococcus (GAS infection. Repeated GAS exposures are proposed to ‘prime’ the immune system for autoimmunity. This notion of immune-priming by multiple GAS infections was first postulated in the 1960s, but direct experimental evidence to support the hypothesis has been lacking. Here we present novel methodology, based on antibody responses to GAS T‑antigens, that enables previous GAS exposures to be mapped in patient sera. T-antigens are surface expressed, type specific antigens and GAS strains fall into 18 major clades or T-types. A panel of recombinant T-antigens was generated and immunoassays were performed in parallel with serum depletion experiments allowing type-specific T‑antigen antibodies to be distinguished from cross-reactive antibodies. At least two distinct GAS exposures were detected in each of the ARF sera tested. Furthermore, no two sera had the same T-antigen reactivity profile suggesting that each patient was exposed to a unique series of GAS T‑types prior to developing ARF. The methods have provided much-needed experimental evidence to substantiate the immune-priming hypothesis, and will facilitate further serological profiling studies that explore the multifaceted interactions between GAS and the host.

  1. Acute Rheumatic Fever in the North East of Iran: A Study of 80 Cases

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    Saeed Talebi

    2006-08-01

    Full Text Available Background: To evaluate the frequency, clinical presentation and cardiac involvement of children with RF in the North-East of Iran. Methods: A case series analysis was conducted on 80 patients with acute rheumatic fever (ARF, who were hospitalized at Ghaem hospital in Mashad between 1994 and 2000, were studied. Laboratory tests and results from echocardiographic examinations, and clinical findings were analyzed. All patients received standard care for children with ARF. The X2 test was used for comparison of binary data. Results: When compared to similar studies from developed countries, our study demonstrates a decreased frequency of RF in North-East Iran over the past few years. However, it is still a major health problem and the most common cause of acquired heart disease in childhood. The distribution of the major modified Jones criteria in our study is slightly different from that described in the literature, with a higher incidence of carditis. Conclusion: It appears that carditis is endemic in this region. Considering the high morbidity and complications involved in this disease, there is an immediate need for effective preventive programs for the initiating cause streptococcal infections, especially since it is treatable.

  2. Historical aspects of rheumatic fever.

    Science.gov (United States)

    Steer, Andrew C

    2015-01-01

    Few diseases have experienced such a remarkable change in their epidemiology over the past century, without the influence of a vaccine, than rheumatic fever. Rheumatic fever has all but disappeared from industrialised countries after being a frequent problem in the 1940s and 1950s. That the disease still occurs at high incidence in resource limited settings and in Indigenous populations in industrialised countries, particularly in Australia and New Zealand, is an indication of the profound effect of socio-economic factors on the disease. Although there have been major changes in the epidemiology of rheumatic fever, diagnosis remains reliant on careful clinical judgement and management is remarkably similar to that 50 years ago. Over the past decade, increasing attention has been given to rheumatic fever and rheumatic heart disease as public health issues, including in Australia and particularly in New Zealand, as well as in selected low and middle income countries. Perhaps the greatest hope for public health control of rheumatic fever is the development of a vaccine against Streptococcus pyogenes, and there are encouraging initiatives in this area. However, an effective vaccine is some time away and in the meantime public health efforts need to focus on effective translation of the known evidence around primary and secondary prophylaxis into policy and practice.

  3. Carotid intima media thickness and arterial stiffness in children with acute rheumatic fever.

    Science.gov (United States)

    Çiftel, Murat; Yılmaz, Osman; Kardelen, Fırat; Kocabaş, Abdullah

    2014-01-01

    Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) constitute important public health problems in developing countries. Inflammation is present both in the early and late stages of the diseases. Chronic inflammation is known to be associated with atherosclerosis. We hypothesize that subclinical atherosclerosis and arterial stiffness may increase due to the ongoing inflammation as well as the increased pulse pressure and left-ventricular systolic dysfunction in RHD. The purpose of the present study was to investigate carotid intima media thickness (CIMT) and carotid artery stiffness in patients with ARF. Forty patients in follow-up due to ARF in the age group of 7-16 years (disease duration 1-10 years) and 36 volunteered subjects with similar body mass index were included in the study. The subjects included in the present study were compared regarding M-mode echocardiographic parameters and CIMT as well as carotid arterial strain (CAS), carotid artery distensibility (CAD), beta stiffness index (βSI), and pressure-strain elasticity modulus (Ep) as carotid artery stiffness parameters. CIMT (0.52 ± 0.08 and 0.48 ± 0.07 mm, p = 0.01), βSI (5.29 ± 2.98 and 3.02 ± 1.30, p < 0.001), and Ep (426.53 ± 210.50 and 254.44 ± 104.69 p < 0.001) were increased, whereas CAS (0.11 ± 0.01 and 0.19 ± 0.09, p < 0.001) and CAD (10.27 ± 4.69 and 17.76 ± 14.41, p < 0.001) were decreased in patients with ARF compared with the control group. There was a positive correlation between pulse pressure and βSI (r = 0.25, p = 0.02) and Ep (r = 0.28, p = 0.01) in addition to a correlation between left atrial dilatation and CIMT (r = 0.55 p < 0.001) in patients with ARF. CIMT and carotid artery stiffness were increased in patients with ARF. Patients with ARF may have an increased risk of subclinical atherosclerosis and cardiovascular events.

  4. Cutting edge issues in rheumatic fever.

    Science.gov (United States)

    Chang, Christopher

    2012-04-01

    Although the incidence of acute rheumatic fever and rheumatic heart disease has decreased significantly in regions of the world where antibiotics are easily accessible, there remains a high incidence in developing nations as well as in certain regions where there is a high incidence of genetic susceptibility. These diseases are a function of poverty, low socioeconomic status, and barriers to healthcare access, and it is in the developing world that a comprehensive prevention program is most critically needed. Development of group A streptococcal vaccines has been under investigation since the 1960s and 50 years later, we still have no vaccine. Factors that contribute to this lack of success include a potential risk for developing vaccine-induced rheumatic heart disease, as well as difficulties in covering the many serological subtypes of M protein, a virulence factor found on the surface of the bacterium. Yet, development of a successful vaccine program for prevention of group A streptococcal infection still offers the best chance for eradication of rheumatic fever in the twenty-first century. Other useful approaches include continuation of primary and secondary prevention with antibiotics and implementation of health care policies that provide patients with easy access to antibiotics. Improved living conditions and better hygiene are also critical to the prevention of the spread of group A streptococcus, especially in impoverished regions of the world. The purpose of this article is to discuss current and recent developments in the diagnosis, pathogenesis, and management of rheumatic fever and rheumatic heart disease.

  5. Clinical assessment and echocardiography follow-up results of the children with acute rheumatic fever

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    Ahmet Basturk

    2016-04-01

    Full Text Available Acute rheumatic fever (ARF is an inflammatory collagenous tissue disease which shows its cardinal signs in joints, heart, skin and nervous system while affecting whole connective tissue system more or less. This study was conducted in order to investigate the clinical pattern and severity of ARF, echocardiographic findings and the course of the patients with heart valve involvement by studying the clinical and laboratory aspects of the patients diagnosed with ARF according to updated Jones criteria. The study included 214 patients diagnosed with ARF for the first time between January 2005 and May 2008. All patients were scanned with doppler echocardiography (ECHO between certain intervals. Severity of carditis was grouped into 3 groups of mild, moderate and severe. The frequency of carditis was 57.9%, arthritis was 73.4%, chorea was 11.7% and erythema marginatum was 0.9% but no subcutaneous nodules. Recovery was observed in 22% of the cases of isolated aortic insufficiency (AI, 50% of the cases with isolated mitral insufficiency (MI and 80% of the cases with mitral and aortic insufficiencies together (MI+AI. Recovery in isolated MI was significantly much more than recovery in isolated AI. However, recovery in AI was significantly much more than in MI in cases of mitral and aortic insufficiencies together. In conclusion, ARF is a cause of acquired and preventable heart disease and it can be reversed through right diagnosis and appropriate treatment. Isolated mitral insufficiency, isolated aortic insufficiency and both mitral and aortic insufficiency are observed during a valvular disease. Remission among valvular diseases are most commonly in those with mitral insufficiency and remissions in both mitral and aortic insufficiency occur most commonly in aortic ones. Regular prophylaxis is the key element for long term prevention of patients with ARF.

  6. Bio-element status in children with acute rheumatic fever: before treatment and after clinical improvement.

    Science.gov (United States)

    Cemek, Mustafa; Büyükokuroğlu, Mehmet Emin; Büyükben, Ahmet; Aymelek, Fatih; Yilmaz, Fatma; Doğan, Murat; Sanli, Fatih; Uner, Abdurrahman; Yildirim, Derya

    2010-10-01

    Acute rheumatic fever (ARF) is an autoimmune multisystem disease. Bio-elements are required in different quantities by an organism to maintain its physiologic function. Monitoring the status of bio-elements is critical in human health. This study aimed to determine possible changes in levels of bio-elements in children with ARF before and after treatment. Levels of trace and major elements in children with ARF were investigated. The study included 33 children with ARF (17 boys and 16 girls) and 20 healthy control children (11 boys and 9 girls). The ages ranged from 5 to 16 years (mean 11.4 ± 3.82 years) in the study group and from 6 to 15 years (mean, 10.7 ± 3.22 years) in the control group. Trace and major element concentrations (total of 14 elements) in the serum were measured by inductively coupled plasma-optical emission spectroscopy. Before treatment, the levels of the major elements potassium (K) and magnesium (Mg) in children with ARF were higher than in the control group, whereas the calcium (Ca) level was lower. Before treatment, the levels of trace elements iron (Fe), selenium (Se), zinc (Zn), aluminum (Al), and barium (Ba) were lower, whereas the copper (Cu), beryllium (Be), cadmium (Cd), chromium (Cr), gallium (Ga), and strontium (Sr) levels were higher in the serum of the patients with ARF than in the control patients. The major findings show that the homeostasis of some trace and major elements were altered in the children with ARF and that these alterations may be a contributing factor in the pathogenesis of this disease.

  7. A timely reminder--rheumatic fever.

    Science.gov (United States)

    Lilic, Nikola; Kumar, Priyanka

    2013-04-19

    Rheumatic fever is a disease diagnosed using the Jones criteria. The Jones criteria were designed using data from areas with a low prevalence of rheumatic fever. In New Zealand there is a high prevalence of rheumatic fever amongst Maori and Pacific peoples. A case is presented where a child of Samoan ethnicity is diagnosed and treated for rheumatic fever without fulfilling the Jones criteria. Evidence supporting the broadening of the diagnostic criteria in high prevalence areas is highlighted.

  8. Crucial role of the CB3-region of collagen IV in PARF-induced acute rheumatic fever.

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    Katrin Dinkla

    Full Text Available Acute rheumatic fever (ARF and rheumatic heart disease are serious autoimmune sequelae to infections with Streptococcus pyogenes. Streptococcal M-proteins have been implicated in ARF pathogenesis. Their interaction with collagen type IV (CIV is a triggering step that induces generation of collagen-specific auto-antibodies. Electron microscopy of the protein complex between M-protein type 3 (M3-protein and CIV identified two prominent binding sites of which one is situated in the CB3-region of CIV. In a radioactive binding assay, M3-protein expressing S. pyogenes and S. gordonii bound the CB3-fragment. Detailed analysis of the interactions by surface plasmon resonance measurements and site directed mutagenesis revealed high affinity interactions with dissociation constants in the nanomolar range that depend on the recently described collagen binding motif of streptococcal M-proteins. Because of its role in the induction of disease-related collagen autoimmunity the motif is referred to as "peptide associated with rheumatic fever" (PARF. Both, sera of mice immunized with M3-protein as well as sera from patients with ARF contained anti-CB3 auto-antibodies, indicating their contribution to ARF pathogenesis. The identification of the CB3-region as a binding partner for PARF directs the further approaches to understand the unusual autoimmune pathogenesis of PARF-dependent ARF and forms a molecular basis for a diagnostic test that detects rheumatogenic streptococci.

  9. Skin infections and immunoglobulin A in serum, sweat, and saliva of patients recovered from poststreptococcal acute glomerulonephritis or acute rheumatic fever and their siblings.

    Science.gov (United States)

    Potter, E V; Vincente, J B; Mayon-WHite, R T; Shaughnessy, M A; Poon-King, T; Earle, D P

    1982-06-01

    Differences in hygienic habits and base-line secretory immunoglobulin (Ig) A which might have contributed to the prevalence of skin infections and/or absence of increased serum IgA values were sought in patients with poststreptococcal acute glomerulonephritis (nephritis) in contrast to patients with acute rheumatic fever in Trinidad by studying patients and their siblings after the patients had recovered from these diseases. The overall history of skin infections was similar at this time in all groups, although they had been much more common in patients with nephritis and their families at the time of acute illness. The recovered nephritis patients bathed slightly less often than the other individuals, used a cream or lotion after bathing rather than coconut oil, and tended to sweat less than the others, but none of these differences was statistically significant. Neither were significant differences demonstrated in amounts of IgA and IgG in serum and saliva of recovered nephritis patients and their siblings compared to recovered rheumatic fever patients and their siblings, while only small amounts of IgA and IgG were present in any sweat, and probably had been transuded rather than secreted. These studies suggest that the lower serum IgA titers in patients with nephritis compared to patients with rheumatic fever in Trinidad do not reflect basic differences in serum IgA or secretory IgA as measured in saliva, and that IgA is not secreted by the eccrine glands.

  10. Acute rheumatic fever and rheumatic heart disease--priorities in prevention, diagnosis and management. A report of the CSANZ Indigenous Cardiovascular Health Conference, Alice Springs 2011.

    Science.gov (United States)

    Rémond, M G W; Wheaton, G R; Walsh, W F; Prior, D L; Maguire, G P

    2012-10-01

    Three priority areas in the prevention, diagnosis and management of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) were identified and discussed in detail: 1. Echocardiography and screening/diagnosis of RHD – Given the existing uncertainty it remains premature to advocate for or to incorporate echocardiographic screening for RHD into Australian clinical practice. Further research is currently being undertaken to evaluate the potential for echocardiography screening. 2. Secondary prophylaxis – Secondary prophylaxis (long acting benzathine penicillin injections) must be seen as a priority. Systems-based approaches are necessary with a focus on the development and evaluation of primary health care-based or led strategies incorporating effective health information management systems. Better/novel systems of delivery of prophylactic medications should be investigated. 3. Management of advanced RHD – National centres of excellence for the diagnosis, assessment and surgical management of RHD are required. Early referral for surgical input is necessary with multidisciplinary care and team-based decision making that includes patient, family, and local health providers. There is a need for a national RHD surgical register and research strategy for the assessment, intervention and long-term outcome of surgery and other interventions for RHD.

  11. Rheumatic fever and rheumatic heart disease in Bangladesh: A review.

    Science.gov (United States)

    Islam, A K M Monwarul; Majumder, A A S

    2016-01-01

    Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common cardiovascular disease in young people aged <25 years, globally. They are important contributors to cardiovascular morbidity and mortality in Bangladesh. Classical risk factors, i.e. poverty, overcrowding, ignorance, and insufficient health care services were responsible for the high incidence and prevalence of these diseases over the last century. In concert with the progresses in socioeconomic indicators, advances in health sectors, improved public awareness, and antibiotic prophylaxis, acute RF came into control. However, chronic RHD continues to be prevalent, and the actual disease burden may be much higher. RHD predominantly affects the young adults, seriously incapacitates them, follows a protracted course, gets complicated because of delayed diagnosis and is sometimes maltreated. The treatment is often palliative and expensive. Large-scale epidemiological and clinical researches are needed to formulate evidence-based national policy to tackle this important public health issue in future.

  12. Heart Lesion After the First Attack of the Rheumatic Fever 22 Years Experience in Single Centre

    OpenAIRE

    2015-01-01

    Background: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was estab...

  13. Challenges to developing effective streptococcal vaccines to prevent rheumatic fever and rheumatic heart disease

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    Sharma A

    2014-05-01

    Full Text Available Abhinay Sharma, D Patric Nitsche-SchmitzDepartment of Medical Microbiology, Helmholtz Center for Infection Research, Braunschweig, GermanyAbstract: Acute rheumatic fever is a sequela of Streptococcus pyogenes and potentially of Streptococcus dysgalactiae subsp. equisimilis infections. Acute rheumatic fever is caused by destructive autoimmunity and inflammation in the extracellular matrix and can lead to rheumatic heart disease, which is the most frequent cardiologic disease that is acquired in youth. Although effective treatments are available, acute rheumatic fever and rheumatic heart disease remain serious threats to human health, which affect millions and cause high economic losses. This has motivated the search for a vaccine that prevents the causative streptococcal infections. A variety of potential vaccine candidates have been identified and investigated in the past. Today, new approaches are applied to find alternative candidates. Nevertheless, several obstacles lie in the way of an approved S. pyogenes vaccine for use in humans. Herein, a subjective selection of promising vaccine candidates with respect to the prevention of acute rheumatic fever/rheumatic heart disease and safety regarding immunological side effects is discussed.Keywords: autoimmune disease, side effects, M protein vaccine, molecular mimicry, coiled-coil, collagen binding, PARF

  14. Doppler echocardiography imaging in detecting multi-valvular lesions: a clinical evaluation in children with acute rheumatic fever.

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    Pushpa Shivaram

    Full Text Available RATIONALE: Doppler echocardiography has been demonstrated to be accurate in diagnosing valvular lesions in rheumatic heart disease (RHD when compared to clinical evaluation alone. OBJECTIVE: To perform Doppler echocardiography in children clinically diagnosed by the Jones criteria to have acute rheumatic fever (ARF, and to then compare the effectiveness of echo in detecting single/multi-valvular lesions with that of the initial clinical evaluation. METHODS AND RESULTS: We enrolled 93 children who were previously diagnosed with ARF by clinical examination. Presence of valvular lesions were enlisted, first by clinical auscultation, and then by performing Doppler echocardiography. We found that Doppler echocardiography was a sensitive technique, capable of detecting valvular lesions that were missed by clinical auscultation alone. Echocardiography of patients with carditis revealed mitral regurgitation to be the most common lesion present (53 patients, 56.98%, followed by aortic regurgitation in 21 patients (22.6%. The difference between clinical and echocardiographic diagnosis in ARF children with carditis was statistically significant for mitral regurgitation, aortic regurgitation and tricuspid regurgitation. Clinical auscultation alone revealed 4 cases of mitral stenosis, 39 mitral regurgitation, 14 aortic regurgitation, 9 tricuspid regurgitation; in contrast, echo revealed 5 cases of mitral stenosis, 53 mitral regurgitation, 21 aortic regurgitation, 18 tricuspid regurgitation. CONCLUSION: Doppler echocardiography is a more sensitive technique for detecting valvular lesions. In the setting of ARF, echo enables a 46.9% higher detection level of carditis, as compared to the clinical examination alone. Echo was very significant in detecting regurgitation lesions, especially for cases of tricuspid regurgitation in the setting of multivalvular involvement. The results of our study are in accordance with previous clinical studies, all of which clearly

  15. Similar erythrocyte sedimentation rate and C-reactive protein sensitivities at the onset of septic arthritis, osteomyelitis, acute rheumatic fever

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    Jonathan E. Reitzenstein

    2010-03-01

    Full Text Available The erythrocyte sedimentation rate (ESR and C-reactive protein (CRP are employed in the evaluation of patients with suspected septic arthritis, osteomyelitis, and acute rheumatic fever. The purpose of this study is to determine if one test has greater sensitivity (rises earlier than the other. Laboratory data were retrieved for pediatric patients hospitalized with one of the above three conditions, who had both ESR and CRP tests done on or shortly prior to admission. Sensitivity calculations were performed for mild, moderate, and severe degrees of ESR and CRP elevation. Microcytic erythrocytes, as defined by mean corpuscular volume (MCV less than 80 μL, were identified to see if this affects the ESR. ESR or CRP sensitivities depend on the cutoff value (threshold chosen as a positive test. The sensitivities were similar for similar degrees of elevation. ESR and CRP discordance was not significantly related to MCV. We concluded that the CRP does not rise earlier than the ESR (their sensitivities are similar. Previously published conclusions are dependent on arbitrary thresholds. We could not find any evidence that MCV affects the ESR.

  16. Rheumatic fever & rheumatic heart disease: the last 50 years.

    Science.gov (United States)

    Kumar, R Krishna; Tandon, R

    2013-04-01

    Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to be a major health hazard in most developing countries as well as sporadically in developed economies. Despite reservations about the utility, echocardiographic and Doppler (E&D) studies have identified a massive burden of RHD suggesting the inadequacy of the Jones' criteria updated by the American Heart Association in 1992. Subclinical carditis has been recognized by E&D in patients with acute RF without clinical carditis as well as by follow up of RHD patients presenting as isolated chorea or those without clinical evidence of carditis. Over the years, the medical management of RF has not changed. Paediatric and juvenile mitral stenosis (MS), upto the age of 12 and 20 yr respectively, severe enough to require operative treatement was documented. These negate the belief that patients of RHD become symptomatic ≥20 years after RF as well as the fact that congestive cardiac failure in childhood indicates active carditis and RF. Non-surgical balloon mitral valvotomy for MS has been initiated. Mitral and/or aortic valve replacement during active RF in patients not responding to medical treatment has been found to be life saving as well as confirming that congestive heart failure in acute RF is due to an acute haemodynamic overload. Pathogenesis as well as susceptibility to RF continue to be elusive. Prevention of RF morbidity depends on secondary prophylaxis which cannot reduce the burden of diseases. Primary prophylaxis is not feasible in the absence of a suitable vaccine. Attempts to design an antistreptococcal vaccine utilizing the M-protein has not succeeded in the last 40 years. Besides pathogenesis many other questions remain unanswered.

  17. Rheumatic fever in indigenous Australian children.

    Science.gov (United States)

    Parnaby, Matthew G; Carapetis, Jonathan R

    2010-09-01

    Rheumatic heart disease (RHD) caused by acute rheumatic fever (ARF) is a disease of poverty, poor hygiene and poor living standards. RHD remains one of the major causes of childhood cardiac disease in developing nations. Within developed nations, there has been a dramatic drop in the prevalence of RHD because of the improvement of living standards, access to health care and the widespread availability of penicillin-based drugs. Despite a dramatic reduction of RHD in Australia overall, it continues to be a major contributor to childhood and adult cardiac disease in Indigenous communities throughout northern and central Australia. Currently, Australia has among the highest recorded rates of ARF and RHD in the world. The most accurate epidemiological data in Australia come from the Northern Territory's RHD control programme. In the Northern Territory, 92% of people with RHD are Indigenous, of whom 85% live in remote communities and towns. The incidence of ARF is highest in 5-14-year-olds, ranging from 150 to 380 per 100,000. Prevalence rates of RHD since 2000 have steadily increased to almost 2% of the Indigenous population in the Northern Territory, 3.2% in those aged 35-44 years. Living in remote communities is a contributing factor to ARF/RHD as well as a major barrier for adequate follow-up and care. Impediments to ARF/RHD control include the paucity of specialist services, rapid turnover of health staff, lack of knowledge of ARF/RHD by health staff, patients and communities, and the high mobility of the Indigenous population. Fortunately, the recently announced National Rheumatic Fever Strategy, comprising recurrent funding to the Northern Territory, Queensland and Western Australia for control programmes, as well as the creation of a National Coordination Unit suggest that RHD control in Australia is now a tangible prospect. For the disease to be eradicated, Australia will have to address the underpinning determinants of poverty, social and living conditions.

  18. High-producing MBL2 genotypes increase the risk of acute and chronic carditis in patients with history of rheumatic fever

    DEFF Research Database (Denmark)

    Schafranski, MD; Pereira Ferrari, L; Scherner, D

    2008-01-01

    Rheumatic fever (RF) and its most severe sequela, chronic rheumatic heart disease (CRHD), are mediated by an abnormal immunological host response following a Streptococcus pyogenes oropharyngeal infection. Mannan-binding lectin (MBL), a collectin that activates complement, binds to N-acetylglucos...

  19. A case of rheumatic fever with acute post-streptococcal glomerulonephritis and nephrotic syndrome caused by a cutaneous infection with beta-hemolytic streptococci

    Directory of Open Access Journals (Sweden)

    Carsten Sauer Mikkelsen

    2010-01-01

    Full Text Available A middle-aged patient of Greenlandic origin was referred for skin infection of the leg. An initial minor trauma of the skin of the distal right lower extremity was complicated by bullous erysipelas which cultured positive for group A β-hemolytic streptococci (GABHS. The clinical condition deteriorated and necrotizing fasciitis developed despite relevant surgical and antibiotic treatment. Approximately 3 weeks later, the patient developed arthralgia, impaired renal function with azotemia, hypertension and severe nephrotic syndrome with periorbital and peripheral edema. A kidney biopsy demonstrated endocapillary glomerulonephritis. Concomitantly, carditis with chest pain, moderately reduced left ventricular ejection fraction and mitral regurgitation were noted. The patient had no signs of pharyngitis in the whole period. The patient thus contracted poststreptococ glomerulonephritis and furthermore she fulfilled the criteria of acute rheumatic fever following a GABHS skin infection. We suggest a possible relation between a virulent GABHS clone causing NF and ARF.

  20. Prevalence of Rheumatic Fever and Rheumatic Heart Disease in School Children in Malwa Region of MP

    OpenAIRE

    2010-01-01

    Rheumatic fever and rheumatic heart disease continue to affect millions of people around the world. Children and adolescents of the developing countries are especially susceptible to this disease. To asses the prevalence of Rheumatic Fever /Rheumatic heart disease in an urban area, we do survey of children aged between 5 to 16 years studying in various government schools in Indore district which were selected randomly. Out of 9879 students enrolled in the study 9526 were examined, the percent...

  1. Prevalence of Rheumatic Fever and Rheumatic Heart Disease in School Children in Malwa Region of MP

    Directory of Open Access Journals (Sweden)

    P Yadav, P Joshi, J Gupta, D Joseph, P Sakhi

    2010-12-01

    Full Text Available Rheumatic fever and rheumatic heart disease continue to affect millions of people around the world. Children and adolescents of the developing countries are especially susceptible to this disease. To asses the prevalence of Rheumatic Fever /Rheumatic heart disease in an urban area, we do survey of children aged between 5 to 16 years studying in various government schools in Indore district which were selected randomly. Out of 9879 students enrolled in the study 9526 were examined, the percentage of absentees being ten. Revised Jones criterion (1992 was used for the diagnosis of rheumatic fever. Doppler echocardiography is used to confirm the diagnosis of rheumatic heart disease. A total of seven cases of definite rheumatic heart disease (out of 13 suspected cases were identified giving overall prevalence rate of 0.73 per 1000. Fifty percent rheumatic heart disease cases gave a history suggestive of rheumatic fever. No case of active rheumatic fever could be identified. The study gave lower result than that reported in earlier studies from developing countries but it is similar to that reported from Indore district in 2009. It is concluded that there is some downward trend in rheumatic fever / rheumatic heart disease prevalence but the low prevalence is also due to the use of Doppler echocardiography which has prevented over diagnosis in the present study.

  2. Rheumatic Fever Associated with Antiphospholipid Syndrome: Systematic Review

    OpenAIRE

    2014-01-01

    Objective. To evaluate the clinical associations between rheumatic fever and antiphospholipid syndrome and the impact of coexistence of these two diseases in an individual. Methods. Systematic review in electronics databases, regarding the period from 1983 to 2012. The keywords: “Rheumatic Fever,” “Antiphospholipid Syndrome,” and “Antiphospholipid Antibody Syndrome” are used. Results. were identified 11 cases described in the literature about the association of rheumatic fever and antiphospho...

  3. The relative problems of diagnosis regarding acute rheumatic fever%急性风湿热诊断的相关问题

    Institute of Scientific and Technical Information of China (English)

    李兴福; 张妮

    2005-01-01

    急性风湿热(acute rheumatic fever,ARF)的特征是多脏器炎症,临床表现常与其他结缔组织病重叠,并且缺乏特异性实验室检查,多年来一直采用Jones标准诊断.其内容包括ARF的5个主要表现:(1)心脏炎;(2)多关节炎;(3)舞蹈病;(4)环形红斑;(5)皮下结节.次要表现:(1)临床表现:发热、关节痛;(2)实验室检查:急性反应物水平增高,血沉增快,C反应蛋白增高,P-R间期延长.如果病人具备两条主要表现,或具备1条主要表现和两条次要表现,兼有链球菌感染的证据:

  4. Towards a Vaccine Against Rheumatic Fever

    Directory of Open Access Journals (Sweden)

    L. Guilherme

    2006-01-01

    Full Text Available Rheumatic fever (RF is an autoimmune disease which affects more than 20 million children in developing countries. It is triggered by Streptococcus pyogenes throat infection in untreated susceptible individuals. Carditis, the most serious manifestation of the disease, leads to severe and permanent valvular lesions, causing chronic rheumatic heart disease (RHD. We have been studying the mechanisms leading to pathological autoimmunity in RF/RHD for the last 15 years. Our studies allowed us a better understanding of the cellular and molecular pathogenesis of RHD, paving the way for the development of a safe vaccine for a post-infection autoimmune disease. We have focused on the search for protective T and B cell epitopes by testing 620 human blood samples against overlapping peptides spanning 99 residues of the C-terminal portion of the M protein, differing by one amino acid residue. We identified T and B cell epitopes with 22 and 25 amino acid residues, respectively. Although these epitopes were from different regions of the C-terminal portion of the M protein, they showed an identical core of 16 amino acid residues. Antibodies against the B cell epitope inhibited bacterial invasion/adhesion in vitro. Our results strongly indicated that the selected T and B cell epitopes could potentially be protective against S. pyogenes.

  5. CLINICAL PROFILE OF RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE IN CHILDREN UNDER 15 YEARS AGE GROUP AND ITS CORRELATION WITH ECHOCARDIOGRAPHY

    Directory of Open Access Journals (Sweden)

    Ramu

    2015-02-01

    Full Text Available Context ( Back ground Acute Rheumatic fever and Rheumatic heart disease are the most common acquired childhood heart disease in India. It is well established that 2 D Echo cardiography is more sensitive in picking up minor degrees of valvular regurgitation than clinical examination . AIMS & OBJECTIVES: To study the clinical profile of “Rheumatic Fever and Rheumatic heart disease“ & correlate it with Echocardiographic fin dings in Children under 15 years age group presenting to a tertiary care hospital. MATERIALS AND METHODS OF STUDY: Thirty six cases of Acute Rheumatic fever, which includes eight cases of first attack and twenty eight cases of reactivation of Rheumatic fev er were studied over a period of two years in paediatric medical wards, King George Hospital, Visakhapatnam. The revised (1992 modified Jones criteria with the 1988 WHO modification was taken as a criterion to diagnose Acute Rheumatic fever . RESULTS : Peak age of Acute Rheumatic fever and Chronic Rheumatic heart disease is between 5 - 10 years (55.8%. No sex variation has been observed. Fever and joint involvement are the most common clinical manifestations (87.5%each in first attack cases. Active cardi tis (75% the second most common manifestation , followed by arthralgia (25% and sore throat (25% , chorea , chest pain , abdominal pain were infrequent manifestations found to be 12.5% each. None of the cases had Erythema marginatum. CONCLUSION : In the pres ent study the clinical findings were correlated with that of previous studies and Echocardiographic findings were correlated well as far as moderate to severe lesions. Further Echocardiography was proved to be more sensitive in detecting even trivial or mi ld aortic regurgitation and mitral or aortic stenosis.

  6. Streptococcal Infections, Rheumatic Fever and School Health Services.

    Science.gov (United States)

    Markowitz, Milton

    1979-01-01

    Because rheumatic fever is a potentially serious complication of a streptococcal sore throat which can lead to permanent heart disease, this article advocates the expansion of school health services in medically underserved areas. (JMF)

  7. A vaccine against Streptococcus pyogenes: the potential to prevent rheumatic fever and rheumatic heart disease.

    Science.gov (United States)

    Guilherme, Luiza; Ferreira, Frederico Moraes; Köhler, Karen Francine; Postol, Edilberto; Kalil, Jorge

    2013-02-01

    Streptococcus pyogenes causes severe, invasive infections such as the sequelae associated with acute rheumatic fever, rheumatic heart disease, acute glomerulonephritis, uncomplicated pharyngitis, and pyoderma. Efforts to produce a vaccine against S. pyogenes began several decades ago, and different models have been proposed. We have developed a vaccine candidate peptide, StreptInCor, comprising 55 amino acid residues of the C-terminal portion of the M protein and encompassing both the T- and B-cell protective epitopes. The present article summarizes data from the previous 5 years during which we tested the immunogenicity and safety of StreptInCor in different animal models. We showed that StreptInCor overlapping peptides induced cellular and humoral immune responses of individuals bearing different HLA class II molecules. These results are consistent with peptides that have a universal vaccine epitope. The tridimensional molecular structure of StreptInCor was elucidated by nuclear magnetic resonance spectroscopy, which showed that its structure is composed of two microdomains linked by an 18-residue α-helix. Additionally, we comprehensively evaluated the structural stability of the StreptInCor peptide in different physicochemical conditions using circular dichroism. Additional experiments were performed with inbred, outbred, and HLA class II transgenic mice. Analysis of several organs of these mice showed neither deleterious nor autoimmune reactions even after a long period of vaccination, indicating that the StreptInCor candidate peptide could be considered as an immunogenic and safe vaccine.

  8. Incidental histological diagnosis of acute rheumatic carditis: case report and review of the literature.

    Directory of Open Access Journals (Sweden)

    Guilherme S. Spina

    2014-11-01

    Full Text Available Rheumatic fever remains endemic in many countries and frequently causes heart failure due to severe chronic rheumatic valvular heart disease, which requires surgical treatment. Here, we report on a patient who underwent an elective surgical correction for mitral and aortic valvular heart disease and had a post-operative diagnosis of acute rheumatic carditis. The incidental finding of Aschoff bodies in myocardial biopsies is frequently reported in the nineteenth-century literature, with prevalences as high as 35%, but no clinical or prognostic data on the patients is included. The high frequency of this finding after cardiac surgery in classical reports suggests that these patients were not using secondary prophylaxis for rheumatic fever. We discuss the clinical diagnosis of acute rheumatic myocarditis in asymptomatic patients and the laboratorial and imaging methods for the diagnosis of acute rheumatic carditis. We also discuss the prognostic implications of this finding and review the related literature.

  9. Clinical presentation of rheumatic fever in an endemic area.

    Science.gov (United States)

    Cann, Megan P; Sive, Alan A; Norton, Robert E; McBride, William J H; Ketheesan, Natkunam

    2010-06-01

    This study documented whether patients diagnosed with acute rheumatic fever (ARF) in North Queensland, Australia, conformed to the 1992 Revised Jones Criteria (RJC). The authors aimed to determine whether inclusion of subclinical carditis (SCC) and monarthritis as major manifestations and a low-grade temperature as a minor manifestation in the RJC are justified in this population. A retrospective review of patients in whom the diagnosis of ARF relied on the experience of clinicians and who were admitted to the Townsville and Cairns Base Hospitals between 1997 and 2007 was undertaken. Of the 98 cases reviewed, 71.4% satisfied the RJC. Modification of the RJC increased the rate of criteria satisfaction to 91.8%. On presentation, 27 patients had SCC. Of the patients with SCC followed up, 70.5% had long-term valvular consequences. In populations endemic for ARF, monarthritis, SCC and a low-grade temperature should be included in the RJC.

  10. Preventing rheumatic fever: M-protein based vaccine.

    Science.gov (United States)

    Tandon, Rajendra

    2014-01-01

    Group A beta hemolytic streptococcus (GAS), the organism which initiates rheumatic fever (RF) continues to be sensitive to penicillin. However, penicillin cannot prevent RF if the preceding sore throat is asymptomatic in more than 70 percent children. Prevention of rheumatic fever (RF) may be possible only with the use of a vaccine. Efforts to design a vaccine based on emm gene identification of GAS, M-protein going on for more than 40 years, is unlikely to succeed. M-protein is strain specific. Infection with one strain does not provide immunity from infection with another strain. Based on the emm gene identification, of 250 or more identified strains of GAS, the distribution is heterogenous and keeps changing. The M-protein gene sequence of the organism tends to mutate. A vaccine prepared from available strains may not be effective against a strain following mutation. Lethal toxic shock syndrome due to GAS infection has been described with organisms without identifiable or functional M-protein. M-protein has been excluded as the antigen responsible for acute glomerulonephritis (GN). Therefore M-protein plays no role in one suppurative (toxic shock syndrome) and one non-suppurative (acute GN) manifestation due to GAS infection. Lastly there is no direct evidence to indicate that M-protein is involved in inducing RF. The role of M-protein and the GAS component resulting in the suppurative manifestations of GAS infections like pyoderma, septic arthritis or necrotizing fasciitis etc is unknown. For a vaccine to be effective, an epitope of the streptococcus which is stable and uniformly present in all strains, needs to be identified and tested for its safety and efficacy. The vaccine if and when available is expected to prevent GAS infection. Preventing GAS infection will prevent all the suppurative as well as non-suppurative manifestations including RF.

  11. RHEUMATIC FEVER AS NONVANISHING DISEASE: A PROBLEM STATE AND CLINICAL CASES

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2010-01-01

    Full Text Available Early diagnostics and treatment of patients with acute rheumatic fever (RF remains actual problem because rheumatic heart disease is still one of the main causes of acquired valvular lesions. Two cases of acute RF occurred in City Clinical Hospital №1 named after N.I. Pirogov in 2009 are presented. Different outcomes were observed during 6 and 10 months of clinical monitoring. The main approaches to diagnostics and treatment of RF are also described taking into consideration national and international guidelines.

  12. Revisiting the pathogenesis of rheumatic fever and carditis.

    Science.gov (United States)

    Tandon, Rajendra; Sharma, Meenakshi; Chandrashekhar, Y; Kotb, Malak; Yacoub, Magdi H; Narula, Jagat

    2013-03-01

    Rheumatic fever is one of the most-neglected ailments, and its pathogenesis remains poorly understood. The major thrust of research has been directed towards cross-reactivity between streptococcal M protein and myocardial α-helical coiled-coil proteins. M protein has also been the focus of vaccine development. The characteristic pathological findings suggest that the primary site of rheumatic-fever-related damage is subendothelial and perivascular connective tissue matrix and overlying endothelium. Over the past 5 years, a streptococcal M protein N-terminus domain has been shown to bind to the CB3 region in collagen type IV. This binding seems to initiate an antibody response to the collagen and result in ground substance inflammation. These antibodies do not cross-react with M proteins, and we believe that no failure of immune system and, possibly, no molecular mimicry occur in rheumatic fever. This alternative hypothesis shares similarity with collagen involvement in both Goodpasture syndrome and Alport syndrome.

  13. Scarlet fever

    Science.gov (United States)

    ... the throat infection. This is crucial to prevent rheumatic fever, a serious complication of strep throat and scarlet ... with the right treatment, but may include: Acute rheumatic fever , which can affect the heart, joints, skin, and ...

  14. The ying and yang of fever in rheumatic disease.

    Science.gov (United States)

    Galloway, James; Cope, Andrew P

    2015-06-01

    Fevers are relatively common in rheumatic disease, largely due to the fact that the inflammatory process is driven by inflammatory mediators that function as endogenous pyrogens. Since the immune system's sensors cannot accurately distinguish between endogenous and exogenous (pathogen-derived) pyrogens a major challenge for physicians and rheumatologists has been to decipher patterns of clinical signs and symptoms to inform clinical decision making. Here we describe some of the common pitfalls and clinical challenges, and highlight the importance of a systematic approach to investigating the rheumatic disease patient presenting with fever.

  15. Once weekly azithromycin in secondary prevention of rheumatic fever.

    Science.gov (United States)

    Gopal, Rakesh; Harikrishnan, S; Sivasankaran, S; Ajithkumar, V K; Titus, T; Tharakan, J M

    2012-01-01

    Rheumatic fever and rheumatic heart disease (RHD) are still important problems in developing countries. Secondary prophylaxis which is the most cost-effective method in preventing recurrences of rheumatic fever is fraught with problems of drug compliance. The utility of 500 mg once weekly azithromycin (AZT), an orally effective long-acting antibiotic was evaluated against oral penicillin (phenoxy methyl penicillin 250 mg twice daily) in this study. Forty-eight consecutive patients (44% males, mean age 29.4 years) with established RHD were randomised into two groups-26 patients received AZT and 22 received oral penicillin. Patients were evaluated at randomisation, at 1 month, 3 months, and 6 months, clinically, serologically and by throat swab culture. End points were absence of streptococcal colonisation, infection or fever at the end of 6 months. During the study, 4 patients (15.4%) in the AZT group developed sore throat and fever, had positive throat culture and positive serology indicating streptococcal infection. None satisfied the criteria for rheumatic fever reactivation. None in the oral penicillin group developed streptococcal infection. In conclusion, weekly 500 mg of AZT is not effective in the prevention of streptococcal throat infection compared to oral penicillin therapy in adult patients with established RHD.

  16. Rheumatic fever, autoimmunity, and molecular mimicry: the streptococcal connection.

    Science.gov (United States)

    Cunningham, Madeleine W

    2014-01-01

    The group A streptococcus, Streptococcus pyogenes, and its link to autoimmune sequelae, has acquired a new level of understanding. Studies support the hypothesis that molecular mimicry between the group A streptococcus and heart or brain are important in directing immune responses in rheumatic fever. Rheumatic carditis, Sydenham chorea and a new group of behavioral disorders called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections are reviewed with consideration of autoantibody and T cell responses and the role of molecular mimicry between the heart, brain and group A streptococcus as well as how immune responses contribute to pathogenic mechanisms in disease. In rheumatic carditis, studies have investigated human monoclonal autoantibodies and T cell clones for their crossreactivity and their mechanisms leading to valve damage in rheumatic heart disease. Although studies of human and animal sera from group A streptococcal diseases or immunization models have been crucial in providing clues to molecular mimicry and its role in the pathogenesis of rheumatic fever, study of human monoclonal autoantibodies have provided important insights into how antibodies against the valve may activate the valve endothelium and lead to T cell infiltration. Passive transfer of anti-streptococcal T cell lines in a rat model of rheumatic carditis illustrates effects of CD4+ T cells on the valve. Although Sydenham chorea has been known as the neurological manifestation of rheumatic fever for decades, the combination of autoimmunity and behavior is a relatively new concept linking brain, behavior and neuropsychiatric disorders with streptococcal infections. In Sydenham chorea, human mAbs and their expression in transgenic mice have linked autoimmunity to central dopamine pathways as well as dopamine receptors and dopaminergic neurons in basal ganglia. Taken together, the studies reviewed provide a basis for understanding streptococcal sequelae and

  17. Overlapping humoral autoimmunity links rheumatic fever and the antiphospholipid syndrome

    DEFF Research Database (Denmark)

    Blank, M; Krause, I; Magrini, L

    2006-01-01

    Rheumatic fever (RF) and the antiphospholipid syndrome (APS) are autoimmune diseases that share similar cardiac and neurological pathologies. We assessed the presence of shared epitopes between M protein, N-acetyl-beta-D-glucosamine (GlcNAc) and beta2 glycoprotein-I (beta2GPI), the pathogenic...

  18. MMPI Profiles of Rheumatic Fever Adolescents and Adults.

    Science.gov (United States)

    Stehbens, James A.; And Others

    1982-01-01

    Showed that Minnesota Multiphasic Personality Inventory (MMPI) scores for adolescent and adult victims of rheumatic fever (N=162) were generally lower than Mayo Clinic norms. Significant age effects confirm findings that adolescents score higher on the MMPI. Found patients without carditis scored higher than carditis patients, contrary to…

  19. Rheumatic Fever Associated with Antiphospholipid Syndrome: Systematic Review

    Directory of Open Access Journals (Sweden)

    Felipe da Silva

    2014-01-01

    Full Text Available Objective. To evaluate the clinical associations between rheumatic fever and antiphospholipid syndrome and the impact of coexistence of these two diseases in an individual. Methods. Systematic review in electronics databases, regarding the period from 1983 to 2012. The keywords: “Rheumatic Fever,” “Antiphospholipid Syndrome,” and “Antiphospholipid Antibody Syndrome” are used. Results. were identified 11 cases described in the literature about the association of rheumatic fever and antiphospholipid syndrome. Clinical presentation of rheumatic fever was characterized by the predominance of carditis (11/11 and chorea (7/11. Regarding the manifestations of APS, the stroke was observed in 7/11 (63.6%, with one of them having probable embolic origin. Conclusion. The present study brings the information that the association between APS and RF is quite rare, however, is of great clinical importance. Doctors who deal with the RF should include in their differential diagnosis the APS, especially in the presence of stroke in patients with RF and whose echocardiogram does not show intracavitary thrombi.

  20. Clinical Observation of Children with Acute Rheumatic Fever Thrombospondin-1%急性风湿热患儿血小板反应蛋白-1的临床观察

    Institute of Scientific and Technical Information of China (English)

    石坤; 陈婷婷; 方钰; 王献民

    2015-01-01

    Objective To observe the clinical relationships between Acute rheumatic fever (ARF)and thrombospondin-1 (TSP-1) levels,and provide a basis for the diagnosis of the disease.Methods Compare TSP-1 level in observer group and control group with Enzyme-linked immunosorbent assay (ELISA).Independent t-test analysis and Pearson cor elation analysis wil be analyzed.Results TSP-1 level in observer group is higher than which in control group [(317.1±103.05)μg/ml VS (206.12±83.65)μg/ml,<0.01].Acute rheumatic fever and ASO serum levels of TSP-1 was positively cor elated(=0.443, <0.05). Conclusion TSP-1 levels in acute rheumatic fever is a marker for disease diagnosis and has a certain significance.%目的:观察急性风湿热(ARF)患儿血清血小板反应蛋白-1(TSP-1)的水平与临床的关系,为疾病的诊断提供一定±据。方法急性风湿热组35例,对照组35例,取血清10μl,应用酶联免疫吸附法(ELISA)检测急性风湿热及对照者血清中TSP-1水平,应用独立资料的t检验分析和Pearson相关性分析对资料进行分析。结果急性风湿热患者血清TS-l的水平明显高于健康对照者[(317.1±103.05)μg/ml VS (206.12±83.65)μg/ml,<0.01]。急性风湿热血清TSP-1与ASO水平呈正相关(r=0.443,<0.05)。结论 TSP-1水平是急性风湿热活动期的血清标记物,对病情诊断具有一定意义。

  1. An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa Town, Sudan.

    OpenAIRE

    1992-01-01

    STUDY OBJECTIVE--The aim was to determine the prevalence of rheumatic fever and rheumatic heart disease and to initiate a programme of secondary prophylaxis in Sahafa Town, Sudan. DESIGN--The study was a prospective case finding survey, carried out by a specially trained team headed by a cardiologist. SETTING--The study involved high risk school children (5-15 years of age) from Sahafa Town in the period 1986-1989. SUBJECTS--A total of 13,332 children on the school registers (7892 boys and 54...

  2. "SURVEY OF PREVALENCE RATE OF RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE AMONG SCHOOL CHILDREN IN TEHRAN"

    Directory of Open Access Journals (Sweden)

    M. Nadimi.

    1973-06-01

    Full Text Available A study was undertaken to find out the prevalence rate or rheumatic fever (R.F. and rheumatic heart disease (R.H.D. among pupils in selected schools of Tehran, and to evaluate the rate of socio-economical factors on prevalence rate of this disease. During period of 5 months, 6, 183 children and adolescents aged 5-17 were studied. Out of 6,183 pupils, 3, 680 were boys (59.5 and 2,503 were girls (40.5%. 1,425(23% were in high, 1,381 (22% in mid, and (55% in low socio- economic classes. Out of these, 32 (5.2/per 1000 had history of R.F. in the past and 17 (2.7/per 1000 had R.H.D. with an all together prevalence rate of 7.9/per 1000. There was no significant difference in the prevalence rate of rheumatic fever and rheumatic heart disease between the children in high and low socioeconomic group.

  3. Is primary prevention of rheumatic fever the missing link in the control of rheumatic heart disease in Africa?

    Science.gov (United States)

    Karthikeyan, Ganesan; Mayosi, Bongani M

    2009-08-25

    Rheumatic fever and rheumatic heart disease continue to be major public health problems in the developing world, particularly in the countries of sub-Saharan Africa. Because of its cost effectiveness, secondary prophylaxis is advocated as the principal means of disease prevention and control. However, in developing countries, valvular damage, due to earlier, unrecognized episodes of rheumatic fever, has already occurred by the time secondary prophylaxis is instituted. Secondary prophylaxis cannot reduce the incidence of new cases of rheumatic fever and has not been shown to alter the natural history of rheumatic valvular disease. Experience from several regions of the world suggests that incorporation of a strategy of primary antibiotic prophylaxis into a comprehensive program for disease control can reduce the incidence of rheumatic fever and rheumatic heart disease. In this article, we argue that a strategy of primary antibiotic prophylaxis, with appropriate modifications, can be successfully implemented in resource-poor settings across the world and should be a key component of any rheumatic heart disease control program. This, we believe, is essential for reducing the global burden of rheumatic heart disease.

  4. Failure of oral penicillin as secondary prophylaxis for rheumatic heart disease: a lesson from a low-prevalence rheumatic fever region.

    Science.gov (United States)

    McGlacken-Byrne, S M; Parry, H M; Currie, P F; Wilson, N J

    2015-11-03

    Our patient is an 18-year-old Caucasian woman from the UK who developed severe mitral stenosis on a history of childhood acute rheumatic fever (ARF) and rheumatic heart disease (RHD). She had been reporting of her oral penicillin secondary prophylaxis regimen since diagnosis. At the age of 15 years, a new murmur was discovered during routine cardiac follow-up. An echocardiogram confirmed moderate-severe mitral stenosis. One year later, her exercise tolerance significantly deteriorated and she subsequently underwent balloon valvuloplasty of her mitral valve to good effect. Our case emphasises the evidence base supporting the use of monthly intramuscular penicillin injection to prevent ARF recurrence and RHD progression; it also emphasises the reduced efficacy of oral penicillin prophylaxis in this context. It particularly resonates with regions of low rheumatic fever endemicity. The long-term cardiac sequelae of ARF can be devastating; prescribing the most effective secondary prophylaxis regimen is essential.

  5. Antiphospholipid syndrome and rheumatic fever: a case spanning three decades of changing concepts and common immunological mechanisms.

    Science.gov (United States)

    Alcock, R; Elsik, M; Yiannikas, C; Yiannikas, J

    2011-10-01

    We present a case of primary antiphospholipid syndrome (APS), initially diagnosed as acute rheumatic fever, resulting in severe mitral valve incompetence. This case raises questions of the specificity of the Jones diagnostic criteria for rheumatic fever in a population where it is infrequently encountered. There are similarities in clinical, pathological and echocardiographic presentations between rheumatic fever and APS, in addition to common immunological mechanisms. Our case highlights the possibility that rather than rheumatic fever being primarily responsible for her recurrent attacks of chorea and arthritis, the streptococcal infections in our patient occurred either in the setting of underlying antiphospholipid antibodies ('second hit' phenomenon), or may have triggered the development of pathogenic antibodies (molecular mimicry), subsequently leading to the clinical evolution of APS. During the three decades of our patient and her recurrent problems, there has been an evolving knowledge of the mechanisms of APS and rheumatic fever, allowing us to extend our understanding beyond symptoms and syndromes, to a better realization of the underlying immunological relationship between the two.

  6. Modern rheumatic fever clinical features in children of Sakha (Yakut republic

    Directory of Open Access Journals (Sweden)

    M V Handy

    2003-01-01

    Full Text Available Objective. To analyse incidence and clinical features of rheumatic fever (RF in children of Sakha (Yakut republic in 1974-2001 years. Material and methods. Sakha (Yakut republic Ministry of Health Protection reports for 1999-2001 years. Case histories of 75 children admitted to pediatric cardiologic department of republic hospital №1. Results. In 2001 RF and chronic rheumatic heart diseases (CRHD part among all rheumatic disease constituted 45,5%. RF incidence was 0,5 for 1000 children (in 1974 - 0,36 %o, acute (primary RF - 0, 2 %o, CRHD - 0,8%c including 0,5%o with rheumatic heart disease (RHD. More than 60% of children admitted in 2001 were 4-10 years old. 65% of children were admitted in winter and early spring months. In 45,2% of admitted pts RF attack was connected with infection history (in 1974 - 76,2%. In primary as well as in repeat RF attack rheumatic process in nearly 80% of cases had signs of I or II activity degree. Primary RF attack ended with RHD formation in 25%, repeat - in 80% of children.

  7. Rheumatic fever in New Zealand: what are the teeth trying to tell us?

    Science.gov (United States)

    Thornley, S; Sundborn, G; Schmidt-Uili, S M

    2014-03-01

    Rheumatic fever remains an important disease of childhood in New Zealand, despite increasing access and awareness of the need for preventive antibiotic treatment. Mãori and Pacific children have an incidence rate about 30 times and 70 times higher than European children, from annual notification data (77.7 per 100,000 for Pacific, 30.4 per 100,000 for Mãori, and 1 per 100,000 for European). In the early 20th century, a Canadian dentist, Weston A. Price, noted that 95% of children who presented with acute rheumatic fever also had advanced dental caries. Oral health surveys show that Mãori and Pacific children are disproportionately affected by dental caries compared to European. Excess dietary sugar intake is widely recognised to cause dental decay and also provides energy to some species of bacteria implicated in the pathogenesis of dental decay and rheumatic fever. We suggest that a case-control study be conducted to evaluate the evidence for an association between sugar intake, dental decay and incidence of disease.

  8. The control of rheumatic fever and rheumatic heart disease: a call to raise the awareness.

    Science.gov (United States)

    Kheir, Sirageldin M; Ali, Sulafa Khalid M

    2014-01-01

    Although the incidence of rheumatic fever (RF) and rheumatic heart disease (RHD) has declined in the developed world and many developing countries, yet it is still high in many countries including Sudan. The decline of frequency of RF in these countries is largely due to improved medical services leading to wide use of antibiotics to treat bacterial pharyngitis. In many developing countries, the incidence is decreased due to development of integrated control programs. Depending on secondary prophylaxis alone was shown to be ineffective, therefore, many countries, including Sudan initiated control programs that utilize both primary and secondary prevention together with increasing awareness and surveillance. The new program started in 2012 in Sudan in order to achieve its goal of reducing mortality of RHD by 25% in individual less than 25 years of age by year 2025. This article throws light on RF and RHD and its control program in Sudan.

  9. Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever.

    Science.gov (United States)

    Wyber, Rosemary; Boyd, Ben J; Colquhoun, Samantha; Currie, Bart J; Engel, Mark; Kado, Joseph; Karthikeyan, Ganesan; Sullivan, Mark; Saxena, Anita; Sheel, Meru; Steer, Andrew; Mucumbitsi, Joseph; Zühlke, Liesl; Carapetis, Jonathan

    2016-10-01

    Rheumatic fever is caused by an abnormal immune reaction to group A streptococcal infection. Secondary prophylaxis with antibiotics is recommended for people after their initial episode of rheumatic fever to prevent recurrent group A streptococcal infections, recurrences of rheumatic fever and progression to rheumatic heart disease. This secondary prophylaxis must be maintained for at least a decade after the last episode of rheumatic fever. Benzathine penicillin G is the first line antibiotic for secondary prophylaxis, delivered intramuscularly every 2 to 4 weeks. However, adherence to recommended secondary prophylaxis regimens is a global challenge. This paper outlines a consultation with global experts in rheumatic heart disease on the characteristics of benzathine penicillin G formulations which could be changed to improve adherence with secondary prophylaxis. Characteristics included dose interval, pain, administration mechanism, cold chain independence and cost. A sample target product profile for reformulated benzathine penicillin G is presented.

  10. Rheumatic fever prophylaxis in South Africa - is bicillin 1,2 million ...

    African Journals Online (AJOL)

    1993-09-30

    Sep 30, 1993 ... in high-risk areas for the development of rheumatic fever should receive .... concentrations, the relationship between serum and urine inhibition zones was ... concentrations (one-sided paired t-test: alpha = 0,05, beta = 0,05). Results .... penicillin concentrations in the management of rheumatic fever, since ...

  11. No Evidence of Human Leukocyte Antigen Gene Association With Rheumatic Fever Among Children in Samoa.

    Science.gov (United States)

    Erdem, Guliz; Seifried, Steven E

    2015-03-01

    Human leukocyte antigens (HLAs) have been implicated in rheumatic fever pathogenesis. This pilot whole genome association study compares genotypes of Samoan children with rheumatic fever to unaffected siblings and unrelated healthy controls. No risk-related genotypes were associated with HLA genes. Thirteen Regions of Interest were identified as candidates for further study.

  12. Rheumatic Fever Prevention Program: long term evolution and outcomes

    Directory of Open Access Journals (Sweden)

    Cleonice Carvalho Coelho Mota

    2015-01-01

    Full Text Available This investigation aims to analyze the profile of long term evolution of rheumatic fever in children and adolescents and outcomes after the control of recurrences. The cohort involved 702 patients followed from 1.3 to 16.9 years covering the two periods, before and after the implementation of a prevention program. Besides the establishment of the Reference Center in the State of Minas Gerais and the implementation of strategies to promote the compliance to prophylaxis, a project for education of health professionals was carried out in 23 cities. In addition to the clinical and epidemiological profile, the severity of the disease was analyzed. Mixed lesions were found in 27.1%, valvar regurgitation in 72.9% and complete regression of the valvar lesions was seen in 34.4% of the patients, mostly presenting mild dysfunctions. The recurrence rate per patient-year was 0,058 and out of a total of 85 recurrences, 21,4% occurred in the first and 7,5% in the second period. More severe degrees of carditis and significant valvar sequels presented a higher prevalence in patients with recurrences. The comparative analysis between the two periods showed no changes regarding the age at the primary attack, gender, type and site of valvar lesions and affected joints; however, important modifications in the indices of severity were observed after the control of recurrences. A significant decrease in the prevalence of severe carditis, obstructive valvar sequels, hospital admissions, surgical approach and deaths was seen. This investigation showed that although the clinical profile of presentation remains unchanged, the control of repeated attacks can improve the morbimortality rates. In this context, the secondary prophylaxis should be the first priority in the control of the disease in developing countries, taking into account the difficulties found for effective primordial and primary prevention. Keywords: rheumatic fever, rheumatic heart disease, secondary

  13. Association of MASP2 polymorphisms and protein levels with rheumatic fever and rheumatic heart disease.

    Science.gov (United States)

    Catarino, Sandra Jeremias dos Santos; Boldt, Angelica Beate Winter; Beltrame, Marcia Holsbach; Nisihara, Renato Mitsunori; Schafranski, Marcelo Derbli; de Messias-Reason, Iara Jose

    2014-12-01

    MASP-2 is a key protein of the lectin pathway of complement system. Several MASP2 polymorphisms were associated with MASP-2 serum levels or functional activity. Here we investigated a possible association between MASP2 polymorphisms and MASP-2 serum levels with the susceptibility to rheumatic fever (RF) and rheumatic heart disease (RHD). We haplotyped 11 MASP2 polymorphisms with multiplex sequence-specific PCR in 145 patients with history of RF from south Brazil (103 with RHD and 42 without cardiac lesion [RFo]) and 342 healthy controls. MASP-2 levels were determined by ELISA. The low MASP-2 producing p.377A and p.439H variants were negatively associated with RF (P=0.02, OR=0.36) and RHD (P=0.01, OR=0.25). In contrast, haplotypes that share the intron 9 - exon 12 g.1961795C, p.371D, p.377V and p.439R polymorphisms increased the susceptibility to RHD (P=0.02, OR=4.9). MASP-2 levels were associated with MASP2 haplotypes and were lower in patients (P<0.0001), which may reflect protein consumption due to complement activation. MASP2 gene polymorphisms and protein levels seem to play an important role in the development of RF and establishment of RHD.

  14. Benzathine Penicillin Prophylaxis in Children with Rheumatic Fever (RF/ Rheumatic Heart Disease (RHD: A Study of Compliance

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    Radha G. Ghildiyal

    2010-04-01

    Full Text Available Aims and Objectives: To study the compliance of patients of Rheumatic fever (RF/ Rheumatic heart disease (RHD regarding secondary prophylaxis with injection benzathine penicillin. Materials and Methods: The study was conducted in the Pediatric Rheumatology Outpatients’ Department (OPD of a tertiary care teaching university affiliated hospital. Patients below 18 years of age diagnosed as Rheumatic fever/ Rheumatic heart disease following up in Pediatric Rheumatology OPD for at least 1 year for benzathine pencillin prophylaxis were included in the study. The patients diagnosed to have RF/ RHD were advised injection benzathine penicillin prophylaxis every 3 weeks. A proforma was devised for recording the clinical details of the patient- including demographic information, clinical details regarding RF/ RHD and rheumatic fever recurrences. The details of the benzathine penicillin prophylaxis taken by the patient were also recorded in the proforma. The reasons for non-compliance were noted and enlisted as per their frequency. Results: The study included 10 patients following up at the specialty clinic for rheumatic heart disease patients. We had 7 males and 3 females in the study. The average age was 9.7 yrs (6 years to 12 years. The average number of months of follow up for assessing the compliance was 20.7 months (12.6 months to 44 months. The average compliance (% of the 10 patients was 89.60% (63.69% to 100%. Out of the 10 subjects, four had a recurrence of rheumatic fever manifesting in the form of congestive cardiac failure & carditis. Though most of the times the patients were not able to recall the reason for missing the dose, trip to one’s native place was an important reason for missed doses besides forgetting the dates of the prophylaxis and doubts about need for the prophylaxis. Conclusions: Compliance of secondary prophylaxis with benzathine penicillin was about 90% in the present study. Frequent travel by patients to their native

  15. Rheumatic

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    Khaled A. Sorour

    2014-06-01

    Full Text Available Rheumatic fever (RF and rheumatic heart disease (RHD have decreased in prevalence in the advanced industrialized nation. In the developing world, RF and RHD although less prevalent than they were 30 to 50 years ago, are still a major health problem. Poor socio-economic standards and difficulty of reaching proper primary health care facilities are the main causes of the still relatively high prevalence. This article will discuss in brief the epidemiology of group A beta hemolytic streptococci (GAS and RF/RHD as well as their global burden. The gloomy past of RF/RHD will hopefully give way to the promising future we all strive to achieve through better social standards, sanitation and hygiene, and availability of better health care for all.

  16. Matrix-assisted laser desorption ionization-time of flight and comparative genomic analysis of M-18 group a Streptococcus strains associated with an acute rheumatic fever outbreak in northeast Italy in 2012 and 2013.

    Science.gov (United States)

    Gaibani, Paolo; Scaltriti, Erika; Foschi, Claudio; Baggio, Enrico; Tamburini, Maria Vittoria; Creti, Roberta; Pascucci, Maria Grazia; Fagioni, Marco; Ambretti, Simone; Comandatore, Francesco; Pongolini, Stefano; Landini, Maria Paola

    2015-05-01

    Acute rheumatic fever (ARF) is a postsuppurative sequela caused by Streptococcus pyogenes infections affecting school-age children. We describe here the occurrence of an ARF outbreak that occurred in Bologna province, northeastern Italy, between November 2012 and May 2013. Molecular analysis revealed that ARF-related group A Streptococcus (GAS) strains belonged to the M-18 serotype, including subtypes emm18.29 and emm18.32. All M-18 GAS strains shared the same antigenic profile, including SpeA, SpeB, SpeC, SpeL, SpeM, and SmeZ. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis revealed that M-18 GAS strains grouped separately from other serotypes, suggesting a different S. pyogenes lineage. Single nucleotide polymorphisms and phylogenetic analysis based on whole-genome sequencing showed that emm18.29 and emm18.32 GAS strains clustered in two distinct groups, highlighting genetic variations between these subtypes. Comparative analysis revealed a similar genome architecture between emm18.29 and emm18.32 strains that differed from noninvasive emm18.0 strains. The major sources of differences between M-18 genomes were attributable to the prophage elements. Prophage regions contained several virulence factors that could have contributed to the pathogenic potential of emm18.29 and emm18.32 strains. Notably, phage ΦSPBO.1 carried erythrogenic toxin A gene (speA1) in six ARF-related M-18 GAS strains but not in emm18.0 strains. In addition, a phage-encoded hyaluronidase gene (hylP.2) presented different variants among M-18 GAS strains by showing internal deletions located in the α-helical and TSβH regions. In conclusion, our study yielded insights into the genome structure of M-18 GAS strains responsible for the ARF outbreak in Italy, thus expanding our knowledge of this serotype.

  17. Fever in acute pulmonary embolism.

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    Stein, P D; Afzal, A; Henry, J W; Villareal, C G

    2000-01-01

    Although fever has been reported in several case series of acute pulmonary embolism (PE), the extent to which fever may be caused by PE, and not associated disease, has not been adequately sorted out. Clarification of the frequency and severity of fever in acute PE may assist in achieving an accurate clinical impression, and perhaps avoid an inadvertent exclusion of the diagnosis. The purpose of this investigation is to evaluate the extent to which fever is caused by acute PE. Patients participated in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Temperature was evaluated among patients with angiographically proven PE. A determination of whether other causes of fever were present was based on a retrospective analysis of discharge summaries, PIOPED summaries, and a computerized list of all discharge diagnoses. Among patients with PE and no other source of fever, fever was present in 43 of 311 patients (14%). Fever in patients with pulmonary hemorrhage or infarction was not more frequent than among those with no pulmonary hemorrhage or infarction, 39 of 267 patients (15%) vs 4 of 44 patients (9%; not significant). Clinical evidence of deep venous thrombosis was often present in patients with PE and otherwise unexplained fever. Low-grade fever is not uncommon in PE, and high fever, although rare, may occur. Fever need not be accompanied by pulmonary hemorrhage or infarction.

  18. Health-related quality of life of school- age children with rheumatic Fever.

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    Essawy, Magda A E; Bahgat, Zebaida S; Kassem, Hamama A

    2010-01-01

    Rheumatic fever (RF) is a major public health problem and it is an important cause of acquired cardiovascular disease in childhood and adolescence. The goal of effective management of rheumatic fever is to allow children with RF to function with minimal restrictions and enjoy a good quality of life(QOL) throughout their lives. The aim of this study was to identify the health-related quality of life of school- age children with rheumatic fever. A convenient sample of 100 school-age children with rheumatic fever and their mothers were selected from outpatient clinic and inpatient pediatric cardiac departments of EL-Shatby Children University Hospital, Alexandria, Egypt. Data was collected from children in the previously mentioned settings who fulfil the following criteria, the children's age ranged from 8 to 12 years & free from any associated disease. Two tools were used in Clinical Data of Rheumatic School-Age Children Questionnaire that was developed by the researcher and Pediatric Quality of Life Inventory scale (Peds QL). The majority (78.3%) of school-age children with rheumatic fever had a neutral HRQOL and less than a quarter of them had high HRQOL. Only small percent (8.7%) of studied subjects had poor HRQOL. Children's parents' reports confirmed such results, where there were a significant positive correlations between children reports and their parents reports in the majority of studied items of HRQOL regarding rheumatic fever. Health education program for school-age children who had rheumatic fever and their parents towards the different measures of high HRQOL is recommended to help those children to improve their quality of life.

  19. Evaluation of physicians' knowledge about prevention of rheumatic fever and rheumatic heart disease before and after a teaching session.

    Science.gov (United States)

    Osman, Gehan M; Abdelrahman, Sirageldin M K; Ali, Sulafa K M

    2015-01-01

    Rheumatic fever (RF) and rheumatic heart disease RHD remain as one of the major cardiovascular problems in Sudanese children. The cornerstones for control of RF and RHD are primary and secondary preventions as adopted by Sudan's programme. This study aimed to describe and raise the paediatric doctors' awareness about prevention of RF and RHD using lectures. It was a prospective, cross-sectional, hospital based study, conducted in Khartoum. The study populations were paediatric doctors including house officers, medical officers and registrars. Data were collected through self-administered questionnaire, which was constructed to assess the doctor's awareness about RF and RHD prevention before and after attending lectures. Eighty seven doctors participated in the study. The results showed that the overall doctors' awareness about prevention of rheumatic fever and rheumatic heart disease was at average level. It was raised by intervention through lectures to good level. It is recommended to introduce training programs for physicians in order to improve doctors' awareness about prevention of RF and RHD. Such activities need to be conducted at regular intervals.

  20. O perfil da antiestreptolisina O no diagnóstico da febre reumática aguda Antistreptolysin O titer profile in acute rheumatic fever diagnosis

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    Claudia Saad Magalhães Machado

    2001-04-01

    under regular penicillin prophylaxis. The levels of ASO in ARF were also significantly higher than in patients with isolated chorea, recurrent oropharyngeal infections or juvenile idiopathic arthritis (P = 0.0025, when age-matched samples of these groups were compared. The test’s sensitivity was 73.3% and the specificity was 57.6%, and it was calculated taking into account the upper limit of normality at 320 IU/ml, as well as the established diagnosis of ARF. The test’s specificity and positive predictive value increased with rising or higher titers, being higher with titers above 960 UI/ml. CONCLUSION: this reappraisal of ASO profile in ARF patients indicates a remarkable response during the acute phase, and that points to the extent to which ASO levels may differentiate ARF from other diseases with high levels of ASO antibodies, as coincidental but unrelated streptococcal infection or chronic arthritis flareup.

  1. EFFECT OF VAMANA KARMA ON AMAVATA (RHEUMATIC FEVER: A CASE REPORT

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    Praveen S Beliraya

    2013-07-01

    Full Text Available Rheumatic fever (RF is an inflammatory disease most commonly seen in children between ages of 6 to 15 years. This disease is believed to be caused following streptococcus pyogens infection such as streptococcal pharyngitis. Amavata is most appropriate correlation to Rheumatic fever due to resemblance in signs and symptoms. Vamana Karma (therapeutic emesis being one of the prime Panchakarma therapies is been tried in the case of Amavata (RF and found to be extremely beneficial. Marked improvement was observed on symptoms like swelling and pain in multiple joints. Even biochemical parameters like ESR, CRP and ASO titer got reduced after Vamana Karma.Keywords: Rheumatic fever, Pancha Karma, Amavata, Vamana Karma

  2. Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease

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    ... Search Donate Circulation My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Doodle → Blip the Doodle Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  3. Dengue fever presenting as acute acalculus cholecystitis.

    Science.gov (United States)

    Joshipura, Vismit P; Soni, Harshad N; Patel, Nitin R; Haribhakti, Sanjiv P

    2007-06-01

    Classically dengue fever presents as fever with myalgia. A patient of dengue fever presented with classical symptoms and signs of acute acalculous cholecystitis. Serology and ultrasound examination identified dengue as the aetiology. Patient was treated successfully by conservative measures.

  4. Rheumatic fever: a forgotten but still existing cause of fever of unknown origin detected on FDG PET/CT.

    Science.gov (United States)

    Sathekge, Mike; Stoltz, Anton; Gheysens, Olivier

    2015-03-01

    We present a case of heterogeneous and strongly increased myocardial and valvular 18F-FDG uptake on 18F-FDG PET/CT in an HIV-positive patient with productive cough, fever, weight loss, and progressive dyspnea for 6 months. Contrast-enhanced CT did not reveal the cause of fever, but hyperechogenic valvular lesions on echocardiography in combination with PET/CT findings are suggestive of endocarditis/myocarditis. Postmortem histology 3 weeks after PET/CT showed Aschoff bodies with Anitschkow cells, pathognomonic for rheumatic carditis. This case illustrates that rheumatic heart disease can be detected on 18F-FDG PET/CT and demonstrates the value of 18F-FDG PET/CT in patients with fever of unknown origin.

  5. Rheumatic fever: a multicenter study in the State of São Paulo

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    Silva Carlos Henrique Martins da

    1999-01-01

    Full Text Available Rheumatic fever is still the most commonly seen rheumatic disease in Brazilian pediatric rheumatology clinics. It remains a significant health problem since subsequent cardiac sequelae represent one of the most important causes of chronic heart disease in children. We reviewed the clinical manifestations of rheumatic fever in 786 patients, followed at seven pediatric rheumatology clinics in the state of São Paulo, Brazil. All patients were diagnosed according to revised Jones' criteria. Regarding major criteria, 396 (50.4% children exhibited carditis, 453 (57.6% polyarthritis, 274 (34.8% chorea, 13 (1.6% erythema marginatum, and 12 (1.5% subcutaneous nodules. Valvular lesions documented by echocardiography in the absence of accompanying auscultatory findings were found in 144 (18.3% patients. Migratory polyarthritis was observed in 290 (64.0% patients with articular involvement. Documented previous streptococcal infection assessed by serum antistreptolysin (ASO titers occurred in 531 (67.5% patients. Even though prophylaxis with benzathine penicillin was recommended to all patients, recurrent attacks were observed in 147 (18.7%. We emphasize the high frequency of chorea, silent carditis and recurrences in our series as well as the variable clinical presentation of arthritis in rheumatic fever. Multicenter studies should be encouraged to improve our understanding of the clinical features of rheumatic diseases in children and adolescents.

  6. [Acute fever in children].

    Science.gov (United States)

    Gras-Le Guen, Christèle; Launay, Élise

    2015-05-01

    Fever in children is a very common symptom associated most of the time with a viral infection. However, in 7% of children, fever without source is the first symptom of a serious bacterial infection such as pneumonia, meningitis, pyelonephritis or bacteremia. The key point in clinical examination of these children is the early identification of toxic signs. Because SBI prevalence is higher in very young children (1-3 month-aged), they required a specific management with some systematic complementary investigations and a broad indication of probabilistic antibiotherapy treatment.

  7. Tendencia en la mortalidad por fiebre reumática aguda y cardiopatía reumática crónica en Venezuela, 1955-1994 Mortality trends for acute rheumatic fever and chronic rheumatic heart disease in Venezuela, 1955-1994

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    César Isaacura

    1998-01-01

    Full Text Available Este estudio incluye defunciones por fiebre reumática aguda (FRA y cardiopatía reumática crónica (CRC registradas en Venezuela de 1955 a 1994, según edad y sexo. Se calcularon tasas de mortalidad por 100.000 habitantes, ajustadas según método directo a la población mundial estándar de la OMS. Se produjo un descenso en la tasa ajustada de mortalidad (TAM por FR para ambos sexos de 7,68 a 1,08 (Variación Porcentual [VP] -85,9%; sexo masculino de 7,53 a 0,84 (VP -88,8% y sexo femenino de 7,83 a 1,33 (VP -83,0%. Las TAM fueron mayores en el sexo femenino. La proporción de muertes por FR sobre las producidas por enfermedades circulatorias (CIE-6 330-334,400-447; CIE-7 330-334,400-447; CIE-8 390-438; CIE-9 390-438 descendió en 88,5%. Se observó, para ambos sexos, un descenso en las TAM por FRA (VP -93,5% y CRC (VP -85,1%. El porcentaje de defunciones por FRA y CRC ocurridas en menores de 45 años mostró una tendencia ascendente. La reducción en las TAM por FR puede ser atribuible a mejoras socioeconómicas, así como a prevención con penicilina. La estabilización en las TAM a partir de 1980 podría explicarse por el deterioro socioeconómico experimentado en Venezuela y por la aparición de cepas más virulentas del EBHA.This study reports on deaths due to acute rheumatic fever (ARF and chronic rheumatic heart disease (CRHD in Venezuela from 1955 to 1994. Census publications and other official sources provide the population data. Yearly age- and sex-specific mortality rates per 100,000 inhabitants were calculated and adjusted by the direct method to the WHO's standard population. The RF-adjusted mortality rate (AMR declined: total from 7.68 to 1.08 (-85.9%; male from 7.53 to 0.84 (-88.8%; and female from 7.83 to 1.33 (-83.0%. In all cases female RF-AMRs were higher than male. There was a reduction of 88.5% in the ratio of RF deaths to cardiovascular deaths (ICD-6 330-334,400-447; ICD-7 330-334,400-447; ICD-8 390-438; ICD-9 390

  8. Rheumatic fever in Ireland: the role of Dr Monica Lea Wilson (1889-1971).

    Science.gov (United States)

    Ward, O Conor

    2013-02-01

    In 1869 William Stokes pointed out that the severity of rheumatic fever in Dublin had declined over recent decades. Similar worldwide decline led to the closure of many internationally famous rheumatic fever centres. The discovery by Robert Collis that rheumatic fever was a sequel to haemolytic streptococcal infection and the subsequent discovery of penicillin accelerated the decline. St Gabriel's Hospital in Dublin opened in 1951 under the clinical direction of Dr Monica Lea Wilson. Contrary to contemporary medical opinion a regimen of very prolonged bed rest was enforced. From 1961 the family doctors became concerned at the adverse psychological effects of the unnecessarily prolonged hospital stay. Twenty-seven of the 56 inpatients were re-assessed. None of them showed any evidence of active rheumatic fever and their parents took them home. The hospital closed in 1968. Dr Lea Wilson distanced herself from mainstream medicine and she is best remembered for having presented an unrecognized Caravaggio painting to the Jesuit Order in recognition of their pastoral support at the time of the controversial assassination in 1920 of her husband Percival, an Inspector in the Royal Irish Constabulary.

  9. Rheumatic fever and rheumatic heart disease at the Department of Child Health, School of Medicine, University of North Sumatera/Dr. Pirngadi Hospital, Medan (1983-1985).

    Science.gov (United States)

    Naim, M; Tjipta, G D; Siregar, A A; Halim, S

    1989-01-01

    A retrospective study on rheumatic fever and rheumatic heart disease in children was conducted at the Department of Child Health, Dr. Pirngadi Hospital Medan, during 1983-1985. The patients consisted of 43 females and 30 males. Most of the patients were over 12 years of age. Of the 73 patients there were 60 patients (82.19%) accompanied by valvular disorders. The most frequent major criteria of Jones found in this study were carditis and polyarthritis. Thirty one patients (42.46%) had functional status (NYHA) of grade II-IV, and 43 patients (58.90%) had cardiomegaly. The major ECG findings were enlargement of the atria or ventricles and first degree AV block. Compliance was only achieved in 25 (34.24%) cases. Rheumatic fever and rheumatic heart disease still remain a challenge for the medical professionals to cope with in the region.

  10. A pilot study for the primary prevention of rheumatic fever in Kosrae, Federated States of Micronesia.

    Science.gov (United States)

    Kohler, L A; Alik, T; Kaplan, E L; Anderson, F L

    2010-04-01

    Rheumatic fever (RF) and its sequel, Rheumatic Heart Disease (RHD) is a disease of significant medical and public health concern in the Federated States of Micronesia. In this preliminary study the feasibility of a rheumatic heart disease primary prevention strategy was examined. Throat swabs were taken from 667 school-aged children and tested for group A streptococci (GAS) by a rapid antigen detection test (RADT): a subset was also tested by conventional culture, so as to compare the RADT with the reference (conventional culture) test. GAS was detected in 124% of the children tested by either rapid antigen test or conventional culture; for RADT alone the detection rate was 11.5% and for culture alone the detection rate was 9.4%. Detection rate of GAS was analyzed in symptomatic and asymptomatic subgroups. The subgroups were compared using Fisher's exact method. The identification of children with GAS allows for their further examination and treatment so that the prevalence of GAS in this vulnerable population, currently with an annual incidence of rheumatic fever of 50-134/100,000, may be reduced. The routine testing of school-aged children appears to be possible with current resources in Kosrae and can be a cost-effective public health measure.

  11. Recent efforts to understand Rheumatic Fever and Rheumatic Heart Disese:Concepts about the Streptococcus and the Human Host

    Institute of Scientific and Technical Information of China (English)

    Edward L. Kaplan

    2001-01-01

    @@though an association between the group A beta hemolytic streptococcus and rheumatic fever has been recognized for more than half a century, many important issues about this relationship remain incompletely defined. The initiating pharyngeal throat infection and the difference between true infection and the relatively harmless streptococcal “carrier state” are not yet understood. Many properties of the organism itself largely remain a mystery. While much has been written about “rheumatogenecity” of certain streptococci, the precise mechanism for inducing “rheumatogenecity”is unknown. Nor is there sufficient evidence to understand the role of “antigenic mimicry” in the pathogenesis.With the introduction of molecular techniques into the basic science laboratory, the nurmer of different streptococcal types (based either on the M protein or the emm gene) has almost doubled during the past ten years, making the problem even greater since little is known about the relative importance or epidemiology of these newly described types.

  12. Chikungunya fever. Rheumatic manifestations of an emerging disease in Europe.

    Science.gov (United States)

    Horcada, M Loreto; Díaz-Calderón, Carlos; Garrido, Laura

    2015-01-01

    Chikungunya fever is a viral disease caused by an alphavirus belonging to the Togaviridae family, transmitted by several species of Aedes mosquitoes: Aedes aegypti and Aedes albopictus (A. albopictus). It is endemic in Africa and Asia with recurrent outbreaks. It is an emerging disease and cases in Europe transmitted by A. albopictus have been established in Mediterranean areas. The first autochthonous cases detected on the Caribbean islands suppose a serious threat of spreading disease to America, which so far has been disease free. Clinical symptoms begin abruptly with fever, skin rash and polyarthritis. Although mortality is low, a high percentage of patients develop a chronic phase defined by persistent arthritis for months or even years. A severe immune response is responsible for joint inflammation. The absence of specific treatment and lack of vaccine requires detailed studies about its immunopathogenesis in order to determine the most appropriate target. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  13. Rheumatic heart disease in Tennessee: An overlooked diagnosis

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    Shahana A Choudhury

    2014-03-01

    Full Text Available Rheumatic heart disease, already a major burden in low- and middle-income countries, is becoming an emerging problem in high-income countries. Although acute rheumatic fever and rheumatic heart disease have almost been eradicated in areas with established economies, the emergence of this problem may be attributable to the migration from low-income to high-income settings. Between 2010 and 2012, we diagnosed a cluster of rheumatic heart disease cases in children from the Middle Tennessee area. The goal of this report is to increase awareness among clinicians as the incidence and prevalence of acute rheumatic fever remain relatively significant in large US metropolitan areas. Although acute rheumatic fever is seasonal, a high suspicion index may lead to the early diagnosis and prevention of its cardiac complications. Furthermore, screening procedures may be recommended for populations at risk for rheumatic heart disease in endemic areas, and active surveillance with echocardiography-based screening might become very important.

  14. A Cost-Effectiveness Tool to Guide the Prioritization of Interventions for Rheumatic Fever and Rheumatic Heart Disease Control in African Nations

    Science.gov (United States)

    Lubinga, Solomon J.; Mayosi, Bongani; Babigumira, Joseph B.

    2016-01-01

    Background Rheumatic heart disease (RHD) prevalence and mortality rates remain especially high in many parts of Africa. While effective prevention and treatment exist, coverage rates of the various interventions are low. Little is known about the comparative cost-effectiveness of different RHD interventions in limited resource settings. We developed an economic evaluation tool to assist ministries of health in allocating resources and planning RHD control programs. Methodology/Principal Findings We constructed a Markov model of the natural history of acute rheumatic fever (ARF) and RHD, taking transition probabilities and intervention effectiveness data from previously published studies and expert opinion. Our model estimates the incremental cost-effectiveness of scaling up coverage of primary prevention (PP), secondary prevention (SP) and heart valve surgery (VS) interventions for RHD. We take a healthcare system perspective on costs and measure outcomes as disability-adjusted life-years (DALYs), discounting both at 3%. Univariate and probabilistic sensitivity analyses are also built into the modeling tool. We illustrate the use of this model in a hypothetical low-income African country, drawing on available disease burden and cost data. We found that, in our hypothetical country, PP would be cost saving and SP would be very cost-effective. International referral for VS (e.g., to a country like India that has existing surgical capacity) would be cost-effective, but building in-country VS services would not be cost-effective at typical low-income country thresholds. Conclusions/Significance Our cost-effectiveness analysis tool is designed to inform priorities for ARF/RHD control programs in Africa at the national or subnational level. In contrast to previous literature, our preliminary findings suggest PP could be the most efficient and cheapest approach in poor countries. We provide our model for public use in the form of a Supplementary File. Our research has

  15. Atypical recurrence of rheumatic chorea

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    Gunjan Pankaj Kumar

    2015-05-01

    Full Text Available Syndenhams Chorea in acute rheumatic fever is reported to occur in 20-30% of patients. It is usually late onset, occurring upto 6 months after acute infection but may occasionally be present as presenting symptom of rheumatic fever. It is a self-limiting condition with spontaneous remission lasting from 1 week to 6 months. The risk of recurrence is present in 1st 1-2 years in about 20% of cases. Most of children (two thirds with rheumatic fever are of school age (5-15 years of age. It is common in India and the incidence has not shown the declining trends seen in the developing countries. We report the clinical findings, investigations and the course of clinical development of a 14-year-old girl, who presented with Rheumatic chorea which recurred 3 years after the initial episode. [Int J Res Med Sci 2015; 3(5.000: 1272-1273

  16. Association between rheumatic fever and Takayasu’s arteritis – Case report

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    Natali W.S. Gormezano

    2016-04-01

    Full Text Available ABSTRACT Takayasu’s arteritis (TA and rheumatic fever are diseases that can start with cardiac fea-tures, making the diagnosis difficult. There are reports of association of RF with Takayasu’sarteritis beginning with cardiac involvement in pediatric patients. The aim of this study isto report the possible association of RF and TA in patients with cardiac abnormalities. Wedescribe the case of an adolescent initially diagnosed with RF who progressed with changesthat allowed making the diagnosis of TA. TA and RF are two important causes of valveinvolvement that may have systemic manifestations.

  17. [Acute rheumatic carditis in Ivory Coast: changes in prevalence during the decade 2000-2009].

    Science.gov (United States)

    Kramoh, K E; N'Goran, Y N K; Aké-Traboulsi, E; Konin, K C; Boka, B C; Koffi, D B J; Sow, T M; Mandah, Y C; Kakou-Guikahue, M

    2013-02-01

    Rheumatic fever and acute rheumatic carditis (ARC), though now rare in developed countries, are the main cause of acquired heart disease in children and young adults and remain endemic in developing countries. This study aims to establish the current prevalence of ARC in Ivory Coast. A cross-sectional retrospective study was performed between January 2000 and December 2009 in the pediatric wards of the three university hospitals in Abidjan and in the Institute of Cardiology of Abidjan. It included all patients whose final diagnosis was ARC. There were 126 patients of which 57.1% were female. The mean age was 15 ± 6.7 years (range: 4 to 28 years). The average annual prevalence was 12.6 cases, with two peaks observed during the years 2004 (27 cases) and 2005 (20 cases). The hospital prevalence of ARC in the 10-year period was 1.1‰ which is less than in previous decades. The principal presentation leading to discovery of the ARC was heart failure (68.9%). This symptom was due to significant valvular regurgitation with dilatation of the cardiac chambers observed in 65.9%. Mitral regurgitation was the main lesion observed (87.3%). Apart from the cases of isolated pericarditis and three cases of mild mitral regurgitation, all other patients were suffering from valvular lesions as a result of previous rheumatic fever. A decrease in the hospital prevalence of ARC was observed. However the cases that were seen were diagnosed late and had a tendency to be severe. Copyright © 2012. Published by Elsevier SAS.

  18. Primary Prevention of Rheumatic Fever, Diagnosis and Treatment of Acute Streptococcal Pharyngitis%风湿热的一级预防及急性链球菌咽炎的诊治——美国心脏学会儿童心血管疾病委员会风湿热、心内膜炎和川崎病组及美国儿科学会2009年指南节选

    Institute of Scientific and Technical Information of China (English)

    李霞; 杜忠东

    2011-01-01

    Primary Prevention of Rheumatic Fever, Diagnosis and Treatment of Acute Streptococcal Pharyngitis-A Scientific Statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young,Endorsed by the American Academy of Pediatrics.%急性风湿热一级预防的主要方法是合理诊断并应用足量抗生素治疗A组乙型溶血性链球菌咽炎.A组乙型溶血性链球菌咽炎依靠临床表现和实验室检查结果综合诊断,其金标准是咽培养.治疗上首选青霉素,对青霉素过敏者,可口服头孢菌素、庆大霉素或大环内酯类/氮杂内酯类药物.

  19. Postpartum Acute Pulmonary Oedema with Sub clinical Rheumatic Heart Disease.

    Science.gov (United States)

    R, Padmaja; Gande, Sri Krishna Padma Challa Rao

    2015-02-01

    Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician. Here, we report a case of postpartum acute pulmonary oedema referred to causality after an emergency caesarean section in a private hospital. No matter what the underlying pathology, prompt administration and appropriate resuscitation is always the first priority. Only after the patient has been stabilized attention must be turned to diagnosis and specific treatment. A diagnosis of severe Mitral Stenosis, probably of rheumatic origin was made after stabilizing the patient.

  20. Rheumatic fever

    Science.gov (United States)

    ... common in countries that have a lot of poverty and poor health systems. It does not often ... may be needed for even longer, perhaps for life. To help manage swelling of inflamed tissues during ...

  1. A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba.

    Directory of Open Access Journals (Sweden)

    David A Watkins

    Full Text Available Acute rheumatic fever (ARF and rheumatic heart disease (RHD persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986-1996. The present study analyzes the cost-effectiveness of this Cuban program.We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a "do nothing" approach. Our population of interest was the cohort of children aged 5-24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program's effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children and saved $7,848,590 (2010 USD despite a total program cost of $202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving.A 10-year

  2. A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba.

    Science.gov (United States)

    Watkins, David A; Mvundura, Mercy; Nordet, Porfirio; Mayosi, Bongani M

    2015-01-01

    Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986-1996. The present study analyzes the cost-effectiveness of this Cuban program. We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a "do nothing" approach. Our population of interest was the cohort of children aged 5-24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs) averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program's effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children) and saved $7,848,590 (2010 USD) despite a total program cost of $202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving. A 10-year program to

  3. Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach.

    Science.gov (United States)

    Ralph, Anna P; Fittock, Marea; Schultz, Rosalie; Thompson, Dale; Dowden, Michelle; Clemens, Tom; Parnaby, Matthew G; Clark, Michele; McDonald, Malcolm I; Edwards, Keith N; Carapetis, Jonathan R; Bailie, Ross S

    2013-12-18

    Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy. We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008-2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation. Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p

  4. Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

    Directory of Open Access Journals (Sweden)

    de Oliveira Sheila KF

    2010-07-01

    Full Text Available Abstract Background More than 15 million people worldwide have rheumatic fever (RF and rheumatic heart disease due to RF. Secondary prophylaxis is a critical cost-effective intervention for preventing morbidity and mortality related to RF. Ensuring adequate adherence to secondary prophylaxis for RF is a challenging task. This study aimed to describe the rates of recurrent episodes of RF, quantify adherence to secondary prophylaxis, and examine the effects of medication adherence to the rates of RF in a cohort of Brazilian children and adolescents with RF. Methods This retrospective study took place in the Pediatric Rheumatology outpatient clinic at a tertiary care hospital (Instituto de Puericultura e Pediatria Martagão Gesteira in Rio de Janeiro, Brazil, and included patients with a diagnosis of RF from 1985 to 2005. Results 536 patients with RF comprised the study sample. Recurrent episodes of RF occurred in 88 of 536 patients (16.5%. Patients with a recurrent episode of RF were younger (p Conclusions We recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary prophylaxis is the main cause of RF recurrence. Detection of irregularity in secondary prophylaxis or in appointments should be an alert about the possibility of loss of follow-up and closer observation should be instituted.

  5. Rheumatic fever with severe carditis: still prevalent in the South West Pacific.

    Science.gov (United States)

    Nandra, Taran Kaur; Wilson, Nigel J; Artrip, John; Pagis, Bruno

    2017-03-10

    Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.

  6. Acute atrial fibrillation during dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Veloso Henrique Horta

    2003-01-01

    Full Text Available Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

  7. Management of acute childhood fevers.

    Science.gov (United States)

    Teuten, Polly; Paul, Siba Prosad; Heaton, Paul Anthony

    2015-01-01

    Feverish illnesses commonly affect children and are the second most frequent reason for a child to be admitted to hospital. Most cases are viral in origin, usually with a good prognosis. Fever can be caused by severe and rapidly progressive illness which needs urgent referral to hospital for potentially life-saving treatment, and community practitioners must be able to identify such cases showing 'red flag'features. The fear of serious disease among parents and carers may result in 'fever phobia' leading to minor illnesses being managed inappropriately. Community practitioners are well placed to reassure and support families, and to provide education regarding the facts about fever, the appropriate use of antipyretic medication, how to avoid dehydration, and the beneficial role of immunisation in preventing infection.

  8. [Levels of total hemolytic complement, C3, C4 and antibodies against the myocardium in rheumatic fever].

    Science.gov (United States)

    Martinez, R D

    1978-01-01

    The levels of the hemolytic complement (UH 50%), C3, C4 and the antibodies against myocardium and against the antigenic fractions of myocardium precipitated with ammonium sulphate were studied in 8 patients with active rehumatic fever (ARF), 28 with inactive rheumatic fever (IRF) and 26 people without cardiopaties (NI). The UH 50% was low in 2 out of 36 patients with rheumatic fever (RF). C3 was normal and C4 low in 12.5% of the ARF patients. C3 had subnormal values in 25% and C4 in 33% of IRF patients, this last value had a stadistic significant decrease with respect to the values of C4 in normal people. The 36 patients with RF had antibodies against the myocardium and also against the heart antigenic fractions precipitated with 10% ammonium sulphate. 11.5% of the normal group had anti-myocardial antibodies and none had antibodies against the fractions. The levels of anti-streptolysin-O and C-reactive protein were higher in the ARF group than in the patients with IRF or the normal people. The participation of the hemolytic complement, the anti-myocardium antibodies, the anti-streptococcus antibodies and the cytophilic activity in the etiopathogeny of rheumatic fever is discussed.

  9. Comparison of illumigene Group A Streptococcus Assay with Culture of Throat Swabs from Children with Sore Throats in the New Zealand School-Based Rheumatic Fever Prevention Program.

    Science.gov (United States)

    Upton, Arlo; Bissessor, Liselle; Farrell, Elizabeth; Shulman, Stanford T; Zheng, Xiaotian; Lennon, Diana

    2016-01-01

    Group A streptococcal (GAS) pharyngitis is a particularly important condition in areas of New Zealand where the incidence of acute rheumatic fever remains unacceptably high. Prompt diagnosis and treatment of GAS pharyngitis are cornerstones of the Rheumatic Fever Prevention Programme, but these are hindered by the turnaround time of culture. Tests with excellent performance and rapid turnaround times are needed. For this study, throat swabs (Copan ESwabs) were collected from schoolchildren self-identifying with a sore throat. Samples were tested by routine culture and the illumigene GAS assay using loop-mediated isothermal amplification. Discrepant results were resolved by retesting of the same specimen by an alternative molecular assay. Seven hundred fifty-seven throat swab specimens were tested by both methods. The performance characteristics of the illumigene assay using culture on blood agar as the "gold standard" and following discrepancy analysis were as follows: sensitivity, 82% and 87%, respectively; specificity, 93% and 98%, respectively; positive predictive value, 61% and 88%, respectively; and negative predictive value, 97% and 97%, respectively. In our unique setting of a school-based throat swabbing program, the illumigene assay did not perform quite as well as described in previous reports. Despite this, its improved sensitivity and rapid turnaround time compared with those of culture are appealing.

  10. ACUTE UNDIFFERENTIATED FEVER IN INTENSIVE CARE UNITS

    Directory of Open Access Journals (Sweden)

    Srikanth Ram Mohan

    2014-03-01

    Full Text Available Acute undifferentiated fever (AUF is common in tropical regions of the developing world, its specific etiology is often unknown. It’s common causes include malaria, dengue fever, enteric fever, leptospirosis, rickettsial infection. AUF is defined as fever without any localised source of infection, of 14 days or less in duration. The objective of the study was to focus on identifying the causes of AUF in patients admitted to Intensive care units & to determine importance of clinical examination in identifying the cause. It was a prospective study done in our Medical college Hospital at Kolar, Karnataka between 1-11-2010 to 30-11-2011. Cases presenting to hospital aged >18 years with complaints of Fever & admitted in Intensive care units were included in study. A total of 558 cases were enrolled. The clinical findings were noted and subsequent Investigations required were asked for. The study compromised of approximately equal number of Male & Female patients & age varied from 18 – 100 years. There was a clear seasonal variation – More no of cases were admitted between April & November. Majority presented with Fever of Short duration (1-3 days. Certain well defined syndromes were identified like:  Fever with Thrombocytopenia – the most common of all the syndromes.  Fever with Myalgia & Arthralgia,  Fever with Hepatorenal dysfunction,  Fever with Encephalopathy,  Fever with Pulmonary - Renal dysfunction and  Fever with Multiorgan dysfunction (MODS. Out of 558 cases AUF was noted in 339 cases (60.86%. An etiological diagnosis could be made for 218 cases (39.06%. Leptospirosis was the commonest cause with 72 cases (12.9%. The no of cases with Dengue were 48(8.6%, Malaria –25 (4.4%, Viral fever –35 (6.2%, Mixed infections – 12 (2.1%, Pulmonary Tuberculosis -25 ( 4.4% and one case of Rickettsial Infection. MODS was the most common presentation in AUF patients, seen in 108 cases (31.8% and 40 cases expired. A study of AUF

  11. PANDAS: the search for environmental triggers of pediatric neuropsychiatric disorders. Lessons from rheumatic fever.

    Science.gov (United States)

    Garvey, M A; Giedd, J; Swedo, S E

    1998-09-01

    Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) is a relatively new diagnostic construct applied to children or adolescents who develop, and have repeated exacerbations of, tic disorders and/or obsessive-compulsive disorder following group A beta-hemolytic streptococcal infections. The proposed pathophysiology is that the group A beta-hemolytic streptococcal bacteria trigger antibodies that cross-react with the basal ganglia of genetically susceptible hosts leading to obsessive-compulsive disorder and/or tics. This is similar to the etiologic mechanisms proposed for Sydenham's chorea, in which group A beta-hemolytic streptococcal antibodies cross-react with the basal ganglia and result in abnormal behavior and involuntary movements. When first proposed, there was much controversy about the idea that streptococcal infections were etiologically related to rheumatic fever. In a like manner, discussion has arisen about the concept of infection-triggered obsessive-compulsive disorder and tic disorders. We review the historical background to these controversies, give an update on the findings provided by research on PANDAS, and address areas of future study.

  12. The laboratory and cardiac equipment examination and analysis of acute rheumatic fever in children%小儿急性风湿热的实验室与心脏器械检查及分析

    Institute of Scientific and Technical Information of China (English)

    马沛然; 李桂梅

    2001-01-01

    通过有关实验室与心脏器械检查,以发现急性风湿热(ARF)诊断的新指标。方法对114例ARF患儿,检查抗链球菌溶血素“O”(ASO),其中60例做了咽部A组β溶血性链球菌快速鉴定(GABHSRA),且对二者阳性率进行对比;将114例的肌酸激酶同功酶(CK-MB)、多普勒超声心动图,与健康儿童对比。结果ARF患儿GABHSRA阳性率为90%(54/60),显著高于ASO阳性率65.8%(75/114)。114例ARF患儿 CK-MB升高者46.5%,α-羟丁酸脱氢酶升高者32.7%;超声心动图左房增大者23.7%,左室扩大者16.7%,右室扩大者7.1%;二尖瓣增厚者13.2%,主动脉瓣增厚者8.8%;多普勒超声心动图检查二尖瓣返流者29.8%,主动脉瓣返流者9.6%,与健康儿童相比,差异均有显著性意义。34例有二尖瓣返流患儿中29例二尖瓣返流流速时间积分增大。结论GABHSRA、心肌酶和多普勒超声心动图检查有助于ARF的诊断与病情了解。%Objective To find new diagnostic index of acute rheumaticfever(ARF) by the lab and cardiac equipment examination in children. Methods Group A β-haemolytic streptococcus rapid assay (GABHSRA), ASO, CK-MB, α- HBDH, Doppler echocardiography were performed in 114 children with ARF. Results GABHSRA was positive in 90% of ARF,CK-MB was elevated in 46. 5%, α-HBDH was elevated in 32.7% of the children with ARF. According to the examination of 114 ARF by Doppler echocardiography, enlargement of LA, LV, RV was 23.7%, 16. 7% and 7. 1% respectively. Thickening of mitral valve and aortic valve was 13.2% and 8. 8% respectively. Regurgitation of mitral valve and aortic valve was 29.8% and 9.3% respectively. Mitral valve regurgitation velocity time interval was increased in 28 patients among 34 patients with mitral regurgitation. Conclusions GABHSRA, CK-MB, α-HBDH and Doppler echocardiography examination is useful in the diagnosis and helpful to the recognization of the carditis of patients

  13. Chikungunya fever presenting with acute optic neuropathy.

    Science.gov (United States)

    Mohite, Abhijit Anand; Agius-Fernandez, Adriana

    2015-07-28

    Chikungunya fever is a vector borne virus that typically causes a self-limiting systemic illness with fever, skin rash and joint aches 2 weeks after infection. We present the case of a 69-year-old woman presenting with an acute unilateral optic neuropathy as a delayed complication of Chikungunya virus (CHIKV) infection contracted during a recent trip to the West Indies. She presented to our ophthalmology department with acute painless visual field loss in the right eye and a recent flu-like illness. She was found to have a right relative afferent pupillary defect (RAPD) with unilateral optic disc swelling. Serology confirmed recent CHIKV infection. Treatment with intravenous methylprednisolone was delayed while awaiting MRI scans and serology results. At 5-month follow-up, there was a persistent right RAPD and marked optic atrophy with a corresponding inferior scotoma in the visual field. 2015 BMJ Publishing Group Ltd.

  14. Management of acute fever in children: Guideline for community ...

    African Journals Online (AJOL)

    Management of acute fever in children: Guideline for community healthcare ... Therefore, it is essential to distinguish between a child with fever who is at high risk ... the appropriate use of antipyretic medication and how to advise parents and ...

  15. Lassa fever presenting as acute abdomen: a case series

    OpenAIRE

    Dongo, Andrew E.; Kesieme, Emeka B.; Iyamu, Christopher E; Okokhere, Peter O.; Akhuemokhan, Odigie C.; Akpede, George O.

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefo...

  16. Acute Rheumatic Fever%急性风湿热

    Institute of Scientific and Technical Information of China (English)

    H A Majeed; 庄俊玲

    2002-01-01

    急性风湿热是A组链球菌咽炎引发的一种疾病。经2~6周的潜伏期,出现急性风湿热临床综合征,是贫困和居住拥挤。然而,1980年代中期美国暴发的急性风湿热患者虽然主要是儿童,但大多来自社会经包括多关节炎,心脏炎、舞蹈症、边缘性红斑和皮下结节。这些症状可单独出现也可以任何组合形式出现。

  17. Acute rheumatic fever%急性风湿热

    Institute of Scientific and Technical Information of China (English)

    Patrick J Commerford; Bongani M Mayosi; 陈益和

    2007-01-01

    急性风湿热(ARF)是由既往链球菌感染引起的非感染性结局,几乎完全是由于自身免疫性病因所致。该病在发达国家已不常见,但仍然是发展中国家一个主要的公共卫生问题,慢性瓣膜性风湿性心脏病(RHD)的一个严重后果就是在那些国家的受累年轻人中产生巨大的发病和死亡负担。

  18. Estudo da prevalência da febre reumática A study of prevalence of rheumatic fever

    Directory of Open Access Journals (Sweden)

    Marluce Oliveira Silva

    1979-03-01

    Full Text Available Foi realizado estudo sobre a prevalência da febre reumática em escolares do primeiro grau de uma unidade escolar do município de São Paulo, Brasil. Dos 1.532 alunos da faixa etária de 7 a 14 anos, foram examinados 316 dos quais surgiram 26 casos que exigiram exame cardiológico pormenorizado. O resultado obtido foi o seguinte: 17 normais, 5 portadores de cardiopatias congênitas, 3 suspeitos de atividade reumática e um caso de cardiopatia reumática. Constatou-se a inexistência de qualquer caso de atividade reumática atual, e apenas um caso de cardiopatia reumática, com passado reumático típico. Em relação aos achados brasileiros (1,1% e 0,3%, o presente resultado não difere estatisticamente ( P > 0,20%. Comentou-se o custo da investigação que resultou na descoberta de apenas um caso de doença reumática, já com comprometimento orovalvar, e a posição que a saúde pública ocupa em relação aos demais problemas observados, tais como: verminose, cárie dentária, subnutrição e outros.A medical and public health, group of the city of São Paulo's Dante Pazzanese Institute of Cardiology (Brazil chose the Valentim Gentil School's 1532 students to be checked for signs of rheumatic fever. Of these 1532 students, 316 were examined; their ages ranged from 7 to 14. Twenty-six required detailed cardiologic examination, which gave the following results: seventeen were normal; five had congenital heart disease; three showed signs of rheumatic activity, not confirmed; and there was one case of rheumatic cardiopathy. No cases of confirmed rheumatic activity were found during the examinations and only one rheumatic cardiopathy with typical rheumatic fever. Other Brazilian statistics for this type of study are 1.1% and 0.3%. Therefore, P > 0.20% is, statistically, not significant. From the standpoint of public health, the findings were out of proportion to the costs of the study when so much needs to be done for those needing care for

  19. Acute transverse myelitis: an unusual complication of typhoid fever.

    Science.gov (United States)

    Mishra, Kirtisudha; Kaur, Sharandeep; Basu, Srikanta; Gulati, Praveen; Parakh, Ankit

    2012-08-01

    Typhoid fever is associated with a wide spectrum of neurological complications. Acute transverse myelitis is a rare complication with only a few reports in adults and none in children. A 15-year-old boy with typhoid fever is reported who developed acute transverse myelitis in the 3rd week of illness. He was treated with antibiotics and corticosteroids and made a complete recovery.

  20. Rheumatic Fever Follow-Up Study (RhFFUS protocol: a cohort study investigating the significance of minor echocardiographic abnormalities in Aboriginal Australian and Torres Strait Islander children

    Directory of Open Access Journals (Sweden)

    Rémond Marc Gerard Wootton

    2012-11-01

    Full Text Available Abstract Background In Australia, rheumatic heart disease (RHD is almost exclusively restricted to Aboriginal Australian and Torres Strait Islander people with children being at highest risk. International criteria for echocardiographic diagnosis of RHD have been developed but the significance of minor heart valve abnormalities which do not reach these criteria remains unclear. The Rheumatic Fever Follow-Up Study (RhFFUS aims to clarify this question in children and adolescents at high risk of RHD. Methods/design RhFFUS is a cohort study of Aboriginal and/or Torres Strait Islander children and adolescents aged 8–17 years residing in 32 remote Australian communities. Cases are people with non-specific heart valve abnormalities detected on prior screening echocardiography. Controls (two per case are age, gender, community and ethnicity-matched to cases and had a prior normal screening echocardiogram. Participants will have echocardiography about 3 years after initial screening echocardiogram and enhanced surveillance for any history suggestive of acute rheumatic fever (ARF. It will then be determined if cases are at higher risk of (1 ARF or (2 developing progressive echocardiography-detected valve changes consistent with RHD. The occurrence and timing of episodes of ARF will be assessed retrospectively for 5 years from the time of the RhFFUS echocardiogram. Episodes of ARF will be identified through regional surveillance and notification databases, carer/subject interviews, primary healthcare history reviews, and hospital separation diagnoses. Progression of valvular abnormalities will be assessed prospectively using transthoracic echocardiography and standardized operating and reporting procedures. Progression of valve lesions will be determined by specialist cardiologist readers who will assess the initial screening and subsequent RhFFUS screening echocardiogram for each participant. The readers will be blinded to the initial assessment and

  1. Elevated D8/17 expression on B lymphocytes, a marker of rheumatic fever, measured with flow cytometry in tic disorder patients

    NARCIS (Netherlands)

    Hoekstra, PJ; Bijzet, J; Limburg, PC; Steenhuis, MP; Troost, PW; Oosterhoff, MD; Korf, J; Kallenberg, CGM; Minderaa, RB

    2001-01-01

    Objective: Elevated D8/17 expression on B lymphocytes is a known susceptibility marker of rheumatic fever. Previous studies have reported higher than usual D8/ 17 expression on B lymphocytes of patients with tic disorders. The purpose of this study was to assess D8/17 expression on B lymphocytes of

  2. Dengue fever mimicking acute appendicitis: A case report.

    Science.gov (United States)

    McFarlane, M E C; Plummer, J M; Leake, P A; Powell, L; Chand, V; Chung, S; Tulloch, K

    2013-01-01

    Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy. A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus. This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery. This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Dengue hemorrhagic fever and acute hepatitis: a case report

    Directory of Open Access Journals (Sweden)

    Maria Paula Gomes Mourão

    Full Text Available Dengue fever is the world's most important viral hemorrhagic fever disease, the most geographically wide-spread of the arthropod-born viruses, and it causes a wide clinical spectrum of disease. We report a case of dengue hemorrhagic fever complicated by acute hepatitis. The initial picture of classical dengue fever was followed by painful liver enlargement, vomiting, hematemesis, epistaxis and diarrhea. Severe liver injury was detected by laboratory investigation, according to a syndromic surveillance protocol, expressed in a self-limiting pattern and the patient had a complete recovery. The serological tests for hepatitis and yellow fever viruses were negative. MAC-ELISA for dengue was positive.

  4. Dengue hemorrhagic fever and acute hepatitis: a case report

    Directory of Open Access Journals (Sweden)

    Maria Paula Gomes Mourão

    2004-12-01

    Full Text Available Dengue fever is the world's most important viral hemorrhagic fever disease, the most geographically wide-spread of the arthropod-born viruses, and it causes a wide clinical spectrum of disease. We report a case of dengue hemorrhagic fever complicated by acute hepatitis. The initial picture of classical dengue fever was followed by painful liver enlargement, vomiting, hematemesis, epistaxis and diarrhea. Severe liver injury was detected by laboratory investigation, according to a syndromic surveillance protocol, expressed in a self-limiting pattern and the patient had a complete recovery. The serological tests for hepatitis and yellow fever viruses were negative. MAC-ELISA for dengue was positive.

  5. Acute Macular Neuroretinopathy Associated With Chikungunya Fever.

    Science.gov (United States)

    Pang, Claudine E; Navajas, Eduardo V; Warner, Simon J; Heisler, Morgan; Sarunic, Marinko V

    2016-06-01

    A 47-year-old man with recent travel to the Caribbean was admitted with acute febrileillness associated with arthralgia and skin rash followed by sudden onset of bilateral visual field defects. Funduscopy revealed subtle bilateral paracentral dark lesions nasal to the fovea best seen on near infrared imaging as hyporeflective, wedge-shaped, paracentral macular lesions. Spectral-domain optical coherence tomography (SD-OCT) through the lesions revealed hyperreflective bands at the level of the outer plexiform layer and outer nuclear layer (ONL), with concomitant attenuation of the underlying external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). Neither fluorescein angiography nor speckle variance OCT angiography (sv-OCTA) showed any defects in retinal circulation. Work up revealed positive Immunoglobulin M for Chikungunya virus (CHIKV). Six months later, the patient had persistent scotomas, although reduced in size. SD-OCT showed subtle ONL thinning and restoration of the ELM, although EZ and IZ remained disrupted. Chikungunya fever may manifest as bilateral acute macular neuroretinopathy (AMN). Clinicians should be aware of possible systemic associations of AMN. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:596-599.]. Copyright 2016, SLACK Incorporated.

  6. Lassa fever presenting as acute abdomen: a case series.

    Science.gov (United States)

    Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

    2013-04-19

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.

  7. 风湿热发病机制的研究进展%The researchful progress about the pathogenesis of rheumatic fever

    Institute of Scientific and Technical Information of China (English)

    黄建林; 古洁若; 余步云

    2005-01-01

    风湿热(Rheumatic fever,RF)是A组β溶血性链球菌(Group A Streptococcus,GAS)感染咽喉部后引起的一种自身免疫性疾病,可累及全身多个系统.长期、反复发作的风湿性心瓣膜炎可导致慢性心瓣膜损害,形成风湿性心脏病(rheumatic heart disease,RHD).

  8. Postpartum Acute Pulmonary Oedema with Sub clinical Rheumatic Heart Disease

    OpenAIRE

    2015-01-01

    Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician.

  9. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands 1

    OpenAIRE

    Keijmel, S.P.; Krijger, E.; Delsing, C.E.; Sprong, T; Nabuurs-Franssen, M.H.; Bleeker-Rovers, C.P.

    2015-01-01

    Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respiratory tract symptoms, or fever and hepatitis, but had negative serologic results for Q fever. Patients with acute Q fever were younger and had higher C-reactive protein levels but lower leukocyte c...

  10. Acute Disseminated Encephalomyelitis Following Typhoid Fever: A Case Report

    Directory of Open Access Journals (Sweden)

    R Adhikari

    2014-04-01

    Full Text Available The involvement of central nervous system in children with typhoid fever is common. Acute disseminated encephalomyelitis is a rare immune mediated and demyelinating disease of the central nervous system that usually affects children. We report a 7-year-old child with typhoid fever who developed acute cerebellar syndrome due to acute disseminated encephalomyelitis.Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 55-58 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10237

  11. Dengue fever presenting as acute liver failure- a case report

    Institute of Scientific and Technical Information of China (English)

    Rajat Jhamb; Bineeta Kashyap; Ranga GS; Kumar A

    2011-01-01

    Dengue fever(DF) and dengue haemorrhagic fever(DHF) are important mosquito-borne viral diseases of humans and recognized as important emerging infectious diseases in the tropics and subtropics. Compared to nine reporting countries in the 1950s, today the geographic distribution includes more than100 countries worldwide. Dengue viral infections are known to present a diverse clinical spectrum, ranging from asymptomatic illness to fatal dengue shock syndrome. Mild hepatic dysfunction in dengue haemorrhagic fever is usual. However, its presentation as acute liver failure(ALF)is unusual. We report a patient with dengue shock syndrome who presented with acute liver failure and hepatic encephalopathy in a recent outbreak of dengue fever in Delhi, India.

  12. Feature changes of rheumatic fever in last ten years%近十年风湿热的演变

    Institute of Scientific and Technical Information of China (English)

    谢旭晶; 徐莉; 陈磷; 魏秋静; 余步云

    2009-01-01

    Objective To investigate the changes of clinical and laboratory manifestations of rheumatic fever (RF) in recent ten years by reviewing the medical data of 315 patients with RF. Methods Three hundred and fifteen in-patients and out-patients with RF during 1985-1995 (group A) and 1997-2007(group B) were selected. Their manifestations were compared. Results Male/female ratio was about 1:2. Carditis and polyarthritis were common manifestations. Compared with group A, the rate of low-grade fever and carditis increased and the rate of heart failure, positive rate of C reaction protein and antistreptolysin O decreased in group B. In group B, 61.4% patients fulfilled the updated Jones diagnostic criteria. 76.2% fulfilled the 2002-2003 WHO criteria. The sensitivity and specificity of peripheral blood lymphocyte procoagulant activity (PCA) for the diagnosis of rheumatic carditis was 79.1% and 71.4% respectively. That of the anti-streptococcal group A polysaccharide (ASP) antibodies was 70.3% and 70% respectively. Five to ten years follow-up clinical data were available for 35 cases since Dec. 1997. The recurrent rate of RF was 62.8%. Only 1/3 cases received regular secondary prevention. Recurrence rate of patients with regular secondary prevention was significantly lower than that of patients without regular secondary prevention. Conclusion Mild earditis has been increasing during last ten years. PCA and ASP are valuable tests for diagnosing rheumatic carditis. More emphasis should be paid to atypical cases, early diagnosis and regular secondary prevention in order to improve prognosis.%目的 探讨近十年风湿热临床表现及实验室榆查的变化,为诊断及治疗提供参考.方法 收集我院风湿热患者共315例,分为2组,1985-1995年就诊的为A组,1997-2007年就诊的为B组,比较2组的临床表现及实验室检查.结果 男:女为1:2.心脏炎、多关节炎仍是最常见的症状.与A组比较,B组低热、心脏炎增加,心力衰竭减少,C

  13. Applying Manual Pressure before Benzathine Penicillin Injection for Rheumatic Fever Prophylaxis Reduces Pain in Children.

    Science.gov (United States)

    Derya, Emre-Yavuz; Ukke, Karabacak; Taner, Yavuz; Izzet, Ayhan Yusuf

    2015-06-01

    The purpose of this study was to evaluate the efficacy of applying manual pressure before benzathine penicillin injection and compare it with the standard injection technique in terms of reducing discomfort in children with rheumatic heart disease grouped by age and gender. This was a single-blind, randomized, crossover study. Fifty-one patients aged 7.1-19.9 years were recruited for this study carried out in the pediatric cardiology outpatient clinic. Twenty-nine were girls (56.9%). All subjects received an intramuscular injection of benzathine penicillin with manual pressure to one buttock or with the standard technique to the other buttock at 3-week intervals. The two techniques were used randomly. The subjects were blinded to the injection technique and a visual analogue scale was used after the procedure. Findings demonstrate that children experienced significantly less pain when they received injections with manual pressure (1.3 ± 0.9) compared with the standard injection (4.4 ± 1.6) technique. The perceived injection pain was negatively related to the age of the children in both techniques. Compared with boys, girls felt more pain, but the difference between each technique group according to gender was negligible. The application of manual pressure reduces pain in children under the stress of repeated intramuscular injections, which supports the suggestion that it should be used in routine practice. Manual pressure to the injection site is a simple, pain-reducing technique. Implementing this technique in routine practice may also promote adherence to the prophylaxis regimen, especially in children.

  14. Pediatric Acute Q Fever Mimics Other Common Childhood Illnesses

    Science.gov (United States)

    Bart, Ingeborg Y.; Schabos, Yvonne; van Hout, Roeland W. N. M.; Leenders, Alexander C. A. P.; de Vries, Esther

    2014-01-01

    Knowledge of Q fever has increased over the last decades, but research has mainly focused on adults. Data in children are scarce, and current knowledge is mostly based on case reports. The aim of this study was to determine predictors for acute Q fever in children in the general population. We retrospectively studied all children tested for Coxiella burnetii by serology and/or PCR upon request of their general practitioner in the regional laboratory for Medical Microbiology of the Jeroen Bosch during the Q fever outbreak in the Netherlands between 2007 and 2011. A total of 1061 patients was analyzed. Influenza-like illness and respiratory tract infection were the most common presentations of acute Q fever, mimicking other common childhood illnesses. None of the reported symptoms was significantly related to a positive test outcome and therefore presenting signs or symptoms have no predictive value in diagnosing Q-fever in children. Only diagnostic tests are reliable. As the infection generally follows a mild and uncomplicated course, we question if the difficulty of recognizing pediatric Q fever is a problem worth solving. PMID:24520412

  15. Dengue fever presenting with acute cerebellitis: a case report.

    Science.gov (United States)

    Withana, Milinda; Rodrigo, Chaturaka; Chang, Thashi; Karunanayake, Panduka; Rajapakse, Senaka

    2014-03-05

    The incidence of dengue fever is on the rise in tropical countries. In Sri Lanka, nearly 45,000 patients were reported in 2012. With the increasing numbers, rare manifestations of dengue are occasionally encountered. We report a patient who presented with bilateral cerebellar signs as the presenting feature of dengue. A 45-year-old previously healthy female from the suburbs of Colombo, Sri Lanka presented with an acute febrile illness associated with unsteadiness of gait. Clinical examination revealed a scanning dysarthria and marked horizontal nystagmus with bilateral dysmetria, dysdiadokokinesia and incordination more prominent on the right. Her gait was wide-based and ataxic with a tendency to fall to the right more than to the left. Dengue nonstructural protein antigen 1 test and IgM antibody testing both became positive indicating acute dengue infection. She recovered from the febrile episode within 9 days since the onset of fever but cerebellar symptoms outlasted the fever by one week. The magnetic resonance imaging of brain was normal and cerebellar signs resolved spontaneously by day 17 of the illness. Cerebellar syndrome in association with dengue fever has been reported in only four instances and our patient is the first reported case of dengue fever presenting with cerebellitis as the first manifestation of disease. This case report is intended to highlight the occurrence of acute cerebellitis as a presenting syndrome of the expanding list of unusual neurological manifestations of dengue infection.

  16. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Saif Khan

    2013-01-01

    Full Text Available Dengue fever is mosquito borne disease caused by dengue virus (DENV of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

  17. Brain MR spectroscopy in children with a history of rheumatic fever with a special emphasis on neuropsychiatric complications

    Energy Technology Data Exchange (ETDEWEB)

    Alkan, Alpay E-mail: aalkan@inonu.edu.tr; Kutlu, Ramazan; Kocak, Gulendam; Sigirci, Ahmet; Emul, Murat; Dogan, Selda; Aslan, Mehmet; Sarac, Kaya; Yakinci, Cengiz

    2004-03-01

    Purpose: To investigate whether there are metabolite changes in basal ganglia of children with complete healing of rheumatic fever (RF), history of Syndenham chorea (SC) and obsessive compulsive-tic disorder (OCTD) developed after RF when compared with healthy controls and each other. Material and methods: A total of 49 children with history of RF and 31 healthy controls were included into the study. All patients and control group underwent a detailed neuropsychiatric evaluation. Children with the history of RF were classified into three groups as; group 1: with history of RF without neuropsychiatric complications (NCRF), group 2: only with history of SC (HSC), group 3: with HSC and OCTD (OCTD). After MR imaging, single voxel MR spectroscopy was performed in all subjects. Voxels (15x15x15 mm) were placed in basal ganglia. N-acetyl aspartate (NAA)/creatin (Cr), and choline (Cho)/Cr ratios were calculated. Results: OCTD were detected in 13 children with HSC. NAA/Cr ratio was found to be decreased in these children when compared with NCRF (n:29), HSC without OCTD (n:7) and control groups (n:31). No significant difference was found in metabolite ratios of children with HSC without OCTD when compared with NCRF and control groups. There were no significant differences in Cho/Cr ratio between patient and control groups. Conclusion: Although MR imaging findings was normal, MR spectroscopy findings (decreased NAA/Cr ratio) in our study support the neuronal loss in basal ganglia of children with OCTD and could indicate the development of permanent damage.

  18. [Two cases of acute hepatitis associated with Q fever].

    Science.gov (United States)

    Yeşilyurt, Murat; Kılıç, Selçuk; Gürsoy, Bensu; Celebi, Bekir; Yerer, Mehmet

    2012-07-01

    Q fever which is caused by Coxiella burnetii, is a worldwide zoonosis. Many species of wild and domestic mammals, birds, and arthropods, are reservoirs of C.burnetii in nature, however farm animals are the most frequent sources of human infection. The most frequent way of transmission is by inhalation of contaminated aerosols. The clinical presentation of Q fever is polymorphic and nonspecific. Q fever may present as acute or chronic disease. In acute cases, the most common clinical syndromes are selflimited febrile illness, granulomatous hepatitis, and pneumonia, but it can also be asymptomatic. Fever with hepatitis associated with Q fever has rarely been described in the literature. Herein we report two cases of C.burnetii hepatitis presented with jaundice. In May 2011, two male cases, who inhabited in Malkara village of Tekirdag province (located at Trace region of Turkey), were admitted to the hospital with the complaints of persistent high grade fever, chills and sweats, icterus, disseminated myalgia and headache. Physical examination revealed fever, icterus and the patient appeared to be mildly ill but had no localizing signs of infection. Radiological findings of the patients were in normal limits. Laboratory findings revealed leukocytosis, increased hepatic and cholestatic enzyme levels, and moderate hyperbilirubinemia- mainly direct bilirubin, whereas serum C-reactive protein and erythrocyte sedimentation rate were found normal. Blood and urine cultures of the patients yielded no bacterial growth. Serological markers for acute viral hepatitis, citomegalovirus and Epstein-Barr virus infections, brucellosis, salmonellosis, toxoplasmosis and leptospirosis were found negative. Acute Q fever diagnosis of the cases were based on the positive results obtained by C.burnetii Phase II IgM and IgG ELISA (Vircell SL, Spain) test, and the serological diagnosis were confirmed by Phase I and II immunofluorescence (Vircell SL, Spain) method. Both cases were treated with

  19. An unusual cause of acute abdominal pain in dengue fever.

    Science.gov (United States)

    Waseem, Tariq; Latif, Hina; Shabbir, Bilquis

    2014-07-01

    Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).

  20. Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Edmond Puca; Arben Pilaca; Pellumb Pipero; Dhimiter Kraja; Entela Y Puca

    2012-01-01

    Hemorrhagic fever with renal syndrome (HFRS) is a systemic infectious disease caused by Hantaviruses and characterized by fevers,bleeding tendencies,gastrointestinal symptoms and renal failure.It encompasses a broad spectrum of clinical presentations,ranging from unapparent or mild illnesses to fulminant hemorrhagic processes.Among the various complications of HFRS,acute pancreatitis is a rare find.In this report,based on clinical data,laboratory and radiologic examination findings,we describe a clinical case,with HFRS from Dobrava virus,associated with acute pancreatitis.The patient was successfully treated by supportive management.Clinicians should be alert to the possibility of HFRS when examining patients with epidemiological data and symptoms of acute pancreatitis.

  1. Acute glomerulonephritis in dengue hemorrhagic fever: A rare case report

    Directory of Open Access Journals (Sweden)

    K R Meena

    2013-01-01

    Full Text Available An 11-year-old male child presented with fever, bodyache, swelling over the whole body, and oliguria. He had hypertension. Urine microscopy showed hematuria and glomerular casts. Renal functions were deranged and had low complement C3 level. Chest X-ray showed plural effusion and ultrasonography abdomen showed mild ascitis. The immunoglobulin (IgM and IgG enzyme-linked immunosorbent essay for dengue virus were positive. Diagnosis of dengue hemorrhagic fever with acute glomerulonephritis was made. He was managed with maintenance fluid, antihypertensive medicine and supportive care. He recovered gradually and was discharged 12 days after admission.

  2. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands(1)

    NARCIS (Netherlands)

    Keijmel, S.P.; Krijger, E.; Delsing, C.E.; Sprong, T.; Nabuurs-Franssen, M.H.; Bleeker-Rovers, C.P.

    2015-01-01

    Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower

  3. Long-term follow-up of acute Q fever patients after a large epidemic

    NARCIS (Netherlands)

    Wielders, CCH

    2014-01-01

    Between 2007 and 2009, one of the largest Q fever epidemics documented worldwide occurred in the Netherlands. This epidemic originated from dairy goat farms and resulted in over 3,500 notified human acute Q fever cases. After an episode of acute Q fever, the causative bacterium Coxiella burnetii may

  4. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands(1)

    NARCIS (Netherlands)

    Keijmel, S.P.; Krijger, E.; Delsing, C.E.; Sprong, T.; Nabuurs-Franssen, M.H.; Bleeker-Rovers, C.P.

    2015-01-01

    Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respir

  5. [Coexistence of acute appendicitis and dengue fever: A case report].

    Science.gov (United States)

    Osuna-Ramos, Juan Fidel; Silva-Gracia, Carlos; Maya-Vacio, Gerardo Joel; Romero-Utrilla, Alejandra; Ríos-Burgueño, Efrén Rafael; Velarde-Félix, Jesús Salvador

    2017-01-03

    Dengue is the most important human viral disease transmitted by mosquitoes. It can be asymptomatic or it can present in any of its 3clinical forms: Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. However, some atypical manifestations have been reported in surgical emergencies caused by acute appendicitis in patients with dengue fever. We report the case of an 18-year-old Mexican male who presented to the emergency department of the General Hospital of Culiacan, Sinaloa, with symptoms of dengue fever, accompanied by crampy abdominal pain with positive Rovsing and Dunphy signs. Dengue infection was confirmed by a positive NS1 antigen test performed by enzyme-linked immunosorbent assay. An abdominal ultrasound revealed an appendicular process; as the abdominal pain in the right side kept increasing, an open appendectomy was performed. Abundant inflammatory liquid was observed during the surgery, and the pathology laboratory reported an oedematous appendix with fibrinopurulent plaques, which agreed with acute ulcerative appendicitis. The patient was discharged fully recovered without complications during the follow-up period. Acute abdominal pain can be caused in some cases by dengue infection. This can be confusing, which can lead to unnecessary surgical interventions, creating additional morbidities and costs for the patient. This unusual and coincident acute appendicitis with dengue highlights the importance of performing careful clinical studies for appropriate decision making, especially in dengue endemic regions during an outbreak of this disease. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  6. 链球菌感染后风湿热和风湿性心脏病%Poststreptococcus rheumatic fever and rheumatic heart diseases

    Institute of Scientific and Technical Information of China (English)

    高路; 袁越

    2006-01-01

    风湿热(rheumatic fever)是儿童上呼吸道或皮肤等感染A族链球菌(group A streptococcus,GAS)后引起的一种自身免疫性疾病。在结缔组织有多发的非化脓性病变,主要累及心脏和关节,脑、皮肤、粘膜、血管、肺、肾等亦可受累,而心脏为本病唯一留有后遗症的器官,可导致永久性瓣膜损害、心力衰竭,甚至死亡。

  7. Features of acute ischemic stroke with rheumatic heart disease in a hospitalized Chinese population.

    Science.gov (United States)

    Wang, Deren; Liu, Ming; Hao, Zilong; Tao, Wendan; Lin, Sen; Zhang, Shihong; Wu, Bo; Ma, Zhenxing; Dong, Wei

    2012-11-01

    Rheumatic heart disease (RHD) is an important risk factor for ischemic stroke in developing countries. Observational data on its characteristics and influence on outcome or recurrence of ischemic stroke are scarce. We aimed to investigate proportions, characteristics, functional outcome, and recurrence of acute ischemic stroke patients with RHD in a hospitalized Chinese population. We prospectively enrolled consecutive patients with acute ischemic stroke who were admitted within 1 month of stroke onset from January 2003 to February 2007, into the analysis. Clinical characteristics such as age, gender, risk factors, and National Institutes of Health Stroke Scale on admission were investigated. Basic characteristics, functional outcomes, and recurrence were compared between RHD group and nonRHD group. Of the 1638 cases included, RHD was present in 130 patients (7.9%). RHD patients, compared with those without RHD, were younger, more frequently female, and more often had experienced atrial fibrillation and higher National Institutes of Health Stroke Scale score on admission (all PStroke Scale on admission, the death risk in patients with RHD was 2.0-fold higher at 3 months, 6 months, and 1 year compared with patients without RHD (all PStroke attributable to RHD is still common in the Chinese population. RHD was associated with 2-fold increased risk of death and 1-fold increased risk of recurrence in stroke patients.

  8. Bilateral acute visual loss from Rathke's cleft cyst apoplexy in a patient with dengue fever

    Directory of Open Access Journals (Sweden)

    Ana Cláudia De Franco Suzuki

    2014-10-01

    Full Text Available Hemorrhagic complications of optic pathway diseases are extremely rare causes of acute visual loss associated with dengue fever. In this paper we report a patient presenting with dengue fever and bilateral acute visual loss caused by chiasmal compression due to Rathke's cleft cyst apoplexy. Considering the importance of early diagnosis and treatment to visual recovery, apoplexy of sellar and suprasellar tumors should be considered in the differential diagnosis of patients with acute visual loss and dengue fever.

  9. Unusual Presentation of Dengue Fever; A child with acute myocarditis

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    Moaz Aslam

    2016-02-01

    Full Text Available Dengue fever (DF is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.

  10. Neutropenia, fever, and infection in children with acute lymphocytic leukemia.

    Science.gov (United States)

    Wolk, J A; Stuart, M J; Stockman, J A; Oski, F A

    1977-02-01

    In an attempt to determine the relationship between neutropenia (absolute granulocyte count less than 1,000/cu mm), infection, and disease status, 20 patients with acute lymphoblastic leukemia were observed for a total of 34 patient-years. Febrile episodes occurred with much greater frequency in patients during the course of treatment induction (0.9/mo), or while in relapse (2.46/mo) than while in remission (0.19/mo). A cause for fever was identified much more frequently in patients in remission, both when neutropenic and nonneutropenic. When absolute granulocyte counts fell below 200/cu mm, a cause for fever was generally identified regardless of disease status. We propose that the majority of febrile episodes in patients at the time of induction of treatment or in relapse with neutrophil counts of more than 200/cu mm are caused by the disease process rather than secondary to a diagnosable infection.

  11. Unusual Presentation of Dengue Fever: A child with acute myocarditis.

    Science.gov (United States)

    Aslam, Moaz; Aleem, Numra A; Zahid, Mohammad F; Rahman, Arshalooz J

    2016-02-01

    Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.

  12. The 2007-2010 Q fever epidemic in The Netherlands: characteristics of notified acute Q fever patients and the association with dairy goat farming.

    NARCIS (Netherlands)

    Dijkstra, F.; Hoek, W. van der; Wijers, N.; Schimmer, B.; Rietveld, A.; Wijkmans, C.J.; Vellema, P.; Schneeberger, P.M.

    2012-01-01

    We describe the Q fever epidemic in the Netherlands with emphasis on the epidemiological characteristics of acute Q fever patients and the association with veterinary factors. Data from 3264 notifications for acute Q fever in the period from 2007 through 2009 were analysed. The patients most affecte

  13. The 2007-2010 Q fever epidemic in The Netherlands: characteristics of notified acute Q fever patients and the association with dairy goat farming.

    NARCIS (Netherlands)

    Dijkstra, F.; Hoek, W. van der; Wijers, N.; Schimmer, B.; Rietveld, A.; Wijkmans, C.J.; Vellema, P.; Schneeberger, P.M.

    2012-01-01

    We describe the Q fever epidemic in the Netherlands with emphasis on the epidemiological characteristics of acute Q fever patients and the association with veterinary factors. Data from 3264 notifications for acute Q fever in the period from 2007 through 2009 were analysed. The patients most

  14. Typhoid Fever Presenting With Acute Renal Failure And Hepatitis Simultaneously - A Rare Presentation

    OpenAIRE

    Rajput R.; Jain D; Kumar A.; Mittal A

    2016-01-01

    Typhoid fever is an important health problem worldwide but its incidence is more in developing countries. Hepatic involvement is common, but both hepatic and renal involvement is rare in typhoid fever. We report a case of typhoid fever presenting with hepatitis and acute renal failure. A 17 year old male presenting with fever and pain abdomen was found to have raised blood urea, creatinine, liver enzymes and bilirubin. Widal and typhidot (IgM,IgG) test were positive. His symptoms subsided and...

  15. Inflammatory status in patients with rheumatic mitral stenosis: Guilty before and after balloon mitral valvuloplasty

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed Abdel Rahman

    2016-06-01

    Conclusion: Inflammatory pathogenesis of rheumatic fever, suggested by hsCRP, seems fixed both before, and after BMV. A basal increase in hsCRP before BMV is related to BMV success and an acute increase immediately after BMV seems related to trauma of balloon dilatations.

  16. The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya.

    Science.gov (United States)

    Migowa, Angela; Colmegna, Inés; Hitchon, Carol; Were, Eugene; Ng'ang'a, Evelyn; Ngwiri, Thomas; Wachira, John; Bernatsky, Sasha; Scuccimarri, Rosie

    2017-01-14

    Pediatric rheumatic diseases are chronic illnesses that can cause considerable disease burden to children and their families. There is limited epidemiologic data on these diseases in East Africa. The aim of this study was to assess the spectrum of pediatric rheumatic diagnoses in an in-patient setting and determine the accuracy of ICD-10 codes in identifying these conditions. Medical records from Gertrude's Children's Hospital in Kenya were reviewed for patients diagnosed with "diseases of the musculoskeletal system and connective tissue" as per ICD-10 diagnostic codes assigned at discharge between January and December 2011. Cases were classified as "rheumatic" or "non-rheumatic". Accuracy of the assigned ICD-10 code was ascertained. Death records were reviewed. Longitudinal follow-up of "rheumatic" cases was done by chart review up to March 2014. Twenty six patients were classified as having a "rheumatic" condition accounting for 0.32% of patients admitted. Of these, 11 (42.3%) had an acute inflammatory arthropathy, 6 (23.1%) had septic arthritis, 4 (15.4%) had Kawasaki disease, 2 (7.7%) had pyomyositis, and there was one case each of septic bursitis, rheumatic fever, and a non-specific soft tissue disorder. No cases of juvenile idiopathic arthritis (JIA) were identified. One case of systemic lupus erythematosus was documented by death records. The agreement between the treating physician's discharge diagnosis and medical records ICD-10 code assignment was good (Kappa: 0.769). On follow-up, one child had recurrent knee swelling that was suspicious for JIA. Pediatric rheumatic conditions represented 0.32% of admissions at a pediatric hospital in Kenya. Acute inflammatory arthropathies, septic arthritis and Kawasaki disease were the most frequent in-patient rheumatic diagnoses. Chronic pediatric rheumatic diseases were rare amongst this in-patient population. Despite limitations associated with the use of administrative diagnostic codes, they can be a first step in

  17. Acute Pericarditis

    Science.gov (United States)

    ... or, in people with AIDS or Kaposi sarcoma ) Rheumatic fever Radiation therapy Drugs, including anticoagulants ( warfarin and heparin ), ... cause pericarditis—for example, leukemia, AIDS, other infections, rheumatic fever , and increased levels of urea in the blood ...

  18. Typhoid Fever Presenting With Acute Renal Failure And Hepatitis Simultaneously - A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Rajput R.

    2016-05-01

    Full Text Available Typhoid fever is an important health problem worldwide but its incidence is more in developing countries. Hepatic involvement is common, but both hepatic and renal involvement is rare in typhoid fever. We report a case of typhoid fever presenting with hepatitis and acute renal failure. A 17 year old male presenting with fever and pain abdomen was found to have raised blood urea, creatinine, liver enzymes and bilirubin. Widal and typhidot (IgM,IgG test were positive. His symptoms subsided and deranged parameters resolved with treatment of typhoid fever.

  19. Acute scrotal ulcers in typhoid Fever: case report and literature review.

    Science.gov (United States)

    Choi, Hil Yin; Nickless, David; Tee, Wennie; Tong, En'en; Aboltins, Craig A

    2015-03-01

    In developed countries, typhoid fever is a travel-associated disease that is often overlooked. However, as standard blood and stool culture methods have relatively low sensitivity, diagnosis depends heavily on clinical signs and symptoms and on a high level of suspicion. Reported here is the case of an 18-year-old male who presented with fever and acute scrotal ulcers and whose blood cultures were positive for Salmonella enterica serotype Typhi. A review of genital ulcers associated with typhoid fever in the literature is discussed. This report suggests that typhoid fever is a differential diagnosis of acute genital ulcers.

  20. Barriers to effective patient management with chronic rheumatic ...

    African Journals Online (AJOL)

    PAF User

    influencing the treatment seeking behavior of rheumatic fever/rheumatic ... and to develop a conceptual tool to improve health service utilization of rural patients. .... Improved family education on understanding the impacts of the disease on.

  1. Neurogenic Fever after Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review

    Science.gov (United States)

    Savage, Katherine E.; Oleson, Christina V.; Schroeder, Gregory D.; Sidhu, Gursukhman S.; Vaccaro, Alexander R.

    2016-01-01

    Study Design  Systematic review. Objective  To determine the incidence, pathogenesis, and clinical outcomes related to neurogenic fevers following traumatic spinal cord injury (SCI). Methods  A systematic review of the literature was performed on thermodysregulation secondary to acute traumatic SCI in adult patients. A literature search was performed using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus. Using strict inclusion and exclusion criteria, seven relevant articles were obtained. Results  The incidence of fever of all origins (both known and unknown) after SCI ranged from 22.5 to 71.7% with a mean incidence of 50.6% and a median incidence of 50.0%. The incidence of fever of unknown origin (neurogenic fever) ranged from 2.6 to 27.8% with a mean incidence of 8.0% and a median incidence of 4.7%. Cervical and thoracic spinal injuries were more commonly associated with fever than lumbar injuries. In addition, complete injuries had a higher incidence of fever than incomplete injuries. The pathogenesis of neurogenic fever after acute SCI is not thoroughly understood. Conclusion  Neurogenic fevers are relatively common following an acute SCI; however, there is little in the scientific literature to help physicians prevent or treat this condition. The paucity of research underscored by this review demonstrates the need for further studies with larger sample sizes, focusing on incidence rate, clinical outcomes, and pathogenesis of neurogenic fever following acute traumatic SCI. PMID:27556002

  2. Massive Retinal Pigment Epithelial Detachment Following Acute Hypokalemic Quadriparesis in Dengue Fever.

    Science.gov (United States)

    Goel, Neha; Bhambhwani, Vishaal; Jain, Pooja; Ghosh, Basudeb

    2016-01-01

    To describe an unusual retinal manifestation of dengue fever in an endemic region. A 35 year old male presenting with acute onset decreased vision in his right eye, was found to have a massive retinal pigment epithelial detachment (PED) extending up to the vascular arcades. He had been diagnosed with acute hypokalemic quadriparesis in dengue fever in the preceding week, which had resolved following treatment. The patient was managed conservatively. At three months follow up, there was spontaneous flattening of the PEDs with improvement in visual acuity. Dengue fever complicated by acute hypokalemic quadriparesis can be associated with PED, which can be large. The condition resolves spontaneously and bears a good prognosis.

  3. Effect of high dose of steroid on plateletcount in acute stage of dengue Fever with thrombocytopenia.

    Science.gov (United States)

    Shashidhara, K C; Murthy, K A Sudharshan; Gowdappa, H Basavana; Bhograj, Abhijith

    2013-07-01

    Dengue infection is the most rapidly spreading mosquito-borne viral disease in the world and an estimated 50 million dengue infections reported annually. The pathogenesis of Thrombocytopenia in dengue fever (DF) is not clearly understood. Increased peripheral destruction of antibody coated platelets and acute bone marrow suppression were strongly suspected as the possible mechanism. This often leads to life threatening dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS). Steroids are used in the treatment of Idiopathic thrombocytopenic purpura to increase the platelet count which is mediated by auto antibodies .This hypothesis would support the use of steroids in dengue fever. The objective of this study was to test whether an intravenous high dose dexamethasone was efficacious in increasing the platelet count in acute stage of dengue fever with thrombocytopenia. During the study period between June 2010 - 2011 in JSS Hospital Mysore, 127 patients were screened for dengue fever with thrombocytopenia (dengue fever.

  4. A Case of Acute Q Fever Hepatitis Diagnosed by F-18 FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Beak, Sora [Hallym Univ. College of Medicine, Seoul (Korea, Republic of); Oh, Minyoung; Lee, Sand-Oh; Yu, Eunsil; Ryu Jin-Sook [Univ. of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-06-15

    A 53-year-old man with fever of unknown origin underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) as a workup for a fever of unknown origin. On presentation, he complained of fever, chills, and myalgia. The F-18 FDG PET/CT scan showed diffusely increased uptake of the liver with mild hepatomegaly. A liver biopsy then revealed fibrin-ring granulomas typically seen in Q fever. The patient was later serologically diagnosed as having acute Q fever as the titers for C. IgM and IgG were 64:1 and -16:1, respectively. He recovered completely following administration of doxycycline. This indicates that F-18 FDG PET/CT may be helpful for identifying hepatic involvement in Q fever as a cause of fever of unknown origin.

  5. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic

    NARCIS (Netherlands)

    Wielders, C.C.; Loenhout, J.A.F. van; Morroy, G.; Rietveld, A; Notermans, D.W.; Wever, P.C.; Renders, N.H.; Leenders, A.C.; Hoek, W. van der; Schneeberger, P.M.

    2015-01-01

    BACKGROUND: Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim

  6. Clinical Diagnosis of Sydenham’s Chorea in Area Endemic for Acute Rheumatic Fever

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-04-01

    Full Text Available A retrospective chart review to determine the causes of childhood chorea was conducted in the Division of Allergy, Immunology and Infectious Disease at the Children’s Hospital of Pittsburgh, PA.

  7. Prevalence of Rheumatic Heart Disease in a Public School of Belo Horizonte

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    Miranda, Lavinia Pimentel, E-mail: lavinia.pimentel@globo.com; Camargos, Paulo Augusto Moreira; Torres, Rosália Morais; Meira, Zilda Maria Alves [Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil)

    2014-08-15

    Previous studies indicate that compared with physical examination, Doppler echocardiography identifies a larger number of cases of rheumatic heart disease in apparently healthy individuals. To determine the prevalence of rheumatic heart disease among students in a public school of Belo Horizonte by clinical evaluation and Doppler echocardiography. This was a cross-sectional study conducted with 267 randomly selected school students aged between 6 and 16 years. students underwent anamnesis and physical examination with the purpose of establishing criteria for the diagnosis of rheumatic fever. They were all subjected to Doppler echocardiography using a portable machine. Those who exhibited nonphysiological mitral regurgitation (MR) and/or aortic regurgitation (AR) were referred to the Doppler echocardiography laboratory of the Hospital das Clínicas of the Universidade Federal of Minas Gerais (HC-UFMG) to undergo a second Doppler echocardiography examination. According to the findings, the cases of rheumatic heart disease were classified as definitive, probable, or possible. Of the 267 students, 1 (0.37%) had a clinical history compatible with the diagnosis of acute rheumatic fever (ARF) and portable Doppler echocardiography indicated nonphysiological MR and/or AR in 25 (9.4%). Of these, 16 (6%) underwent Doppler echocardiography at HC-UFMG. The results showed definitive rheumatic heart disease in 1 student, probable rheumatic heart disease in 3 students, and possible rheumatic heart disease in 1 student. In the population under study, the prevalence of cases compatible with rheumatic involvement was 5 times higher on Doppler echocardiography (18.7/1000; 95% CI 6.9/1000-41.0/1000) than on clinical evaluation (3.7/1000-95% CI)

  8. Prevalence of Rheumatic Heart Disease in a Public School of Belo Horizonte

    Directory of Open Access Journals (Sweden)

    Lavinia Pimentel Miranda

    2014-08-01

    Full Text Available Background: Previous studies indicate that compared with physical examination, Doppler echocardiography identifies a larger number of cases of rheumatic heart disease in apparently healthy individuals. Objectives: To determine the prevalence of rheumatic heart disease among students in a public school of Belo Horizonte by clinical evaluation and Doppler echocardiography. Methods: This was a cross-sectional study conducted with 267 randomly selected school students aged between 6 and 16 years. students underwent anamnesis and physical examination with the purpose of establishing criteria for the diagnosis of rheumatic fever. They were all subjected to Doppler echocardiography using a portable machine. Those who exhibited nonphysiological mitral regurgitation (MR and/or aortic regurgitation (AR were referred to the Doppler echocardiography laboratory of the Hospital das Clínicas of the Universidade Federal of Minas Gerais (HC-UFMG to undergo a second Doppler echocardiography examination. According to the findings, the cases of rheumatic heart disease were classified as definitive, probable, or possible. Results: Of the 267 students, 1 (0.37% had a clinical history compatible with the diagnosis of acute rheumatic fever (ARF and portable Doppler echocardiography indicated nonphysiological MR and/or AR in 25 (9.4%. Of these, 16 (6% underwent Doppler echocardiography at HC-UFMG. The results showed definitive rheumatic heart disease in 1 student, probable rheumatic heart disease in 3 students, and possible rheumatic heart disease in 1 student. Conclusion: In the population under study, the prevalence of cases compatible with rheumatic involvement was 5 times higher on Doppler echocardiography (18.7/1000; 95% CI 6.9/1000-41.0/1000 than on clinical evaluation (3.7/1000-95% CI.

  9. Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

    Directory of Open Access Journals (Sweden)

    Kenneth C Eze

    2014-01-01

    Full Text Available Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008. Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer′s patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of

  10. [Rheumatic cardiopathy in children younger than 6 years of age].

    Science.gov (United States)

    Vázquez-Antona, C; Calderón-Colmenero, J; Attié, F; Zabal, C; Buendía-Hernández, A; Díaz-Medina, L H; Bialkowski, J; García Arenal, F

    1991-01-01

    Most of the published papers on Rheumatic Fever (RF) have not included the younger population. We selected 211 cases of children with RF younger than 6 years of age from 9,471 clinical files from 1944 to 1982. These were followed retrospectively to identify the presence of rheumatic activity, subsequent attacks and penicillin profilaxis. From de 211 cases, 209 had carditis; 57% of them were girls and 43% boys. There were no previous infections of the upper respiratory tract in 36% of the patients. The number of cases with RF increased abruptly after 3 years of age and continued increasing until 5 years of age when 70.5% of the population had there first clinically recognized attack. Lesions were present in the mitral valve in 80% of the cases, in the aortic valve in 12%, in the tricuspid in 5% and in the pulmonary valve in 3%. The death rate during the first attack was 20% being refractory heart failure the main cause of death. Thirteen cases suffered rheumatic pneumonia, 9 of whom died (69.2%). 1) The incidence of acute rheumatic fever in children under 6 years of age has decreased with time. 2) The death rate as well as the valvular damage decreased with the parents cooperation with the treatment. 3) The changes in the clinical picture and the severity of valve sequelea may be due to penicillin profilaxis and the better understanding of the disease.

  11. Dengue as a cause of acute undifferentiated fever in Vietnam

    NARCIS (Netherlands)

    Phuong, H.L.; de Vries, P.J.; Nga, T.T.T.; Giao, P.T.; Hung, L.Q.; Binh, T.Q.; Nam, N.V.; Nagelkerke, N.; Kager, P.A.

    2006-01-01

    Background: Dengue is a common cause of fever in the tropics but its contribution to the total burden of febrile illnesses that is presented to primary health facilities in endemic regions such as Vietnam, is largely unknown. We aimed to report the frequency of dengue as a cause of fever in Binh

  12. Dengue as a cause of acute undifferentiated fever in Vietnam

    NARCIS (Netherlands)

    Phuong, H.L.; de Vries, P.J.; Nga, T.T.T.; Giao, P.T.; Hung, L.Q.; Binh, T.Q.; Nam, N.V.; Nagelkerke, N.; Kager, P.A.

    2006-01-01

    Background: Dengue is a common cause of fever in the tropics but its contribution to the total burden of febrile illnesses that is presented to primary health facilities in endemic regions such as Vietnam, is largely unknown. We aimed to report the frequency of dengue as a cause of fever in Binh Thu

  13. Qualidade de vida de crianças e adolescentes portadores de febre reumática Quality of life of children and adolescents with rheumatic fever

    Directory of Open Access Journals (Sweden)

    Márcia F. C. Carvalho

    2009-10-01

    Full Text Available OBJETIVO: Avaliar a qualidade de vida de portadores de febre reumática em acompanhamento ambulatorial em dois hospitais. MÉTODOS: Estudo seccional utilizando o Questionário de Saúde da Criança (Child Health Questionnaire, CHQ aplicado aos pais de 133 pacientes com febre reumática, com idade entre 5 e 18 anos. Foram calculados os escores das diferentes dimensões do questionário e comparados nas categorias de variáveis clínicas e sociodemográficas, utilizando-se teste não paramétrico. RESULTADOS: A idade dos pacientes variou de 5 a 18 anos, com média de 12 e desvio padrão de 2,8. A forma de apresentação mais comum da doença foi a articular associada à cardíaca, presente em 74 casos (56,1%. A maioria das famílias pertencia à classe média baixa/pobre. Os seguintes parâmetros do questionário tiveram melhor performance: função física; atividade física social; aspectos sociais, emocionais e comportamentais na vida diária; dor corporal; e atividades familiares. Os itens com pior performance foram: coesão familiar; saúde geral; comportamento global; e impacto emocional nos pais. As meninas apresentaram melhor desempenho para: autoestima; aspectos sociais, emocionais e comportamentais; e saúde geral. A classe social B apresentou melhor performance para: saúde mental; função física; atividade física social; e atividades familiares. A classe social D/E, para dor corporal e aspectos socioemocionais. CONCLUSÕES: A qualidade de vida observada foi semelhante à de outras doenças crônicas estudadas, com resultado da performance nos diferentes parâmetros com valores intermediários, tanto no domínio físico como no domínio psicossocial. A classe social foi a variável que se associou a um maior número de componentes do CHQ.OBJECTIVE: To assess the quality of life of patients with rheumatic fever receiving outpatient treatment at two hospitals. METHODS: Cross-sectional study using the Child Health Questionnaire (CHQ

  14. Lutembacher Syndrome and Rheumatic Pulmonary Stenosis

    Institute of Scientific and Technical Information of China (English)

    Jufang Chi; Hangyuan Guo; Biao Yang

    2008-01-01

    We discdbed a case of a 55-yr-old woman diagnosed with Lutembacher syndrome and rheumatic pulmonary stenosis.Congenital atrial septal defect was found in age 7 and rheumatic fever in age 34.As the patient developed pulmonary hypertension with calcified mitral valve leaflet and pulmonary stenosis so surgery was not indicated.So the patient was managed by medical therapy alone.

  15. Acute Compressive Ulnar Neuropathy in a Patient of Dengue Fever: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Anil K Mehtani

    2013-04-01

    Full Text Available Introduction: Dengue haemorrhagic fever is known for its haemorrhagic and neurologic complications. Neurologic complications are caused by three mechanism namely neurotropism, systemic complications causing encephalopathy and postinfectious immune-mediated mechanisms. However acute compressive neuropathy due to haemorrhage is not frequent and we could find no literature describing this Case Report: We report a case of acute compressive ulnar neuropathy due to peri neural hematoma, following an attempt at intravenous cannulation in the cubital fossa in a patient of dengue haemorrhagic fever with thrombocytopenia. Immediate fasciotomy and removal of haematoma was performed to relieve the symptoms. Conclusion: Compression neuropathies can be seen in dengue hemorrhagic fever and removal of compressing hematoma relieves symptoms. Keywords: Dengue haemmorrhagic fever; coagulopathy; peri neural haematoma.

  16. Estudo comparativo das avaliações clínica e ecocardiográfica Doppler na evolução das lesões valvares em crianças e adolescentes portadores de febre reumática Comparative study of clinical and Doppler echocardiographic evaluations of the progression of valve diseases in children and adolescents with rheumatic fever

    Directory of Open Access Journals (Sweden)

    Zilda Maria Alves Meira

    2006-01-01

    Full Text Available OBJETIVO: Comparar os exames clínico e ecocardiográfico Doppler na avaliação das lesões valvares em crianças e adolescentes com febre reumática, bem como investigar a evolução da doença segundo essas avaliações. MÉTODOS: Trata-se de estudo observacional longitudinal que englobou 258 crianças e adolescentes com diagnóstico de febre reumática, baseado nos critérios de Jones. Os pacientes foram acompanhados durante o período de 2 a 15 anos. A presença e a quantificação das lesões valvares nas fases aguda e crônica foram determinadas pelas avaliações clínica e ecocardiográfica Doppler. Utilizou-se a estatística de Kappa para estimar a concordância entre as avaliações, e as evoluções clínica e ecocardiográfica Doppler da cardite e valvite, respectivamente, foram comparadas pelo teste do qui-quadrado ou de Fisher, p OBJECTIVE: Compare clinical and Doppler echocardiographic evaluations in assessing valvular diseases in children and adolescents with rheumatic fever, as well as assess the progression of the disease in light of these assessments. METHODS: This is a longitudinal study of 258 children and adolescents diagnosed with rheumatic fever according to Jones’ criteria. The follow-up period ranged from 2-15 years. The presence and quantification of valve diseases were determined by means of clinical and Doppler echocardiographic evaluations performed during the acute and chronic phases. The Kappa statististics method was used to estimate the degree of agreement between clinical and Doppler echocardiographic evaluations. Comparisons between clinical and Doppler echocardiographic findings on the progress of carditis and valvulitis, respectively, were made using chi-square test or Fisher’s exact test, p< 0.05. RESULTS: Of the 109 patients who underwent Doppler echocardiographic evaluation during the acute phase, 31 did not present clinical evidence of carditis, but the Doppler echocardiograms of 17 (54.8% of them

  17. Typhoid fever as a triggering factor in acute and intractable bronchial asthma attack.

    Science.gov (United States)

    Wardhana; Surachmanto, Eko E; Datau, E A

    2013-10-01

    Typhoid fever is an enteric infection caused by Salmonella typhi. In Indonesia, typhoid fever is endemic with high incidence of the disease. In daily practice we frequently have patients with bronchial asthma, and it is becoming worse when these patients get typhoid fever. After oral ingestion, Salmonella typhi invades the the intestine mucosa after conducted by microbial binding to epithelial cells, destroying the microfold cells (M cell) then passed through the lamina propria and detected by dendritic cells (DC) which express a variety of pathogen recognition receptors on the surfaces, including Toll-Like Receptor (TLR). expressed on macrophages and on intestinal epithelial cells inducing degradation of IB, and translocation of NF-B (Nuclear Factor-Kappa Beta). This process initiates the induction of pro-inflammatory gene expression profile adhesion molecules, chemokines, adhesion molecules, and other proteins that induce and perpetuate the inflammation in host cells then will induce acute ant intractable attack of bronchial asthma. The role of typhoid fever in bronchial asthma, especially in persons with acute attack of bronchial asthma, is not well understood. In this article, we will discuss the role of typhoid fever in the bronchial asthma patients which may cause bronchial asthma significantly become more severe even triggering the acute and intractable attack of bronchial asthma. This fact makes an important point, to treat completely the typhoid fever in patients with bronchial asthma.

  18. [Skin changes in rheumatic diseases].

    Science.gov (United States)

    Dobrić, Ivan

    2005-01-01

    The Intruduction includes those eflorescences that might be useful for diagnostics in rheumatology. Further in the text we have described four groups of rheumatic disorders. The first group: rheumatic diseases (lupus erythematosus, dermatomyositis, systemic scleroderma, the mixed connective tissue disease, allergic vasculitis, polyarteritis) which are the most common from the dermatological point of view. The second group: rheumatic diseases (Wegener's granulomatosis, rheumatoid arthritis, Sjögren, Reiter and Behçet syndrome and Kawasaki's disease) which are rarely of interest to our dermatologists. In this group there is also psoriatic arthritis, which is not rare in dermatology but its diagnostics and treatment belong to rheumatologists' field of expertise. The third group: infections (rheumatic fever, diseminated gonococcal infection, subacute bacterial endocarditis, Lyme disesease). The fourth group: metabolic disorders (gout). The diseases of the first group are described completely. In the second, third and fourth group of the diseases we have included only skin changes.

  19. Antibiotic therapy for acute Q fever in The Netherlands in 2007 and 2008 and its relation to hospitalization

    NARCIS (Netherlands)

    Dijkstra, F.; Riphagen-Dalhuisen, J.; Wijers, N.; Hak, E.; van der Sande, M. A. B.; Morroy, G.; Schneeberger, P. M.; Schimmer, B.; Notermans, D. W.; van der Hoek, W.

    2011-01-01

    Data about the effectiveness of different antibiotic regimens for the treatment of acute Q fever from clinical studies is scarce. We analysed the antibiotic treatment regimens of acute Q fever patients in 2007 and 2008 in The Netherlands and assessed whether hospitalization after a minimum of 2 days

  20. Acute meningoencephalitis as the sole manifestation of Q fever.

    Science.gov (United States)

    Guerrero, M; Gutierrez, J; Carnero, C; Gonzalez-Maldonado, R; Maroto, C

    1993-01-01

    The case of a 25-year old man who presented with meningoencephalitis as the sole clinical manifestation of Q fever is described. Serological studies revealed the presence of IgM and IgG antibodies to Coxiella burnetii. The patient responded favourably to a ten-day course of i.v. ceftriaxone and was discharged without any neurological sequelae.

  1. Acute Inhalation Exposure to Titanium Ethanolate as a Possible Cause of Metal Fume Fever

    Directory of Open Access Journals (Sweden)

    M Ahmadimanesh

    2014-04-01

    Full Text Available Occupational inhalation exposure to noxious agents is not uncommon. Herein, we present a 26-year-old male student who had accidental acute inhalation exposure to a large quantity of titanium ethanolate and hydrogen chloride in chemistry lab. He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. After 24 hrs of symptomatic treatment (oxygen therapy and acetaminophen, the fever was subsided and the patient discharged home in a good clinical condition. The presented symptoms could be interpreted as a form of metal fume fever. It can therefore be concluded that organo-metallic compound of titanium metal may have the potential to produce metal fume fever in human.

  2. Disturbance of intracardiac hemodynamics in children with chronic rheumatic cardiac disease

    Directory of Open Access Journals (Sweden)

    Kondratiev V.A.

    2013-12-01

    Full Text Available By means of Doppler echocardiography there have been studied disturbances of intracardiac hemodynamics in 44 children aged 8-17 years with chronic rheumatic cardiac disease and developed mitral aortal and combined heart defects, as well as in chronic rheumatic cardiac disease without developed valvar defect. Differential approach has been defined to administration of inhibitors of angiotensin-converting factor in rheumatic heart defects: developed insufficiency of mitral and/or aortal valves II-III stage leads to remodeling of the left heart portions with developing chronic insufficiency of blood circulation, being an index for prolonged, not less than a year usage of the angiotensin-converting factor. In the presence of isolated mitral regurgitation, I stage in children with chronic rheumatic cardiac disease usage of the angiotensin-converting factor may be cancelled due to insignificant disturbances of valvar hemodynamics and a small risk of developing blood circulation insufficiency. Timely sanation of chronic infection foci in nasopharynx (conservative and surgical treatment of chronic tonsillitis, adenoid vegetations, therapy of hemolytic streptococcus presence decreases risk of developing rheumatic heart defect in children suffered acute rheumatic fever.

  3. 祛痹汤内服外洗治疗风湿热痹的效果观察%Efficacy of Oral Washing Qubi soup paralysis of rheumatic fever treatment

    Institute of Scientific and Technical Information of China (English)

    钟斯婷

    2016-01-01

    目的:研究对风湿热痹应用自拟祛痹汤内服外洗治疗的效果。方法:选取我科于2013年1月~2015年10月收治的126例风湿热痹患者为研究对象,随机分成治疗组(自拟祛痹汤内服+外洗治疗)和对照组(常规西药治疗)。就两组的治疗效果展开对比分析。结果:治疗组总有效率93.85%,高于对照组的83.61%,关节肿胀、关节疼痛、发热、晨僵的症候积分均低于对照组,P<0.05;治疗组不良反应发生率7.69%显著低于对照组的14.75%,P<0.05。结论:在风湿热痹临床治疗中,与常规西药治疗相比,自拟祛痹汤内服加外洗治疗疗效确切,能有效缓解临床症状,安全性高,值得在临床推广。%Objective: To study the effect of washing for the treatment of rheumatic fever were treated with Qubi Decoction orally and externally. Methods: 126 cases of rheumatic fever in our department from January 2013 to October were selected as study subjects, Randomly divided into treatment groups (Self - made QU-Bi decoction Oral + Washing treatment) and control group (conventional western medicine therapy). Comparison and analysis the curative effect of two groups. Results: Treatment group total effective rate of 93.85%, 83.61% higher than that of control group, and joint swelling, joint pain, fever, morning stiffness symptom score were lower than the control group, P<0.05; The incidence of adverse reactions in patients treated with 7.69% 14.75% was significantly lower than the control group, P<0.05. Conclusion: In the clinical treatment of rheumatic fever, compared with conventional treatment of Western medicine, self-made QU-Bi decoction combined with external washing treatment curative effect, can effectively relieve the clinical symptoms, and high security, it is worth popularization and application in the clinical treatment.

  4. Clinical presentation of acute Q fever in Spain: seasonal and geographical differences

    Directory of Open Access Journals (Sweden)

    Elena Espejo

    2014-09-01

    Conclusions: Our results suggest the existence of seasonal differences in the presentation of acute Q fever in Spain, with a higher proportion of pneumonic forms in the colder months. Furthermore, we confirmed the existence of geographical differences, with a higher proportion of pneumonic forms in the region of La Rioja, in the north of the country.

  5. Viral respiratory tract infections among patients with acute undifferentiated fever in Vietnam

    NARCIS (Netherlands)

    H.L. Phuong; T.T.T. Nga; G.J. van Doornum; J. Groen; T.Q. Binh; P.T. Giao; L.Q. Hung; N.V. Nams; P.A. Kager; P.J. de Vries

    2010-01-01

    To investigate the proportion of viral respiratory tract infections among acute undifferentiated fevers (AUFs) at primary health facilities in southern Vietnam during 2001-2005, patients with AUF not caused by malaria were enrolled at twelve primary health facilities and a clinic for malaria control

  6. HIV and Rheumatic Disease

    Science.gov (United States)

    ... A Patient / Caregiver Diseases & Conditions HIV & Rheumatic Diseases HIV and Rheumatic Disease Fast Facts Rheumatic diseases related ... knows he or she has HIV. What are HIV-associated rheumatic diseases? Some diseases of the joints ...

  7. Genetics and Rheumatic Disease

    Science.gov (United States)

    ... Well with Rheumatic Disease Genetics and Rheumatic Disease Genetics and Rheumatic Disease Fast Facts Studying twins has ... 70%, and for non-identical pairs, even lower. Genetics and ankylosing spondylitis Each rheumatic disease has its ...

  8. HIV and Rheumatic Disease

    Science.gov (United States)

    ... A Patient / Caregiver Diseases & Conditions HIV & Rheumatic Diseases HIV and Rheumatic Disease Fast Facts Rheumatic diseases related ... knows he or she has HIV. What are HIV-associated rheumatic diseases? Some diseases of the joints ...

  9. Genetics and Rheumatic Disease

    Science.gov (United States)

    ... Well with Rheumatic Disease Genetics and Rheumatic Disease Genetics and Rheumatic Disease Fast Facts Studying twins has ... 70%, and for non-identical pairs, even lower. Genetics and ankylosing spondylitis Each rheumatic disease has its ...

  10. MITRAL VALVE REPLACEMENT AT 11 YEARS OLD GIRL WITH RHEUMATIC MITRAL STENOSIS

    Directory of Open Access Journals (Sweden)

    Suryani Malik

    2015-05-01

    Full Text Available Rheumatic heart disease (RHD is the permanent heart valve damage resulting from one or more attacks of acute rheumatic fever (ARF, representing the permanent lesions of the cardiac valve. Rheumatic heart disease’s patient with valvar involvement usually require long term follow-up. The ultimate decision of clinical management or invasive therapy is made on an individual basis. We reported a 11-year-old girl with RHD and severe mitral stenosis whom underwent   mitral valve replacement with mechanical valve. Postoperative echocardiogram showed no mitral regurgitation and we gave anticoagulant to maintain INR of 3-4 by giving warfarin 2mg / kg each day for lifelong to prevent bleeding and thrombosis. [MEDICINA 2014;45:120-6]    

  11. Lassa Fever

    Science.gov (United States)

    ... The CDC Cancel Submit Search The CDC Lassa Fever Note: Javascript is disabled or is not supported ... French) Recommend on Facebook Tweet Share Compartir Lassa fever is an acute viral illness that occurs in ...

  12. Typhoid Fever and Acute Appendicitis: A Rare Association Not Yet Fully Formed

    Directory of Open Access Journals (Sweden)

    Daniel J. Sartori

    2017-08-01

    Full Text Available Infections caused by foodborne enteric pathogens including typhoidal and non-typhoidal Salmonella species can mimic symptoms of acute appendicitis. The association between such bacterial pathogens and pathology-proven acute appendicitis has been described, but this link is poorly understood. Here we describe a case of a young man with typhoid fever presenting with histology-proven acute appendicitis requiring urgent appendectomy, and provide a brief review of relevant literature to prompt more widespread recognition of this rare cause of a common surgical emergency.

  13. Observation on Medicated Cupping and Blood-letting Therapy for Rheumatic Fever%药罐结合放血疗法治疗风湿热疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘虹

    2013-01-01

    目的:观察药罐结合放血疗法治疗风湿热的疗效.方法:将60 例患者随机分为2 组,治疗组采用药罐联合放血疗法,对照组除不采用放血疗法外其余治疗方式与治疗组相同.结果:总有效率治疗组为93.3%,对照组为90.0%;愈显率治疗组为70%,对照组为50.0%.2 组总有效率和治疗前后疼痛缓解程度比较,差异无统计学意义,但2组愈显率比较有统计学差异(P<0.05).结论:药罐配合放血疗法,对风湿热有较好地治疗优势.%Objective: To explore clinical effects of medicated cupping and blood-letting therapy in treating rheumatic fever. Method: All 60 patients were randomized into the treatment group and the control group. The patients in the treatment group were administered with medicated cupping and blood-letting therapy, the control group received the same therapy, except blood-letting therapy. Result: Total effective rates of the treatment group and the control group were 93.3% and 90.0%. The difference between both groups expressed no statistical meaning in total effective rate and remission degrees of pain before and after treating, but the comparison presented statistical difference in excellent and cure rate(P<0.05). Conclusion: Medicated cupping and blood-letting therapy show advantage in treating rheumatic fever.

  14. To Explore the Treatment Experience of Analysis of Rheumatic Fever in Children Based on 26 Cases%浅析26例小儿风湿热治疗

    Institute of Scientific and Technical Information of China (English)

    张玉芹

    2015-01-01

    ObjectiveTo analyze pediatric rheumatic fever and its treatment. Methods 26 cases of children in our hospital from January 2013 to December 2014 were selected in the study. We conducted in-depth research. Results 26 patients received the symptomatic treatment of hospitalized for four to twelve days. There were 13 cases improved markedly, 9 patients completely cured. The remaining four cases’ conditions were more serious, who received deferred treatment. Conclusion Rheumatic fever is more common in children with connective tissue disease. The illness for the children’s growth and development play a negative role. We should pay attention to clinical treatment and strengthen the prevention.%目的:对小儿风湿热及其治疗情况进行分析研究。方法选取我院2013年1月~2014年12月收治的患儿26例作为研究对象,进行深入研究。结果选取的26例患儿经4~12天左右的入院对症治疗,有13例患者病情明显好转,有9例患者完全治愈。其余4例患者病情较严重,进行延期治疗。结论风湿热是较常见的小儿结缔组织疾病,其对患儿的生长发育起到一定的负面作用,应引起临床上的重视,加强预防。

  15. Coxiella burnetii Isolates Cause Genogroup-Specific Virulence in Mouse and Guinea Pig Models of Acute Q Fever

    NARCIS (Netherlands)

    Russell-Lodrigue, K.E.; Andoh, M.; Poel, M.W.J.; Shive, H.R.; Weeks, B.R.; Zhang, G.Q.; Tersteeg, C.; Masegi, T.; Hotta, A.; Yamaguchi, T.; Fukushima, H.; Hirai, K.; McMurray, D.N.; Samuel, J.E.

    2009-01-01

    Q fever is a zoonotic disease of worldwide significance caused by the obligate intracellular bacterium Coxiella burnetii. Humans with Q fever may experience an acute flu-like illness and pneumonia and/or chronic hepatitis or endocarditis. Various markers demonstrate significant phylogenetic separati

  16. 10.8.Rheumatic heart disease

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920083 A preliminary study of cell immunefunction in rheumatic heart disease.YANG Qi(杨奇),et al.Res Lab Cardiovasc Dis,Luzhou MedColl Hosp,Sichuan.Chin Cir J 1991; 6 (5): 392-394.Cell immune function of forty one patients withrheumatic heart disease (RHD),forty four withRHD and rheumatic fever (RF) and fifty normal

  17. Neurologic Manifestations of Childhood Rheumatic Diseases

    Directory of Open Access Journals (Sweden)

    Reza SHIARI

    2012-10-01

    Full Text Available Children with rheumatic disorders may have a wide variety of clinical features ranging from fever or a simple arthritis to complex multisystem autoimmune diseases. Information about the prevalence of neurological manifestations in children with rheumatologic disorders is limited. This review describes the neurologic complications of childhood Rheumatic disease either solely or combined with symptoms of other organs involvement, as a primary manifestation or as a part of other symptoms, additionally.

  18. [Fever and lymphadenopathy: acute toxoplasmosis in an immunocompetent patient].

    Science.gov (United States)

    Kaparos, Nikolaos; Favrat, Bernard; D'Acremont, Valérie

    2014-11-26

    Toxoplasmosis is an infectious disease caused by the intracellular parasite Toxoplasma gondii. In Switzerland about a third of the population has antibodies against this pathogen and has thus already been in contact with the parasite or has contracted the disease. Immunocompetent patients are usually asymptomatic (80-90%) during primary infection. The most common symptom is neck or occipital lymphadenopathy. Serology is the diagnostic gold standard in immunocompetent individuals. The presence of IgM antibodies is however not sufficient to make a definite diagnosis of acute toxoplasmosis. Distinction between acute and chronic toxoplasmosis requires additional serological tests (IgG avidity test). If required, the most used and probably most effective treatment is the combination of pyrimethamine and sulfadiazine, with folinic acid.

  19. Acute fever and delayed leukoencephalopathy following low dose intraventricular methotrexate.

    OpenAIRE

    Boogerd, W.; vd Sande, J J; Moffie, D

    1988-01-01

    Nine out of 14 patients treated with intraventricular methotrexate (MTX) for meningeal carcinomatosis from breast carcinoma and surviving more than 4 months developed disseminated necrotising leukoencephalopathy (DNL). All four patients who had received both intraventricular MTX and whole brain radiotherapy developed DNL. Five of the six patients who experienced an acute febrile reaction with mild encephalopathic signs following intraventricular administration of MTX developed DNL after a mea...

  20. [Rheumatic carditis in the adult. Anatomoclinical correlation].

    Science.gov (United States)

    Guadalajara, J F; Gual, J J; Valvuena, N; Vera, A; Laplaza, I; Salinas, L

    1990-01-01

    The histologic findings of 325 necropsies of rheumatic patients at the National Institute of Cardiology in Mexico, between 1980-1985 were studied forty five of them had Aschoff nodules plus valvular inflammation-Out of these 45 cases two groups were formed: children-adolescent group (24 cases) and an adult group (21 cases). The clinical, histologic and laboratory findings were compared. Clinical records were reviewed searching for history of rheumatic fever. Active rheumatic fever was suspected in 16 patients in the younger group (67%) and only in 3 adults (14.2%). As far as Jones' criteria is concerned, the most common finding was carditis, principally in the younger group (83%). In the adult group, it appeared in 50% of the patients. All other criteria were only occasionally seen or could not be identified during the patients lifetime. The most common laboratory finding which could suggest active rheumatic fever were: a high levels of anti-streptolysin in younger patients (95%) and elevation of erythro-sedimentation in adults (83%). We conclude that in active rheumatic fever of the adult; Jones criteria are not met, so the illness is difficult to recognize, and there is clinical-histologic discrepancy. In this context the disease has a "silent" evolution.

  1. An outbreak of acute fever among steam turbine condenser cleaners.

    Science.gov (United States)

    Lauderdale, J F; Johnson, C C

    1983-03-01

    Ten of twelve men who participated in the cleaning of an electric power steam turbine condenser clogged with freshwater sponge experienced an acute febrile illness. Two similar outbreaks have been previously described, one of which has been attributed to the Legionnaires' Disease bacterium. Epidemiologic studies of this case showed a syndrome very similar to the two previously reported episodes. However, the exact etiology for this outbreak has not been identified. Environmental sampling was not initiated until after the cleaning was completed. Subsequent testing did not reveal any likely cause for the outbreak. The delayed onset of symptoms and the nature of the illness pointed to an infectious agent. In the absence of any suitable criteria for employee exposure evaluation, it is suggested that crews cleaning condensers under unusually dirty conditions, especially if eye or respiratory symptoms are reported, should be provided with respiratory protection.

  2. Rheumatic diseases during pregnancy

    OpenAIRE

    Rahman YAVUZ

    2013-01-01

    Pregnancy induces immunologic changes that may differentially impact rheumatic disorders. The effects of pregnancy on rheumatic diseases vary by condition. The systemic rheumatic illnesses commonly complicating pregnancy are systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA), scleroderma.

  3. 儿童风湿性心脏炎的超声评价%Echocardiographic Evaluation of Children with Acute Rheumatic Fever and Rheumatic Carditis

    Institute of Scientific and Technical Information of China (English)

    杨炳昂; 钟文津; 林凌; 刘起珠; 林东岩

    2002-01-01

    目的:评价超声心动图对风湿性心脏炎的诊断价值.方法:选择连续住院确诊的风湿热患儿77例,根据本次及以前有无心脏炎分为急性风湿热、风湿热伴初发心脏炎和复发心脏炎3组.超声心动图检查了解风湿性心脏炎患儿的瓣膜形态、瓣膜功能、心包积液和心脏大小及心功能改变.结果:Ⅱ组中19例(90%)患儿二尖瓣增厚、85%中~重度返流.4例二尖瓣瓣叶有不同于感染性心内膜炎的小结节.Ⅲ组全部患儿二尖瓣增厚、3例有瓣叶小结节,21例(91%)二尖瓣中~重度返流.Ⅱ组中分别有12例、3例和1例主动脉瓣、三尖瓣和肺动脉瓣增厚.93%患儿心脏扩大,以左房扩大为主.绝大多数患儿左室收缩功能测值正常或偏高.结论:风湿性心脏炎患儿二尖瓣最易受累,表现为瓣叶增厚、回声稍强、瓣膜明显返流,部分患儿二尖瓣有小结节.超声心动图可检出风湿性心脏炎所致的瓣膜增厚、瓣膜返流、心包积液和心脏扩大,具有重要的临床诊断价值.

  4. factors that precipitate heart failure among children with rheumatic ...

    African Journals Online (AJOL)

    2011-11-11

    Nov 11, 2011 ... Objective: To identify factors that precipitates heart failure in children with rheumatic ... Arrhythmia, recurrent rheumatic fever, pneumonia, infective endocarditis, ... heart disease is a leading cause of cardiac morbidity and mortality although the exact disease burden is unknown (3). .... review of literature.

  5. Acute fever and delayed leukoencephalopathy following low dose intraventricular methotrexate.

    Science.gov (United States)

    Boogerd, W; vd Sande, J J; Moffie, D

    1988-10-01

    Nine out of 14 patients treated with intraventricular methotrexate (MTX) for meningeal carcinomatosis from breast carcinoma and surviving more than 4 months developed disseminated necrotising leukoencephalopathy (DNL). All four patients who had received both intraventricular MTX and whole brain radiotherapy developed DNL. Five of the six patients who experienced an acute febrile reaction with mild encephalopathic signs following intraventricular administration of MTX developed DNL after a mean time of 5 months and a low mean dose of 44 mg MTX. DNL was also noted in two patients without a previous febrile reaction or whole brain radiotherapy, following prolonged intraventricular MTX therapy after a mean time of 19.5 months and a mean dose of 147 mg MTX. These findings confirm the hazards of (1) high cumulative doses of intrathecal MTX and (2) combined intrathecal chemotherapy and whole brain radiotherapy. This study also suggests a possible relationship between an early and transient febrile reaction during intraventricular administration of MTX and the development of DNL.

  6. Acute fever and delayed leukoencephalopathy following low dose intraventricular methotrexate.

    Science.gov (United States)

    Boogerd, W; vd Sande, J J; Moffie, D

    1988-01-01

    Nine out of 14 patients treated with intraventricular methotrexate (MTX) for meningeal carcinomatosis from breast carcinoma and surviving more than 4 months developed disseminated necrotising leukoencephalopathy (DNL). All four patients who had received both intraventricular MTX and whole brain radiotherapy developed DNL. Five of the six patients who experienced an acute febrile reaction with mild encephalopathic signs following intraventricular administration of MTX developed DNL after a mean time of 5 months and a low mean dose of 44 mg MTX. DNL was also noted in two patients without a previous febrile reaction or whole brain radiotherapy, following prolonged intraventricular MTX therapy after a mean time of 19.5 months and a mean dose of 147 mg MTX. These findings confirm the hazards of (1) high cumulative doses of intrathecal MTX and (2) combined intrathecal chemotherapy and whole brain radiotherapy. This study also suggests a possible relationship between an early and transient febrile reaction during intraventricular administration of MTX and the development of DNL. Images PMID:3225584

  7. Fever in Children and Fever of Unknown Origin.

    Science.gov (United States)

    Dayal, Rajeshwar; Agarwal, Dipti

    2016-01-01

    Fever is the most common symptom in children and can be classified as fever with or without focus. Fever without focus can be less than 7 d and is subclassified as fever without localizing signs and fever of unknown origin (FUO). FUO is defined as a temperature greater than 38.3 °C, for more than 3 wk or failure to reach a diagnosis after 1 wk of inpatient investigations. The most common causes of FUO in children are infections, connective tissue disorders and neoplasms. Infectious diseases most commonly implicated in children with FUO are salmonellosis, tuberculosis, malaria and rickettsial diseases. Juvenile rheumatic arthritis is the connective tissue disease frequently associated with FUO. Malignancy is the third largest group responsible for FUO in children. Diagnostic approach of FUO includes detailed history and examination supported with investigations. Age, history of contact, exposure to wild animals and medications should be noted. Examination should include, apart from general appearance, presence of sweating, rashes, tonsillitis, sinusitis and lymph node enlargement. Other signs such as abdominal tenderness and hepatosplenomegly should be looked for. The muscles and bones should be carefully examined for connective tissue disorders. Complete blood count, blood smear examination and level of acute phase reactants should be part of initial investigations. Radiological imaging is useful aid in diagnosing FUO. Trials of antimicrobial agents should not be given as they can obscure the diagnosis of the disease in FUO.

  8. Acutely developed elbow arthritis in a patient with Brucellosis: Familial Mediterranean Fever

    Directory of Open Access Journals (Sweden)

    Erkan Yula

    2011-12-01

    Full Text Available Familial Mediterranean Fever (FMF is an autosomal recessivedisorder that is prevalent in non-Ashkenazi Jews,Armenians, Turks and Arabs. The characteristic featuresof FMF is recurrent self-limited attacks of fever, polyserositis(synovitis, peritonitis, and pleuritis, and secondaryamyloidosis. Genetic studies have shown that the genefor FMF is located on chromosome 16p is designatedMEFV. The diagnosis of FMF is based on a clinical historyof typical acute attacks, ethnic background, and familyhistory.Brucellosis is a systemic infectious disease caused bygram-negative bacillus. The prevalence of the disease ishigher in developing countries. It is frequently transmittedto humans via consumption of infected unpasteurizeddairy products and infected by direct contact with infectedanimals.In this article, we discussed a patient who was in our followup with diagnosis of brucellosis, after sudden effusionof elbow; we diagnosed the case FMF together with brucellosis.J Clin Exp Invest 2011; 2 (4: 437-440

  9. ROC 曲线分析风湿3项指标在猩红热的诊断评价%Diagnostic evaluation of rheumatism disease 3 indicators to scarlet fever with ROC curve analysis

    Institute of Scientific and Technical Information of China (English)

    叶迎宾; 武艳; 黄秀香; 章健; 田楠楠; 李晓宇; 刘金艳; 靳圆圆

    2016-01-01

    OBJECTIVE To discuss the expression and the clinical significance of rheumatism disease 3 indicators to scarlet fever,so as to provide reference for clinical treatment.METHODS A total of 40 cases of children with scar-let fever in Handan infectious disease hospital from Jun.2013 to Jun.2015 were selected as scarlet fever groups, another 20 cases of children with normal physical examination as control group.ROC curve of three indicators in the diagnosis of scarlet fever were drawn and the critical value was determined.The clinical significances of anti streptolysin O (ASO),rheumatoid factor (RF)and C-reactive protein (CRP)to scarlet fever were analyzed. RESULTS RF and CRP in scarlet fever group were significantly higher than those of normal control group (P <0.01),and ASO expresses were similar in two groups.According to the principle of taking the maximum from the ROC curve and sensitiveness + specificity,the critical value of ASO,RF and CRP were 35.1 IU/mL,23.4 IU/mL and 4.65 mg/L in children with scarlet fever.CONCLUSION CRP is better than RF and ASO in the diagnosis, treatment and prognosis of scarlet fever,which has a high clinical value.%目的:探讨风湿3项指标在猩红热的表达及临床意义,为临床治疗提供参考依据。方法收集2013年6月-2015年6月于邯郸市传染病医院就诊的40例猩红热患儿为猩红热组,20名正常体检的儿童为对照组,绘制风湿3项指标在猩红热诊断中的 ROC 曲线,并确定临界值,分析并评价抗链球菌溶血素 O(ASO)、类风湿因子(RF)和 C-反应蛋白(CRP)在猩红热的临床意义。结果猩红热组患儿血清 RF 和 CRP 的含量明显高于正常对照组(P <0.01),ASO 在两组中的表达相近;根据 ROC 曲线以及敏感度+特异度取最大值的原则,确立猩红热患儿的 ASO、RF、CRP 的临界值分别是35.1 IU/ml、23.4 IU/ml 和4.65 mg/L。结论 CRP 优于 RF 和 ASO,在猩红热的诊断、

  10. Acute Q-fever and history taking--a lesson learned.

    Science.gov (United States)

    Chee, Y; Clayton, R A E; Watson, D; Porter, D E

    2008-01-01

    A 50-year-old patient underwent a routine primary total hip replacement. Soon after surgery, he developed acute respiratory failure from post-operative sepsis. His condition deteriorated rapidly despite supportive management and he required admission into intensive care unit for assisted ventilation. It took almost one week before the underlying cause of the deterioration was determined to be unrelated to complications of surgery. A diagnosis of Q-fever was made following detailed attention to the clinical history. Appropriate treatment was started and the patient made a full recovery. The diagnosis was confirmed later following discharge from hospital.

  11. Paediatric Dengue Fever diagnosed through parents' epidemiologic report and preventive strategy during the acute phase of infection.

    Science.gov (United States)

    Poddighe, Dimitri; Bonomelli, Irene; Giardinetti, Silvia; Nedbal, Marco; Bruni, Paola

    2016-01-01

    In Europe, Dengue Fever is one of the most frequent imported diseases and also autochthonous cases occurred in areas where the insect vector is present. Here, we describe a child returning from Philippines and diagnosed with Dengue Fever, through the information provided by parents about an ongoing outbreak in their municipality. An appropriate clinical management in the hospital was established to monitor the occurrence of complications and to cancel the risk of dengue virus transmission in the acute phase of infection.

  12. A Historical Look at the First Reported Cases of Lassa Fever: IgG Antibodies 40 Years After Acute Infection

    OpenAIRE

    Bond, Nell; Schieffelin, John S.; Lina M Moses; Bennett, Andrew J; Bausch, Daniel G

    2013-01-01

    Lassa fever is an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. One important question regarding Lassa fever is the duration of immunoglobulin G (IgG) antibody after infection. We were able to locate three persons who worked in Nigeria dating back to the 1940s, two of whom were integrally involved in the early outbreaks and investigations of Lassa fever in the late 1960s, including the person from whom Lassa virus was first isolated. Two persons had high titers ...

  13. A False Positive Dengue Fever Rapid Diagnostic Test Result in a Case of Acute Parvovirus B19 Infection.

    Science.gov (United States)

    Izumida, Toshihide; Sakata, Hidenao; Nakamura, Masahiko; Hayashibara, Yumiko; Inasaki, Noriko; Inahata, Ryo; Hasegawa, Sumiyo; Takizawa, Takenori; Kaya, Hiroyasu

    2016-01-01

    An outbreak of dengue fever occurred in Japan in August 2014. We herein report the case of a 63-year-old man who presented with a persistent fever in September 2014. Acute parvovirus B19 infection led to a false positive finding of dengue fever on a rapid diagnostic test (Panbio Dengue Duo Cassette(TM)). To the best of our knowledge, there are no previous reports of a false positive result for dengue IgM with the dengue rapid diagnostic test. We believe that epidemiological information on the prevalence of parvovirus B19 is useful for guiding the interpretation of a positive result with the dengue rapid diagnostic test.

  14. Acute Q fever infection in Thuringia, Germany, after burial of roe deer fawn cadavers (Capreolus capreolus: a case report

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    B.T. Schleenvoigt

    2015-11-01

    Full Text Available We report on a case of a 48-year-old man who presented with acute Q fever infection after burying two fawn cadavers (Capreolus capreolus. Recent outbreaks of Q fever in Europe have been traced back to intensive goat breeding units, sheep flocks in the proximity of highly populated urban areas or to farmed deer. To our knowledge, this is the first case report describing Q fever infection in a human linked to roe deer as a source of infection.

  15. Acute mercury poisoning presenting as fever of unknown origin in an adult woman: a case report.

    Science.gov (United States)

    Cicek-Senturk, Gonul; Altay, Fatma Aybala; Ulu-Kilic, Aysegul; Gurbuz, Yunus; Tutuncu, Ediz; Sencan, Irfan

    2014-08-01

    Mercury intoxication may present in a wide range of clinical forms from a simple disease to fatal poisoning. This article presents a case of acute mercury poisoning, a rare condition that presents challenges for diagnosis with fever of unknown origin. A 52-year-old Caucasian woman was admitted to the hospital with high fever, sore throat, a rash over her entire body, itching, nausea, and extensive muscle pain. She had cervical, bilateral axillary and mediastinal lymphadenopathies. We learned that her son and husband had similar symptoms. After excluding infectious pathologies, autoimmune diseases and malignancy were investigated. Multiple organs of our patient were involved and her fever persisted at the fourth week of admission. A repeat medical history elicited that her son had brought mercury home from school and put it on the hot stove, and the family had been exposed to the fumes for a long period of time. Our patient's serum and urine mercury levels were high. She was diagnosed with mercury poisoning and treated accordingly. Mercury vapor is a colourless and odorless substance. Therefore, patients with various unexplained symptoms and clinical conditions should be questioned about possible exposure to mercury.

  16. Dengue fever causing febrile neutropenia in children with acute lymphoblastic leukemia: an unknown entity.

    Science.gov (United States)

    Ramzan, Mohammed; Yadav, Satya Prakash; Dinand, Veronique; Sachdeva, Anupam

    2013-06-01

    Dengue fever is endemic in many parts of the world but it has not been described as a cause of febrile neutropenia. We describe here clinical features, laboratory values and outcome in 10 children with acute lymphoblastic leukemia (ALL) and with dengue fever as a cause of febrile neutropenia. These data are compared to an age-matched control population of 22 children with proven dengue infection without ALL. Except for fever in all patients and plethoric face in one patient, typical symptoms of dengue such as abdominal pain, myalgias, and headaches, were absent. Mean duration of hospital stay was 6.3±2.0 days in ALL patients vs. 5.0±2.0 in controls (p=0.096). Median platelet count was 13,000/cmm (range 1000-28,000) in cases vs. 31,500 (range 13,000-150,000) in controls (p=0.018). Mean time for recovery for platelet was 6.0±1.3days in ALL patients vs. 2.5±0.9days in controls (pfebrile neutropenia although typical symptoms may be lacking. Platelet recovery may be significantly delayed.

  17. Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage

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    Na Rae Yang

    2017-05-01

    Full Text Available Background Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH. The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC. However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. Methods We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. Results Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2% were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033 and the initial consecutive fasting time (OR, 1.325; P = 0.024. Conclusions AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this

  18. Chikungunya Fever Among Patients with Acute Febrile Illness Attending a Tertiary Care Hospital in Mumbai

    Science.gov (United States)

    Galate, Lata Baswanna; Agrawal, Sachee R; Shastri, Jayanthi S; Londhey, Vikram

    2016-01-01

    Background: Chikungunya fever (CHIK) is an arboviral disease. Dengue fever (DENG) and CHIK are indistinguishable clinically and need to be differentiated by laboratory investigations. Purpose: This study aimed at estimating the seroprevalence of CHIK mono-infection and CHIK and DENG dual infection in suspected patients. We also analyzed the age, sex distribution, joint involvement, and relation of joint movement restriction with visual analog scale (VAS). Materials and Methods: Two hundred patients clinically suspected with DENG and CHIK were enrolled from a Tertiary Care Hospital in Mumbai from April 2012 to October 2013. The detailed history and examination findings were recorded. Serum samples were subjected to DENG and CHIK immunoglobulin G (IgM) enzyme-linked immunosorbent assay (ELISA). Results: The seroprevalence of CHIK was 12.5%. Mono-infection of CHIK was 3%, and CHIK and DENG dual infection was 9.5%. Most affected age group in CHIK cases was 46–60 years wherein female preponderance was seen. All 6 patients with CHIK mono-infection had fever and joint involvement; knee and elbow were the most commonly affected joints. All CHIK patients had VAS score of 6–10 with restricted joint movement. Of the patients with dual infection, the majorities were from 31 to 45 years with male preponderance; all had fever and joint pain mainly affecting knee and elbow. Of patients who had VAS score 6–10 in patients with dual infection, only 5.26% had restricted joint movement. Conclusion: IgM ELISA for Chikungunya infection should be included in the routine laboratory tests for acute febrile illness. PMID:27365916

  19. EuroSCORE models in a cohort of patients with valvular heart disease and a high prevalence of rheumatic fever submitted to surgical procedures.

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    Ricardo Casalino

    Full Text Available Epidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery.Between 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC curve analysis.The mean age was 56 ± 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery. Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70-0.81 for the additive EuroSCORE, 0.76 (95% CI 0.70-0.81 for the logistic EuroSCORE and 0.81 (95% CI 0.76-0.86 for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II.In this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate.

  20. USE OF A NEW FORM OF IBUPROFEN IN CHILDREN WITH FEVER AND ACUTE RESPIRATORY TRACT INFECTIONS

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    E. E. Lokshina

    2013-01-01

    Full Text Available Aim: to study clinical efficacy, tolerance and safety of a new pelleted ibuprofen form for children in treatment of fever in patients with acute respiratory tract infection. Patients and methods: children aged from 6 to 12 years old with clinical manifestation of respiratory tract infections and requiring antipyretic treatment were included into the study. Children (n = 50 were administered ibuprofen at a single dose of 5–10 mg/kg of body weight, not more than 3–4 times per day. The efficacy assessment included time needed for temperature decrease (assessment was performed in 15, 30 and 60 minutes and duration of the antipyretic effect (assessment in 6, 8 and 12 hours. Rapidity of analgesic effect in children with ear ache, headache and myalgias was performed in 15, 30, 60 minutes and 6, 8 and 12 hours after the drug intake. Results: antipyretic effect of pelleted ibuprofen for children begins in 15 minutes after its intake. Stable temperature decrease during the first 6 hours was observed in 58% of children (the mean temperature was 37,1 ± 0,3 and maintained up for 12 hours. Relief of pain intensity was established in 62,1% of patients during the first 3 hours, and in 37,9% the pain syndrome was arrested completely. Conclusions: the new pelleted form of ibuprofen for children was proved to have high clinical efficacy and safety in treatment of fever in children with acute respiratory tract infections.

  1. 风湿热的预防和治疗进展%The progress in the prevention and the therapy of rheumatic fever

    Institute of Scientific and Technical Information of China (English)

    胡绍先; 何培根

    2005-01-01

    风湿热(rheumatic fever)是A组乙型溶血性链球菌感染后的一种并发症,其临床表现通常出现在链球菌感染后3周左右.当易感个体感染链球菌后产生自身免疫反应,引起弥漫性结缔组织炎性病变,可出现心脏炎、关节炎、舞蹈病、环形红斑和皮下结节等.风湿性心脏炎是风湿热最严重的临床表现,是全世界儿童和青年人获得性心脏病最常见的病因,常常因为风湿热反复急性发作,引起心脏瓣膜纤维化,并发展为慢性心脏瓣膜病而出现血液动力学改变,严重时导致心衰,甚至死亡.本病初发年龄以9~17岁多见,严重威胁着学龄儿童和青少年的身体健康.

  2. Molecular typing of Streptococcus pyogenes from remote Aboriginal communities where rheumatic fever is common and pyoderma is the predominant streptococcal infection.

    Science.gov (United States)

    McDonald, M I; Towers, R J; Fagan, P; Carapetis, J R; Currie, B J

    2007-11-01

    Aboriginal Australians in remote communities have high rates of rheumatic heart disease (RHD); yet pharyngitis is reportedly rare whilst pyoderma is common. Some strains of group A streptococci (GAS) have preference for the throat and others for the skin depending on M protein type. A study in three remote communities provided 350 GAS isolates for emm sequence typing, 244 were also emm pattern typed. There was 100% correlation between emm sequence and pattern type. Patterns D and E (non-throat tropic) made up 71% of throat and 87% of skin isolates although patterns A-C (throat tropic) were more common in the throat than the skin (RR 2.3, 95% CI 1.4-3.8) whilst the opposite was found for pattern D (RR 2.2, 95% CI 1.7-3.0). Pattern E favoured the throat (RR 1.4, 95% CI 1.1-1.8). Where environmental factors predispose to skin infection, emm pattern types D and E prevail, whatever the recovery site.

  3. Rheumatic diseases in children and adolescents in the Russian Federation (2009—2010

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    Rimma Mikhailovna Balabanova

    2013-01-01

    Full Text Available In pediatrics, rheumatic diseases (RD are characterized by particularly severe social consequences. This investigation was undertaken to clarify the prevalence of RD from the 2009—2010 statistical data of the Ministry of Health and Social Development of the Russian Federation. Analysis of these data has led to the conclusion that the acute rheumatic fever situation is relatively favorable in Russia. As for musculoskeletal system diseases, patients with inflammatory RD are a small percentage among those with this pathology; however, they are critically ill and become disabled early and frequently despite the fact that the majority of novel highly effective drugs have not approved for use in children, which makes their timely use difficult. Most children with locomotor diseases suffer from non-inflammatory diseases. This shows the importance of measures for the prevention, early detection, and correction of acquired or inherited pathology of the joints and vertebral column.

  4. Can troponin T levels be useful in the diagnosis of rheumatic carditis?

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    Mehmet Halil Ertug

    2011-01-01

    Full Text Available Objective: Acute rheumatic fever (ARF is an endemic disease observed in children of developing countries. The purpose of this study was to test if it was possible to identify myocardial involvement in cases with rheumatic carditis by the measurement of serum cardiac TnT. Methods: 30 patients diagnosed as ARF underwent echocardiography and their cardiac troponin T (cTnT serum levels were measured. Patients were divided into group 1: Arthritis alone, group 2: carditis, and group 3 carditis with congestive heart failure (CHF. Results: cTnT serum levels were normal in all except one patient with in group 3. Two patients in carditis (group 2 and three patients in CHF (group 3 had dilation in left ventricular end diastolic diameter. Conclusions: Normal cTnT levels in our patient group suggests that inflammation rather than myocardial necrosis is predominant in ARF carditis.

  5. [Sacroiliitis in familial Mediterranean fever].

    Science.gov (United States)

    Connemann, B J; Steinhoff, J; Benstein, R; Sack, K

    1991-11-22

    A 15-year-old girl of Turkish descent had for one year complained of severe recurrent fever-associated deep back pains. Since she was three years of age she had suffered from repeated attacks of fever and severe abdominal pain which ceased spontaneously in 1-3 days. On physical examination the sacrum and iliosacral joints were very painful to percussion, and she limped. Radiography revealed symmetric destructive sacroiliitis. Despite the unusual location of the arthritis, the triad of fever, abdominal pain and arthritis, as well as her belonging to an ethnic "at risk" group, pointed to the diagnosis of familial mediterranean fever (FML) or recurrent hereditary polyserositis. This diagnosis was confirmed by a positive metaraminol provocation test in that infusion of metaraminol reproduced the typical pains. Collagen diseases, rheumatic disease, acute porphyria and chronic infectious processes were excluded. The sacroiliitis quickly responded to long-term administration of colchicine, 0.5 mg twice daily. The patient also has Hageman factor deficiency whose significance remains unclear.

  6. [Therapeutic experience with cefadroxil syrup in acute infections, especially scarlet fever, in pediatric field (author's transl)].

    Science.gov (United States)

    Minamitani, M; Hachimori, K; Nakazawa, H; Tomori, N

    1981-02-01

    Clinical effects were investigated on cefadroxil powder for syrup (containing 100 mg of cefadroxil per 1 g) for acute bacterial infections (mostly scarlet fever) in the field of pediatrics, and the results were obtained as follows. Cefadroxil was applied in 100 cases of scarlet fever. Among 49 cases administered 30-39 mg/kg/day, the results were excellent in 34 cases and good in 15 cases, efficacy ratio being thus 100%. Among 38 cases administered 40-49 mg/kg/day, the results were excellent in 33 cases, and good in 5 cases, efficacy ratio being thus 100%. Out of 4 cases administered 20-29 mg/kg/day, the results were excellent in 3 cases and good in 1 case, while out of 9 cases administered 50-59 mg/kg/day, excellent in 4 cases and good in 5 cases. Among 78 cases of scarlet fever from which beta-hemolytic Streptococcus was proven from swab liquid of palatal tonsil, 67 cases received cefadroxil at a daily dose of 30-49 mg/kg, and the bacteria turned to negative the next day of administration in 72 cases, 2 days later in 6 cases. Cefadroxil was administered at a daily dose of 46 mg/kg for 7 days in 1 case of SSS syndrome of which Staphylococcus aureus was proven from skin lesion, and local bacteria turned to negative, as well as clinical effect was excellent. No pathogen was proven in 1 case of acute tonsillitis, maybe because ampicillin (ABPC) and cefazolin (CEZ) were administered before cefadroxil treatment, and yet a clinical efficacy was judged by administering cefadroxil at a daily dose of 46 mg/kg, though no clinical improvement was observed with the prior antibiotics. As to the side effects of cefadroxil in 102 cases, a slight vomiting was noticed in 6 cases, though the administration could be continued, and a slight rise of GOT or GPT was observed respectively in 3 cases and 1 case, all of which were recovered without abnormal clinical findings. Among the patients of scarlet fever, after beta-hemolytic Streptococcus became negative, reelimination or recurrence

  7. A historical look at the first reported cases of Lassa fever: IgG antibodies 40 years after acute infection.

    Science.gov (United States)

    Bond, Nell; Schieffelin, John S; Moses, Lina M; Bennett, Andrew J; Bausch, Daniel G

    2013-02-01

    Lassa fever is an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. One important question regarding Lassa fever is the duration of immunoglobulin G (IgG) antibody after infection. We were able to locate three persons who worked in Nigeria dating back to the 1940s, two of whom were integrally involved in the early outbreaks and investigations of Lassa fever in the late 1960s, including the person from whom Lassa virus was first isolated. Two persons had high titers of Lassa virus-specific IgG antibody over 40 years after infection, indicating the potential for long-term duration of these antibodies. One person was likely infected in 1952, 17 years before the first recognized outbreak. We briefly recount the fascinating stories of these three pioneers and their important contribution to our understanding of Lassa fever.

  8. High-sensitivity cardiac troponin T levels and risk of cerebral microbleeds in acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease.

    Science.gov (United States)

    Liu, Junfeng; Wang, Deren; Xiong, Yao; Liu, Bian; Wei, Chenchen; Ma, Zhenxing; Wu, Bo; Tang, Hehan; Liu, Ming

    2016-10-15

    Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with coronary disease and small-vessel ischemic stroke through their associations with atherosclerosis. Considering the relationship between atherosclerosis and cerebral microbleeds (CMBs), the purpose of this study was to examine associations between serum hs-cTnT levels and risk of CMBs in acute ischemic stroke patients. This prospective study involved consecutively recruited acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease treated at a large tertiary care hospital in southwestern China. Clinico-demographic data were collected and analyzed by logistic regression to identify the relationship between serum hs-cTnT levels and CMB occurrence and location. In the final analysis, of 66 patients (27 males; mean age, 68.7years), 39 (59.1%) had CMBs. Hs-cTnT levels were not associated with risk of strictly lobar CMBs. However, after adjusting age, sex, current alcohol consumption, total cholesterol, hypertension, diabetes mellitus, prior antithrombotic therapy and NIHSS on admission, patients in the higher tertile were more likely to have CMBs and deep or infratentorial CMBs (PCMBs, particularly of deep or infratentorial CMBs. This finding justifies further research into how hs-cTnT levels may contribute to CMBs and potentially other subclinical small-vessel diseases. Copyright © 2016. Published by Elsevier B.V.

  9. STUDY OF CLINICAL PROFILE OF DENGUE FEVER WITH SPECIAL REFERENCE TO ACUTE COMPLICATIONS

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    Keshava

    2014-02-01

    Full Text Available ABSTRACT: Dengue is the arthropode borne viral infection transmitted by mosquitoes to humans. AIM: To study the various clinical manifestations and acute complications of dengue fever. METHODS: 100 cases of confirmed dengue infection admitted to KIMS, Bangalore between December 2009 and September 2011 were studied. A detailed clinical history and physical examination was done and baseline investigations were performed. The cases were followed-up daily for the clinical and laboratory parameters and were treated according to WHO guidelines. The data related to each of these cases was collected, compiled and analyzed. RESULTS: of the total 100 cases there were 61 male and 39 female. Age group of 21-30 (41 was most commonly affected Maximum number of patients was seen in the September, October, august, July. Commonest presentation was Fever (100% followed by Headache (78%, Myalgia (70%, Arthralgia (66%, low back ache (60%. On examination patients found to have icterus (22%, bleeding spots (26%, rashes (50%, Splenomegaly (18%, Hepatomegaly (15% and Ascites (9%, pleural effusion (16%, crepitations (7%. Platelet count was not very well correlated with the bleeding tendencies. Incidence of DHF was more with secondary Dengue infection than the primary dengue infection. The frequency of complications was high in the patients with secondary dengue infection than the primary infection. CONCLUSION: In our present study classical dengue fever was most common presentation followed by DHF and DSS. Hypotension, hemorrhagic spots, positive tourniquet test, jaundice, pleural effusion, ascites, neck stiffness are the common findings on examination associated with complicated forms of dengue. Bleeding, shock, hepatitis, polyserositis, meningitis, pneumonia are the complications seen in severe forms. On investigation Deranged liver function test, renal function test, secondary dengue infection, thickened gall bladder wall, hepatosplenomegaly on ultrasound abdomen

  10. Fatal Fever of Unknown Origin in Acute Cervical Spinal Cord Injury: Five Cases

    Science.gov (United States)

    Ulger, Fatma; Dilek, Ahmet; Karakaya, Deniz; Senel, Alparslan; Sarihasan, Binnur

    2009-01-01

    Background/Objective: Patients with traumatic upper thoracic and cervical spinal cord injuries are at increased risk for the development of autonomic dysfunction, including thermodysregulation. Thermoregulation is identified as an autonomic function, although the exact mechanisms of thermodysregulation have not been completely recognized. Quad fever is a hyperthermic thermoregulatory disorder that occurs in people with acute cervical and upper thoracic spinal cord injuries. First described in 1982, it has not been widely discussed in the literature. Methods: Case reports of 5 patients with cervical spinal cord injury (SCI). Results: Five of 18 patients (28%) with acute cervical SCI who were admitted during a 1-year period had fatal complications caused by persistent hyperthermia of unknown origin. Conclusions: Patients with acute traumatic cervical and upper thoracic SCI are at risk for thermoregulatory dysfunction. Changes in the hypothalamic axis may be implicated, especially in the light of modification in hypothalamic afferent nerves, but this hypothesis has not yet been explored. Thermodysregulation may be an early sign of autonomic dysfunction. A comprehensive guideline is needed for the management of elevated body temperature in critically ill patients with cervical SCI, because this condition may be fatal. PMID:19810636

  11. Acute disseminated encephalomyelitis presenting as fever of unknown origin: case report.

    Science.gov (United States)

    Costanzo, Margherita Di; Camarca, Maria Erminia; Colella, Maria Giovanna; Buttaro, Giuseppe; Elefante, Andrea; Canani, Roberto Berni

    2011-11-10

    Fever of unknown origin (FUO) can be defined as a body temperature higher than 38.3°C on several occasions over more than 3 weeks, the diagnosis of which remains uncertain after 1 week of evaluation. Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system with a wide range of clinical manifestations. The highest incidence of ADEM is observed during childhood and it usually occurs following a viral or bacterial infection or, more rarely, following a vaccination, or without a preceding cause. Here, we describe an atypical case of ADEM that initially manifested as several weeks of FUO in a fifteen years old boy. This case report suggests a new possible syndromic association between ADEM and FUO, which should be considered in the clinical examination of patients with FUO, especially in the presence of also modest neurologic or neuropsychiatric symptoms.

  12. [Rheumatic diseases in pregnancy].

    Science.gov (United States)

    Märker-Hermann, E; Bauer, H; Gromnica-Ihle, E

    2008-11-01

    Rheumatic diseases can influence the reproduction, the course of pregnancy and the development of the fetus. The inflammatory rheumatic disease itself can be modulated in its activity in terms of amelioration or exacerbation of the rheumatic symptoms. The associations between rheumatic diseases and pregnancy will be illustrated with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and systemic lupus erythematosus as examples. Antirheumatic drug therapy during pregnancy and the breast feeding period has to be adapted critically.

  13. High seroprevalence of Mycoplasma pneumoniae IgM in acute Q fever by enzyme-linked immunosorbent assay (ELISA.

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    Chung-Hsu Lai

    Full Text Available Q fever is serologically cross-reactive with other intracellular microorganisms. However, studies of the serological status of Mycoplasma pneumoniae and Chlamydophila pneumoniae during Q fever are rare. We conducted a retrospective serological study of M. pneumoniae and C. pneumoniae by enzyme-linked immunosorbent assay (ELISA, a method widely used in clinical practice, in 102 cases of acute Q fever, 39 cases of scrub typhus, and 14 cases of murine typhus. The seropositive (57.8%, 7.7%, and 0%, p<0.001 and seroconversion rates (50.6%, 8.8%, and 0%, p<0.001 of M. pneumoniae IgM, but not M. pneumoniae IgG and C. pneumoniae IgG/IgM, in acute Q fever were significantly higher than in scrub typhus and murine typhus. Another ELISA kit also revealed a high seropositivity (49.5% and seroconversion rate (33.3% of M. pneumoniae IgM in acute Q fever. The temporal and age distributions of patients with positive M. pneumoniae IgM were not typical of M. pneumoniae pneumonia. Comparing acute Q fever patients who were positive for M. pneumoniae IgM (59 cases with those who were negative (43 cases, the demographic characteristics and underlying diseases were not different. In addition, the clinical manifestations associated with atypical pneumonia, including headache (71.2% vs. 81.4%, p=0.255, sore throat (8.5% vs. 16.3%, p=0.351, cough (35.6% vs. 23.3%, p=0.199, and chest x-ray suggesting pneumonia (19.3% vs. 9.5%, p=0.258, were unchanged between the two groups. Clinicians should be aware of the high seroprevalence of M. pneumoniae IgM in acute Q fever, particularly with ELISA kits, which can lead to misdiagnosis, overestimations of the prevalence of M. pneumoniae pneumonia, and underestimations of the true prevalence of Q fever pneumonia.

  14. Study of acute undifferentiated fever cases and their etiologies in rural Konkan area of Maharashtra state

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    Patil S. N

    2016-08-01

    Full Text Available Background: Acute undifferentiated fever (AUF is a common cause for which the patients seek health care in India. It is region specific and has similar clinical presentation, with varied etiologies. Due to this it posses challenge to the diagnosis, treatment and public health. Majority of patients present with nondescript symptoms. Scrub typhus, Malaria, Enteric Fever, Dengue, Leptospirosis, Chikungunya, Spotted fever, Rickettsiosis, Hantavirus, Q fever, Brucellosis, Influenza and other bacterial infections are some of the common etiologies of AUF. The prevalence of local AUF etiologies helps to prioritize differential diagnosis and guide the treatment. The study aimed to find out the predominant AUF etiologies in the rural Konkan area of Maharashtra state in India. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital on the samples received from District hospitals and Primary health centers from Sindhudurg District of Maharashtra state for the duration of October 2012 to January 2014. Patients with age 5years and with classical symptoms of febrile illness were included in the study. About 500 blood samples received were investigated for Malaria, Bacterial culture sensitivity, Leptospira culture, ELISA for scrub typhus, Brucella, Dengue and Leptospira and further evaluated for commonest region specific AUF etiology. Results: The study included 500 blood samples obtained from patients presenting with classical symptoms of AUF. Samples received from males showed highest number of positive cases amounting for 82.47% with majority of cases (83% cases in middle age group. The sero-positivity of samples accounted for 42.8%. Brucella was the most common cause of AUF (28.50% followed by Leptospira (27.10% and Scrub typhus (21.49%. Interestingly there were no positive cases of malaria and only 11.21% samples positive for Dengue which are considered as most common AUF etiologies and treated accordingly

  15. Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment.

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    Herremans, Tineke; Hogema, Boris M; Nabuurs, Marrigje; Peeters, Marcel; Wegdam-Blans, Marjolijn; Schneeberger, Peter; Nijhuis, Carla; Notermans, Daan W; Galama, Joep; Horrevorts, Anton; van Loo, Inge H M; Vlaminckx, Bart; Zaaijer, Hans L; Koopmans, Marion P; Berkhout, Hanneke; Socolovschi, Cristina; Raoult, Didier; Stenos, John; Nicholson, William; Bijlmer, Henk

    2013-01-01

    The indirect immunofluorescence assay (IFA) is considered the reference method for diagnosing Q fever, but serology is also performed by complement fixation assay (CFA) or enzyme-linked immunosorbent assay (ELISA). However, comparability between these assays is not clear, and therefore a quality assessment was performed. A total of 25 serum samples from negative controls, Q fever patients, and a serial diluted high-positive sample were analyzed in 10 Dutch laboratories. Six laboratories performed CFA, 5 performed IFA, and 5 performed ELISAs. Three international reference laboratories from Australia, France, and the USA also participated in this study. Qualitative values between laboratories using the same methods were within close range, and all 3 methods correctly identified acute Q fever patients. The IFA, ELISA, and CFA are all suitable serodiagnostic assays to diagnose acute Q fever, but the IFA remains an important tool in the follow-up of patients and in identifying patients at risk for developing chronic Q fever. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis.

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    Kucuk, Adem; Erol, Mehmet Fatih; Senel, Soner; Eroler, Emir; Yumun, Havvanur Alparslan; Uslu, Ali Ugur; Erol, Asiye Mukaddes; Tihan, Deniz; Duman, Ugur; Kucukkartallar, Tevfik; Solak, Yalcin

    2016-03-01

    Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.

  17. Rheumatic heart disease: 15 years of clinical and immunological follow-up

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    Roney O Sampaio

    2008-01-01

    Full Text Available Roney O Sampaio, Kellen C Fae, Lea MF Demarchi, Pablo MA Pomerantzeff, Vera D Aiello, Guilherme S Spina, Ana C Tanaka, Sandra E Oshiro, Max Grinberg, Jorge Kalil, Luiza GuilhermeHeart Institute (InCor, University of São Paulo, BrazilAbstract: Rheumatic fever (RF is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD, the major sequel of RF, occurs in 30%–45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximately 90% of early childhood valvular surgery in the country. In this study, we present a 15-year clinical follow-up of 25 children who underwent surgical valvular repair. Histopathological and immunological features of heart tissue lesions of RHD patients were also evaluated. The patients presented severe forms of RHD with congestive symptoms at a very young age. Many of them had surgery at the acute phase of RF. Histological analysis showed the presence of dense valvular inflammatory infiltrates and Aschoff nodules in the myocardium of 21% of acute RHD patients. Infiltrating T-cells were mainly CD4+ in heart tissue biopsies of patients with rheumatic activity. In addition, CD4+ and CD8+ infiltrating T-cell clones recognized streptococcal M peptides and cardiac tissue proteins. These findings may open the possibilities of new ways of immunotherapy. In addition, we demonstrated that the surgical procedure during acute phase of the disease improved the quality of life of young RHD patients.Keywords: rheumatic heart disease, Streptococcus pyogenes, heart failure, inflammatory infiltrate, T lymphocytes, molecular mimicry

  18. Rheumatic Heart Disease in the Twenty-First Century.

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    Woldu, Bethel; Bloomfield, Gerald S

    2016-10-01

    Rheumatic heart disease (RHD) is a chronic valvular disease resulting after severe or repetitive episodes of acute rheumatic fever (ARF), an autoimmune response to group A Streptococcus infection. RHD has been almost eliminated with improved social and health infrastructure in affluent countries while it remains a neglected disease with major cause of morbidity and mortality in many low- and middle-income countries, and resource-limited regions of high-income countries. Despite our evolving understanding of the pathogenesis of RHD, there have not been any significant advances to prevent or halt progression of disease in recent history. Long-term penicillin-based treatment and surgery remain the backbone of a RHD control program in the absence of an effective vaccine. The advent of echocardiographic screening algorithms has improved the accuracy of diagnosing RHD and has shed light on the enormous burden of disease. Encouragingly, this has led to a rekindled commitment from researchers in the most affected countries to advocate and take bold actions to end this disease of social inequality.

  19. [A group fever: safari's fever].

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    Cantiniaux, S; Serratrice, J; De Roux-Serratrice, C; Disdier, P; Perez, L; Bricaire, F; Caumes, E; Mary, C; Weiller, P J

    2004-12-01

    Acute schistosomiasis, called safari's fever in Africa and Katayama fever in Japan, is an immunoallergic reaction due to transcutaneous penetration of infective cercaria. We report the collective case of seven young adults spending holidays in Mali. An eighteen years-old girl presents fever, headache, diarrhoea and abdominal pains at return from Dogon country (south of Mali). After turned down malaria and with the notion of bathing in fresh water followed by pruritus, we think to safari's fever. So we alarm all other members of the group. All can be treated to avoid chronic schistosomiasis. These observations recall that acute schistosomiasis is a real danger for tourists when bathing in fresh water in endemic areas of Africa. Education of travellers is necessary. Occurrence of safari's fever should alert physicians to prevent chronic schistosomiasis.

  20. Características demográficas, clínicas, laboratoriais e radiológicas da febre reumática no Brasil: revisão sistemática Demographic, clinical, laboratorial, and radiological characteristics of rheumatic fever in Brazil: systematic review

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    Luciana Parente Costa

    2009-10-01

    Full Text Available A febre reumática (FR se caracteriza por um processo inflamatório não supurativo que se instala após uma infecção pelo estreptococo beta-hemolítico do grupo A de Lancefield. Sua prevalência é maior nos países em desenvolvimento como o Brasil. Em nosso país, entretanto, dados epidemiológicos sistemáticos sobre a doença são incompletos e escassos. Estima-se uma prevalência de FR ao redor de 3% entre as crianças e os adolescentes brasileiros. Neste artigo, foi realizada uma revisão sistemática dos principais estudos brasileiros, utilizando como fonte de pesquisa as bases de dados do LILACS, Scielo e Medline, tendo como palavras-chave Febre Reumática e Rheumatic Fever. Foram selecionados 10 trabalhos epidemiológicos e a análise comparativa não demonstrou diferenças em relação a predominância de sexo, quadro clínico, laboratorial e radiológico dos pacientes nas diversas regiões do país.Rheumatic fever (RF is characterized by a non-suppurative inflammatory process that begins after a group A betahemolytic streptococci infection. Its prevalence is higher in developing countries, such as Brazil. However, in our country, systematic epidemiologic data on the disease are scarce and incomplete. Rheumatic fever has an estimated incidence of 3% among Brazilian children and adolescents. We undertook a systematic review of the main Brazilian studies using the LILACS, Scielo, and Medline databases searching for expressions like Febre Reumática and Rheumatic Fever. Ten epidemiological studies were selected and comparative analysis did not show a predominance of gender, clinical presentation, and laboratorial and radiological parameters in the different regions of the country.

  1. Cerebral Microbleeds Do Not Predict Hemorrhagic Transformation in Acute Ischemic Stroke Patients with Atrial Fibrillation and/or Rheumatic Heart Disease.

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    Liu, Junfeng; Wang, Deren; Li, Jie; Lin, Jing; Xiong, Yao; Liu, Bian; Wei, Chenchen; Wu, Bo; Ma, Zhenxing; Zhang, Shihong; Liu, Ming

    2017-01-01

    Cerebral microbleeds (CMBs) are known to be potential risk factors for intracerebral hemorrhage (ICH), but there is controversy on the relationship between CMBs and hemorrhagic transformation (HT) after ischemic stroke. Besides, the question regarding whether the relationship between CMBs and HT can be affected by antithrombotic drugs in acute stage of ischemic stroke has not yet reached a consensus. 174 acute ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD) were prospectively and consecutively enrolled in the study, of which 160 patients (mean 68.09 ±12.59 years) were finally included in the final analysis (West China Hospital, Sichuan University, n=125; People's Hospital of Deyang City, n=35).We assessed the presence, location and number of CMBs by using susceptibility-weighted imaging (SWI) within 7 days after admission, and the incidence of hemorrhagic transformation was evaluated by magnetic resonance imaging(MRI) during hospitalization. The univariate and multivariate analyses were used to analyze the relationship between CMBs and HT. CMBs were detected in 90 patients (56.3%). HT was found in 62 (38.8%) patients, among which 43 were hemorrhagic infarction (HI) and 19 were parenchymal haemorrhage (PH). The presence of CMBs was not significantly different among different HT subtypes (no HT, HI and PH; 59.2%, 51.2%, versus 52.6%, P=0.64). There was no relationship between the number/location of CMBs and hemorrhagic transformation subtypes (P=0.38). In the 2 subgroups of patients treated with anticoagulants and antiplatelets after admission, the incidence of HT was not significantly different between patients with and without CMBs (anticoagulants, 13.3% versus 18.2%, P=0.71; antiplatelets, 29.2% versus 40.3%, P= 0.21). The present study suggests that CMBs do not predict the presence of hemorrhagic transformation in acute ischemic stroke patients with AF and/or RHD. The results were not affected by anticoagulant or

  2. BIOPSY PROVEN ACUTE TUBULAR NECROSIS DUE TO RHABDOMYOLYSIS IN A DENGUE FEVER PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

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    Liliany P. Repizo

    2014-01-01

    Full Text Available Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI. We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.

  3. PROSPECTIVE STUDY OF ETIOLOGY, CLINICAL PROFILE AND OUTCOME IN PATIENTS WITH FEVER, JAUNDICE AND ACUTE KIDNEY INJURY

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    Pradeep

    2015-09-01

    Full Text Available OBJECTIVE: To study etiology, risk factors, various clinical and lab parameters and outcome of patients presenting with fever, jaundice and acute kidney injury. MATERIALS AND METHODS : An open prospective study was done on 100 patients presented with triad of fever, jaundice and acute kidney injury (AKI in the Depar tment of Medicine of G R Medical College and JA Group of Hospitals, Gwalior, MP from September 2011 to November 2012. Patients having temperature more than >100 0 F, serum creatinine ≥1.3 mg/dL or a 50 % increase from baseline or a reduction in urine output (documented oliguria of 6 hours, serum bilirubin >1.8 mg/dL were included in the study. A detailed history, clinical examination and investigations were done to find the cause of these derangements and all the patients were managed acc ordingly. RESULTS: A total 100 patients were included in study out of which 70% were males. Out of 100 patients, 50% were of septicemia, 34% were having malaria, 12% had acute pancreatitis and 4% patients were of dengue. Out of 50 septicemia patients, 35(7 0% were male, out of which 11(31.42% were of 56 - 65 years of age. Out of 17 deaths, 13(76% were males. Among total death, 11(22% were in septicemia followed by 5(14.70% in malaria patients. CONCLUSION: Many infectious and non - infectious diseases like malaria, septicemia, acute pancreatitis, dengue fever etc. can present with fever, jaundice and deranged renal functions. This triad of presentation is associated wi th high morbidity and mortality and the advanced age, male gender presences of anemia were the risk factors for high mortality. AKI occurs most commonly in association with P. falciparum malaria. Early diagnosis and prompt management including dialysis can reduce mortality and expedite recovery of renal function

  4. Acute phase response and oxidative stress status in familial Mediterranean fever (FMF).

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    Guzel, Savas; Andican, Gulnur; Seven, Arzu; Aslan, Mahmure; Bolayirli, Murat; Guzel, Eda Celik; Hamuryudan, Vedat

    2012-06-01

    We aimed to determine acute phase response (APR) and oxidative stress in patients with familial Mediterranean fever (FMF) and compare these characteristics with those in healthy controls; 20 patients with FMF and 15 healthy controls were enrolled in the study. The erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), fibrinogen, and leukocyte levels were determined as markers of APR. Thiobarbituric acid reactive substances (TBARS), conjugated diene, and lipid hydroperoxide levels were measured as markers of lipid peroxidation. Carbonyl group and thiol (T-SH) levels were analyzed to determine the oxidative damage to proteins, and 8-hydroxy-2-deoxyguanosine (8-OHdG) was measured to reflect DNA oxidation. The erythrocyte glutathione (GSH) level, and glutathione peroxidase (GSH-Px), CuZn superoxide dismutase (CuZn SOD), and catalase activities were measured as markers of antioxidant status. Conjugated diene (p FMF patients compared with controls. FMF patients in the attack period (n = 8) had significantly higher CRP, ESR, fibrinogen, and leukocyte levels (p FMF patients in the attack period. The findings revealed upregulated APR during the attack period in FMF patients and enhanced oxidative stress in the FMF patients as compared to controls.

  5. Clinical significance of markers of collagen metabolism in rheumatic mitral valve disease.

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    Tanima Banerjee

    Full Text Available BACKGROUND: Rheumatic Heart Disease (RHD, a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression. METHODOLOGY: This is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS and Mitral Regurgitation (MR. Carboxy-terminal propeptide of type I procollagen (PICP, amino-terminal propeptide of type III procollagen (PIIINP, total Matrix Metalloproteinase-1(MMP-1 and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1 were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value 459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve. CONCLUSIONS: Levels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.

  6. Black water fever associated with acute renal failure among Congolese children in Kinshasa

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    Joseph M Bodi

    2014-01-01

    Full Text Available Acute renal failure (ARF is reported in some severe forms of malaria such as black water fever (BWF. It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics′ Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8% had severe malaria (39 with BWF and 5 with cerebral malaria. The mean age of the patients was 8.2 ± 1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%. Urea and creatinine levels were elevated in all cases (135.4 ± 88.2 and 3.83 ± 2.81 mg/dL, respectively. Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate <15 mEq/L in 61.5% and hyponatremia (<130 mEq/L in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%, including 20 on dialysis, fully recovered and 14 died (22.2%, including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.

  7. Development of ELISAs for diagnosis of acute typhoid fever in Nigerian children.

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    Felgner, Jiin; Jain, Aarti; Nakajima, Rie; Liang, Li; Jasinskas, Algis; Gotuzzo, Eduardo; Vinetz, Joseph M; Miyajima, Fabio; Pirmohamed, Munir; Hassan-Hanga, Fatimah; Umoru, Dominic; Jibir, Binta Wudil; Gambo, Safiya; Olateju, Kudirat; Felgner, Philip L; Obaro, Stephen; Davies, D Huw

    2017-06-01

    Improved serodiagnostic tests for typhoid fever (TF) are needed for surveillance, to facilitate patient management, curb antibiotic resistance, and inform public health programs. To address this need, IgA, IgM and IgG ELISAs using Salmonella enterica serovar Typhi (S. Typhi) lipopolysaccharide (LPS) and hemolysin E (t1477) protein were conducted on 86 Nigerian pediatric TF and 29 non-typhoidal Salmonella (NTS) cases, 178 culture-negative febrile cases, 28 "other" (i.e., non-Salmonella) pediatric infections, and 48 healthy Nigerian children. The best discrimination was achieved between TF and healthy children. LPS-specific IgA and IgM provided receiver operator characteristic areas under the curve (ROC AUC) values of 0.963 and 0.968, respectively, and 0.978 for IgA+M combined. Similar performance was achieved with t1477-specific IgA and IgM (0.968 and 0.968, respectively; 0.976 combined). IgG against LPS and t1477 was less accurate for discriminating these groups, possibly as a consequence of previous exposure, although ROC AUC values were still high (0.928 and 0.932, respectively). Importantly, discrimination between TF and children with other infections was maintained by LPS-specific IgA and IgM (AUC = 0.903 and 0.934, respectively; 0.938 combined), and slightly reduced for IgG (0.909), while t1477-specific IgG performed best (0.914). A similar pattern was seen when comparing TF with other infections from outside Nigeria. The t1477 may be recognized by cross-reactive antibodies from other acute infections, although a robust IgG response may provide some diagnostic utility in populations where incidence of other infections is low, such as in children. The data are consistent with IgA and IgM against S. Typhi LPS being specific markers of acute TF.

  8. Discontinuation of empirical antibiotic therapy in neutropenic acute myeloid leukaemia patients with fever of unknown origin: is it ethical?

    Science.gov (United States)

    Micol, J-B; Chahine, C; Woerther, P-L; Ghez, D; Netzer, F; Dufour, C; Merad, M; Blot, F; Chachaty, E; de Botton, S; Gachot, B

    2014-07-01

    Based on recommendations of the ECIL-4, we prospectively evaluated discontinuation of empirical antibiotic therapy in high-risk neutropenic acute myeloid leukaemia patients with fever of unknown origin. Seven patients (median neutropenia duration 30 days) were included. Four of them remained afebrile but quickly recovered from neutropenia. The other three had rapid recurrent fever. Two of these three patients had bacteraemia with susceptible strains and one of them was transferred to the ICU for septic shock. Median duration of sparing of antibiotics for the seven patients was 3 days (2-4). Because of these limited results the study was stopped. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  9. [Rheumatic diseases during pregnancy].

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    Fischer-Betz, R

    2012-09-01

    The treatment of inflammatory rheumatic diseases, such as rheumatoid arthritis, spondylitis ankylosans and systemic lupus erythematosus, is improving continuously. This has lead to an increasing number of young patients with a wish to have children. Greater insight into the course of rheumatic diseases during pregnancy and post partum has enabled optimized support for women with rheumatic diseases wishing to have children. To ensure a favorable outcome, pregnancy should be started during a period of disease stability and should be monitored closely. A careful assessment of possible risks and the justified use of antirheumatic drugs before, during and after pregnancy are key issues for success.

  10. Emerging trends in Lassa fever: redefining the role of immunoglobulin M and inflammation in diagnosing acute infection

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    Branco Luis M

    2011-10-01

    Full Text Available Abstract Background Lassa fever (LF is a devastating hemorrhagic viral disease that is endemic to West Africa and responsible for thousands of human deaths each year. Analysis of humoral immune responses (IgM and IgG by antibody-capture ELISA (Ab-capture ELISA and Lassa virus (LASV viremia by antigen-capture ELISA (Ag-capture ELISA in suspected patients admitted to the Kenema Government Hospital (KGH Lassa Fever Ward (LFW in Sierra Leone over the past five years is reshaping our understanding of acute LF. Results Analyses in LF survivors indicated that LASV-specific IgM persists for months to years after initial infection. Furthermore, exposure to LASV appeared to be more prevalent in historically non-endemic areas of West Africa with significant percentages of reportedly healthy donors IgM and IgG positive in LASV-specific Ab-capture ELISA. We found that LF patients who were Ag positive were more likely to die than suspected cases who were only IgM positive. Analysis of metabolic and immunological parameters in Ag positive LF patients revealed a strong correlation between survival and low levels of IL-6, -8, -10, CD40L, BUN, ALP, ALT, and AST. Despite presenting to the hospital with fever and in some instances other symptoms consistent with LF, the profiles of Ag negative IgM positive individuals were similar to those of normal donors and nonfatal (NF LF cases, suggesting that IgM status cannot necessarily be considered a diagnostic marker of acute LF in suspected cases living in endemic areas of West Africa. Conclusion Only LASV viremia assessed by Ag-capture immunoassay, nucleic acid detection or virus isolation should be used to diagnose acute LASV infection in West Africans. LASV-specific IgM serostatus cannot be considered a diagnostic marker of acute LF in suspected cases living in endemic areas of West Africa. By applying these criteria, we identified a dysregulated metabolic and pro-inflammatory response profile conferring a poor

  11. Three cases of fever of unknown origin (FUO) with acute multifocal non-bacterial osteitis (NBO) as reactive osteomyelitis.

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    Hong, Young Hoon

    2013-01-01

    Evaluation for fever of unknown origin (FUO) requires a long list of studies. Recently, the validity of PET scan in FUO evaluation has been approved for screening and qualification. Non-bacterial osteitis (NBO) refers to non-bacterial and non-specific inflammation of bone, which is usually chronic, and involves multiple bony sites. We have experienced 3 cases of FUO associated with increased symmetric multiple fluorodeoxyglucose uptake preferentially at the epiphysis of the femur and tibia on fusion Positron emission tomography/Computed tomography (PET/CT). Patients were young women, who complained of intermittent fever lasting several months, which was associated only with neutropenia and relative lymphocytosis. Bone biopsies revealed increased lymphocytes and histiocyte infiltration of the cortical bone with reactive bone marrow. With no evidence of infection, the fever showed spontaneous remission within 2 weeks of conservative treatment. We report on 3 cases of FUO with self-limited acute NBO as reactive osteomyelitis and suggest that this unique pattern on PET/CT would be helpful for FUO evaluation.

  12. Evidence of acute rickettsioses among patients presumed to have chikungunya fever during the chikungunya outbreak in Sri Lanka.

    Science.gov (United States)

    Premaratna, R; Halambarachchige, L P; Nanayakkara, D M; Chandrasena, T G A N; Rajapakse, R P V J; Bandara, N K B K R G W; de Silva, H J

    2011-12-01

    Chikungunya fever (CGF) and rickettsioses are known to cause acute onset febrile illnesses associated with severe arthritis. Rickettsial arthritis is curable with the use of appropriate anti-rickettsial antibiotics, however the arthritis of CGF tends to have a prolonged course leading to protracted disability. The aim of this study was to investigate the contribution of CGF and rickettsioses to cases of fever and arthritis during a presumed CGF outbreak in Sri Lanka. Fifty-eight consecutive patients with presumed CGF were further investigated to determine the occurrence of rickettsioses among them, and to identify differences in clinical, hematological, and biochemical parameters between the two diseases. Nearly a third of the patients had serological evidence of rickettsioses accounting for their illness. The presence of a late onset major joint arthropathy sparing the small joints of the hands and feet, and the occurrence of a late onset discrete maculopapular rash over the trunk and extremities, suggested rickettsioses over CGF. White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and liver function tests were not helpful in differentiating rickettsioses from CGF. Patients with rickettsioses and arthritis who received an empirical course of doxycycline recovered faster than those who did not receive specific treatment. The establishment of rapid diagnostic methods able to differentiate the etiological agents of fever and arthritis, such as CGF and rickettsioses, would be beneficial in endemic settings. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  13. [The rheumatism of acne conglobata (author's transl)].

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    Bastin, R; Verliac, F; Kernbaum, S; Kahn, M F; Feffer, J; Habas, J P

    1978-03-11

    The authors report a case of painful joint, para-articular and muscular involvement accompanying acne conglobata. Fifteen other cases of rheumatism associated with this very special type of acne have been reported. The patients affected are young men suffering from acne conglobata (severe form of acne characterised by its ulcerating course and the possibility of its being accompanied by systemic manifestations), who suddenly develop fever, an altered general state and assymetrical arthralgia involving mainly the large joints, accompanied by signs of muscular involvement. The course is one of spontaneous recovery, relapses being possible. This falls within the context of the group of rheumatic disorders associated with the signs of an inflammatory skin disease.

  14. Acute Parasitic Infections as a Cause of Fever of Unknown Origin in Egypt

    Science.gov (United States)

    1993-10-01

    patients with acute Fasciola and Beeson, 1961) and tuberculosis was hepatica infection, 9 patients with acute the most common infection causing FUO...fascioliasis Safwat Y and Woody JN. (1990b): in Egypt. Am. J. Trop. Med. -,9g. 32, The treatment of acute Fasciola hepatica 550: 554. infection in children...infection. Clinically, acute Fasciola and patients with an infection. 32 were caused acute Schistosoma infection present a by tuberculosis and of these 32

  15. Management of acute fever in children: guideline for community healthcare providers and pharmacists.

    Science.gov (United States)

    Green, Robin; Jeena, Prakash; Kotze, Shane; Lewis, Humphrey; Webb, David; Wells, Mike

    2013-09-03

    Fever is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with a self-limiting viral infection in children, it may also be a presenting symptom of more serious conditions requiring urgent medical care. Therefore, it is essential to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. This guideline aims to assist pharmacists, primary healthcare workers and general practitioners in risk-stratifying children who present with fever, deciding on when to refer, the appropriate use of antipyretic medication and how to advise parents and caregivers. 

  16. Chikungunya: acute fever, rash and debilitating arthralgias in a returning traveler from Haiti.

    Science.gov (United States)

    Anderson, Kathryn B; Pureza, Vincent; Walker, Patricia F

    2014-01-01

    The following case report details a case of chikungunya fever in a returning traveler from Haiti. The report highlights the clinical presentation and natural history of the disease, and emphasizes that chikungunya has become established in the western hemisphere, with a resultant need for heightened provider awareness. © 2014 International Society of Travel Medicine.

  17. Murine Typhus and Leptospirosis as Causes of Acute Undifferentiated Fever, Indonesia

    NARCIS (Netherlands)

    Gasem, M.H.; Wagenaar, J.F.P.; Goris, M.G.A.; Adi, M.S.; Isbandrio, B.B.; Hartskeerl, R.A.; Rolain, J.M.; Raoult, D.; van Gorp, E.C.M.

    2009-01-01

    To investigate rickettsioses and leptospirosis among urban residents of Semarang, Indonesia, we tested the blood of 137 patients with fever. Evidence of Rickettsia typhi, the agent of murine typhus, was found in 9 patients. Another 9 patients showed inconclusive serologic results. Thirteen patients

  18. Sphingomonas paucimobilis bacteraemia and shock in a patient with rheumatic carditis

    Directory of Open Access Journals (Sweden)

    Y Yozgat

    2014-01-01

    Full Text Available Acute rheumatic fever (ARF carditis is treated with steroids, which can cause changes in the cellular immune response, especially decreased CD3 (+ T cells. Nosocomial infections due to steroid use for treatment of ARF carditis or secondary to the changes in the cellular immune response have not been reported in the literature. Sphingomonas paucimobilis is a Gram-negative bacillus causing community- and hospital-acquired infections. It has been reported as causing bacteraemia/sepsis, pneumonia or peritonitis in patients with malignancies, immunosuppression or diabetes. We present a case with S. paucimobilis bacteraemia/sepsis and shock after administration of steroids for treatment of ARF carditis. We suggest early identification of the causative agent and appropriate adjustments of the treatment plan to avoid shock and possible mortality. This is the first reported case of S. paucimobilis bacteraemia/sepsis in the setting of steroid use for ARF carditis.

  19. Aspectos da gravidez e pós-parto de adolescentes portadoras de febre reumática Aspects of the pregnancy and post delivery of adolescents with rheumatic fever

    Directory of Open Access Journals (Sweden)

    Ana Julia Pantoja Moraes

    2004-09-01

    Full Text Available OBJETIVO: Avaliar a incidência e evolução de gravidez entre adolescentes portadoras de febre reumática (FR do nosso serviço. MÉTODOS: Avaliação retrospectiva de 510 prontuários de pacientes com diagnóstico de FR, no período de 1983 a 2001. RESULTADOS: Dos 510 pacientes analisados, 123 (46% eram adolescentes femininas. Dezesseis (13% engravidaram neste período, com um total de 19 gestações (uma apresentou duas gestações e outra três; 14 realizaram pré-natal adequadamente. A idade da primeira gestação variou de 14 a 19 anos (média 16,7; e a idade do início da atividade sexual, de 13 a 18 anos (média 15,2. Insuficiência mitral ocorreu em 15 casos, estando associada com insuficiência aórtica em cinco. Intercorrências durante o pré-natal foram observadas em duas pacientes: em uma houve recidiva da FR com Coréia e em outra infecção pelo HIV. O parto vaginal ocorreu em sete adolescentes, parto fórcipe em três e cesareana em quatro: uma com HIV, uma com gestação gemelar e duas com distocia funcional. Treze recém-nascidos foram adequados para idade gestacional e apenas os gêmeos foram prematuros. No pós-parto, uma paciente apresentou infecção na incisão cirúrgica e outra abscesso mamário. Nenhuma paciente reativou a FR no parto e pós-parto. CONCLUSÕES: As gestações não apresentaram descompensação cardíaca, com predomínio de valvulites de leve intensidade. Atividade sexual precoce e aumento da gravidez em adolescentes são realidades nos ambulatórios de reumatologia pediátrica, justificando a necessidade de uma melhor orientação em relação à sexualidade e uso de métodos anticoncepcionais na rotina do atendimento.BACKGROUND: To evaluate the incidence and follow-up of pregnancy among adolescents with rheumatic fever (RF attended at the authors' service. METHODS: A retrospective evaluation was undertaken of 510 patients with a diagnosis of RF according to records from 1983 to 2001. RESULTS: We

  20. [A case of Chikungunya fever in the Primorye Territory].

    Science.gov (United States)

    Simakova, A I; Popov, A F; Sokotun, S A; Sokotun, O A; Petukhova, S A

    2014-01-01

    The authors analyze a case of Chikungunya fever imported to Vladivostok. The disease was severe and resulted in disability in a female patient for more than 6 months. There were difficulties in its differential diagnosis with rheumatic diseases.

  1. Fever of unknown origin: a clinical approach.

    Science.gov (United States)

    Cunha, Burke A; Lortholary, Olivier; Cunha, Cheston B

    2015-10-01

    Fevers of unknown origin remain one of the most difficult diagnostic challenges in medicine. Because fever of unknown origin may be caused by over 200 malignant/neoplastic, infectious, rheumatic/inflammatory, and miscellaneous disorders, clinicians often order non-clue-based imaging and specific testing early in the fever of unknown origin work-up, which may be inefficient/misleading. Unlike most other fever-of-unknown-origin reviews, this article presents a clinical approach. Characteristic history and physical examination findings together with key nonspecific test abnormalities are the basis for a focused clue-directed fever of unknown origin work-up. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Pregnancy and rheumatic diseases.

    Science.gov (United States)

    Gayed, M; Gordon, C

    2007-11-01

    Pregnancy is an issue that should be discussed with all patients with rheumatic diseases who are in the reproductive age group. Infertility is rarely due to the disease but can be associated with cyclophosphamide therapy. Most rheumatic diseases that are well controlled prior to pregnancy do not deteriorate in pregnancy, providing that the patient continues with appropriate disease-modifying therapy. Some patients with inflammatory arthritis go in to remission during pregnancy. Patients with renal involvement may be at increased risk of disease flare. This needs to be distinguished from pre-eclampsia. Intrauterine growth restriction is more likely in patients with active systemic disease, hypertension, a history of thrombosis and renal involvement. Premature delivery may need to be planned to reduce the risks of stillbirth and can be associated with a variety of neonatal complications. Post-partum flare is common in all the rheumatic diseases.

  3. Clinical, epidemiological and virological features of dengue virus infections in vietnamese patients presenting to primary care facilities with acute undifferentiated fever

    NARCIS (Netherlands)

    K.T.D. Thai; H.L. Phuong; T.T.T. Nga; P.T. Giao; L.Q. Hung; N.V. Nam; T.Q. Binh; C. Simmons; J. Farrar; T.T. Hien; H.R. van Doorn; M.D. de Jong; P.J. de Vries

    2010-01-01

    Objectives: To explore clinical and virological characteristics and describe the epidemiology of dengue in patients who presented with acute undifferentiated fever (AUF) at primary health centers (PHC) in Binh Thuan Province, Vietnam. Methods: A prospective observational study was conducted from 200

  4. No evidence for distinguishing bacterial from viral acute rhinosinusitis using fever and facial/dental pain: a systematic review of the evidence base

    NARCIS (Netherlands)

    Hauer, A.J.; Luiten, E.L.; van Erp, N.F.; Blase, P.E.; Aarts, M.C.J.; Kaper, N.M.; van der Heijden, G.J.M.G.

    2014-01-01

    Objective To assess the diagnostic value of fever and facial and dental pain in adults suspected of acute bacterial rhinosinusitis. Data Sources PubMed, EMBASE, and the Cochrane Library. Review Methods A comprehensive systematic search was performed on March 18, 2013. We included articles reporting

  5. Fever, Haematuria, and Acute Graft Dysfunction in Renal Transplant Recipients Secondary to Adenovirus Infection: Two Case Reports

    Directory of Open Access Journals (Sweden)

    J. Ramírez

    2013-01-01

    Full Text Available We report two cases of adenoviral infection in kidney transplant recipients that presented with different clinical characteristics under similar demographic and posttransplant conditions. The first case presented with fever, gross haematuria, and acute graft dysfunction 15 days following renal transplantation. A graft biopsy, analyzed with immunohistochemistry, yielded negative results. However, the diagnosis was confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. The immunosuppression dose was reduced, and ribavirin treatment was started, for which the patient quickly developed toxicity. Antiviral treatment allowed for transient response; however, a relapse occurred. The viral real-time PCR became negative upon immunosuppression reduction and administration of IVIG; graft function normalized. In the second case, the patient presented with fever and dysuria 1 month after transplantation. The initial imaging studies revealed graft enlargement and areas of hypoperfusion. In this case, the diagnosis was also confirmed with blood and urine real-time PCR for adenovirus 3 days after the initial clinical manifestations. Adenoviral nephritis was confirmed through a graft biopsy analyzed with light microscopy, immunohistochemistry, and PCR in frozen tissue. The immunosuppression dose was reduced, and IVIG was administered obtaining excellent clinical results along with a negative real-time PCR.

  6. NONSPECIFIC ANTI-INFLAMMATORY AGENTS. SOME NOTES ON THEIR PRACTICAL APPLICATION, ESPECIALLY IN RHEUMATIC DISORDERS.

    Science.gov (United States)

    BOLAND, E W

    1964-03-01

    A number of acute and chronic inflammatory disorders are amenable to varying degrees of therapeutic control with the administration of nonspecific anti-inflammatory drugs. An evaluation of these suppressive agents in the field of rheumatic diseases and practical suggestions regarding their administration are presented. Eight synthetically modified corticosteroid compounds are available commercially. Each of them exhibits qualitative differences in one or several physiologic actions, each has certain advantages and disadvantages in therapy, and each shares the major deterrent features of corticosteroids. Prednisone, prednisolone, methylprednisolone, fluprednisolone and paramethasone have similar therapeutic indices, and there is little choice between them for the usual rheumatoid patient requiring steroid therapy. Conversely, the therapeutic indices of dexamethasone, betamethasone and triamcinolone are lower than that of prednisolone; they are less desirable for routine use and should be reserved for specially selected cases. Salicylates are preferred to adrenocortical steroids in the treatment of the ordinary patient with acute rheumatic fever. Steroid therapy should be reserved for resistant cases and for those with significant carditis. Salicylates are mainstays for pain relief in rheumatoid arthritis, but with the analgesic doses usually employed their anti-inflammatory action is slight.Phenylbutazone is a highly useful anti-inflammatory agent, especially in management of acute gouty arthritis and ankylosing (rheumatoid) spondylitis; its metabolite, oxyphenylbutazone, does not exhibit clear-cut advantages. Colchicine specifically suppresses acute gouty arthritis. Its analogues, desacetylcolchicine and desacetylthiocolchicine, produce fewer unpleasant gastrointestinal symptoms, but may promote agranulocytosis and alopecia.A number of indole preparations with anti-inflammatory activity have been tested clinically. One of them, indomethacin, has received extensive

  7. Oncohematologic diseases and rheumatic disorders

    Directory of Open Access Journals (Sweden)

    Nelson Hamerschlak

    2008-03-01

    Full Text Available Mielodysplasia, leukemia, lynfoma and multiple myeloma are themain oncohematologic diseases related to rheumatic manifestations.In multiple myeloma the pain manifestation is caused by fracturefrom bone lesions as a direct consequence of the disease, not beingan associateda true rheumatic manifestation. An interesting aspectof this subject is that many rheumatic manifestations occur beforehematologic diseases as, for example, lymphomas. Therefore we cansay that some rheumatic diseases are associated to a greater riskof oncohematologic diseases. On the other hand, oncohematologicdiseases can present rheumatic manifestations in articulations,muscles and vessels. Theses cases are usually interpreted as paraneoplasics.This chapter is divided in three parts: oncohematologicdiseases with rheumatic manifestations; rheumatic diseases thatpresent greater risk of oncohematologic pathologies; and the mainrheumatic manifestations of oncohematologic diseases.

  8. Clinical and echocardiographic features of children with rheumatic heart disease and their serum cytokine profile.

    Science.gov (United States)

    Ali, Sulafa Khalid Mohamed; Eldaim, Inaam Noor; Osman, Samia Hassan; Bakhite, Sahar Mohamed

    2012-01-01

    Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) constitute important public health problems in developing countries. Children with ARF and RHD seen at Children's Hospital-Sudan from May 2008-2009 were examined clinically and by echocardiography. Blood cytokines (interleukin 10 (IL10), Tumor necrosis factor alpha (TNF- alpha) and interferon gamma (IFN-gamma) were done. Thirty six children were enrolled; 63% had established RHD, and 37% ARF. Mitral regurgitation (MR) was the most common lesion (94%).Ninety five percent of the valve lesions were severe. The serum interleukin IL10 level ranged between 3-6 pg/ml. TNF alpha levels were 9- 100 pg/ml in 12 patients (40%), 101-1000 pg/ml in 10 patients (33%), more than 1000 in 8 patients (26%). The level of IFN gamma ranged between 2-7 pg/m in all patients except 2 (84 and 135 pg/ml). RHD is manifested with severe valvular lesions and a high TNF alpha indicating and ongoing inflammation.

  9. [Natural history of rheumatic carditis. A follow-up of more than 20 years].

    Science.gov (United States)

    Guadalajara, J F; Laplaza, I; Torres Tono, A; Vera Delgado, A; Gual Juliá, J M; Huerta, D

    1989-01-01

    In this retrospective study of 43 patients of the National Institute of Cardiology of Mexico, 20 to 35 years after the first attack of rheumatic carditis shows that the prognosis of the heart valve disease is directly influenced by the number of attacks of rheumatic fever. In fact, when patients had only one rheumatic attack the secuelae was mild mitral regurgitation (19%), without hemodynamic significance, with less proportion of mitral stenosis (15%), or aortic regurgitation (7.6%), less plurivalvular lesions (16%), or required heart surgery (15%). In the other hand, when the patients suffered three rheumatic attacks had more proportion of mitral stenosis (33%), aortic regurgitation (41%), pluryvalvular lesions (38%) and required more heart (50%). We conclude that prophylactic treatment is important in patients with chronic rheumatic heart disease.

  10. Familial Mediterranean fever is no longer a rare disease in Japan

    OpenAIRE

    Migita, Kiyoshi; Izumi, Yasumori; Jiuchi, Yuka; Iwanaga, Nozomi; Kawahara, Chieko; Agematsu, Kazunaga; Yachie, Akihiro; Masumoto, Junya; Fujikawa, Keita; Yamasaki, Satoshi; Nakamura, Tadashi; Ubara, Yoshifumi; Koga, Tomohiro; Nakashima, Yoshikazu; Shimizu, Toshimasa

    2016-01-01

    Background The aim of this study was to evaluate the clinical manifestations and prevalence of familial Mediterranean fever (FMF) in Japanese patients with unexplained fever and rheumatic manifestations. Methods We enrolled 601 patients with unexplained fever or suspected FMF throughout Japan between 2009 and 2015. Patients were divided into three groups according to Tel Hashomer criteria: sure FMF, probable FMF, and non-FMF patients, including definitive rheumatic diseases. Mutation detectio...

  11. Fever without apparent source on clinical examination, lower respiratory infections in children, other infectious diseases, and acute gastroenteritis and diarrhea of infancy and early childhood.

    Science.gov (United States)

    McCarthy, P L; Klig, J E; Kahn, J S; Shapiro, E D; Baron, M A

    1997-02-01

    This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. Jean Klig reviews recent literature about lower respiratory tract infection in children. Jeffrey Kahn and Eugene Shapiro discuss literature concerning several infectious diseases commonly seen in office settings and concerning which recent developments are of interest. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood.

  12. An evaluation of purified Salmonella Typhi protein antigens for the serological diagnosis of acute typhoid fever.

    Science.gov (United States)

    Tran Vu Thieu, Nga; Trinh Van, Tan; Tran Tuan, Anh; Klemm, Elizabeth J; Nguyen Ngoc Minh, Chau; Voong Vinh, Phat; Pham Thanh, Duy; Ho Ngoc Dan, Thanh; Pham Duc, Trung; Langat, Pinky; Martin, Laura B; Galan, Jorge; Liang, Li; Felgner, Philip L; Davies, D Huw; de Jong, Hanna K; Maude, Rapeephan R; Fukushima, Masako; Wijedoru, Lalith; Ghose, Aniruddha; Samad, Rasheda; Dondorp, Arjen M; Faiz, Abul; Darton, Thomas C; Pollard, Andrew J; Thwaites, Guy E; Dougan, Gordon; Parry, Christopher M; Baker, Stephen

    2017-08-01

    The diagnosis of typhoid fever is a challenge. Aiming to develop a typhoid diagnostic we measured antibody responses against Salmonella Typhi (S. Typhi) protein antigens and the Vi polysaccharide in a cohort of Bangladeshi febrile patients. IgM against 12 purified antigens and the Vi polysaccharide was measured by ELISA in plasma from patients with confirmed typhoid fever (n = 32), other confirmed infections (n = 17), and healthy controls (n = 40). ELISAs with the most specific antigens were performed on plasma from 243 patients with undiagnosed febrile disease. IgM against the S. Typhi protein antigens correlated with each other (rho > 0.8), but not against Vi (rho Typhoid patients exhibited higher IgM against 11/12 protein antigens and Vi than healthy controls and those with other infections. Vi, PilL, and CdtB exhibited the greatest sensitivity and specificity. Specificity and sensitivity was improved when Vi was combined with a protein antigen, generating sensitivities and specificities of 0.80 and >0.85, respectively. Applying a dynamic cut-off to patients with undiagnosed febrile disease suggested that 34-58% had an IgM response indicative of typhoid. We evaluated the diagnostic potential of several S. Typhi antigens; our assays give good sensitivity and specificity, but require further assessment in differing patient populations. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  13. Clinical significance of markers of collagen metabolism in rheumatic mitral valve disease.

    Science.gov (United States)

    Banerjee, Tanima; Mukherjee, Somaditya; Ghosh, Sudip; Biswas, Monodeep; Dutta, Santanu; Pattari, Sanjib; Chatterjee, Shelly; Bandyopadhyay, Arun

    2014-01-01

    Rheumatic Heart Disease (RHD), a chronic acquired heart disorder results from Acute Rheumatic Fever. It is a major public health concern in developing countries. In RHD, mostly the valves get affected. The present study investigated whether extracellular matrix remodelling in rheumatic valve leads to altered levels of collagen metabolism markers and if such markers can be clinically used to diagnose or monitor disease progression. This is a case control study comprising 118 subjects. It included 77 cases and 41 healthy controls. Cases were classified into two groups- Mitral Stenosis (MS) and Mitral Regurgitation (MR). Carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), total Matrix Metalloproteinase-1(MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) were assessed. Histopathology studies were performed on excised mitral valve leaflets. A p value valve replacement (pvalve area (r = -0.40; r = 0.49 respectively) and pulmonary artery systolic pressure (r = 0.49; r = -0.49 respectively); while in MR they correlated with left ventricular internal diastolic (r = 0.68; r = -0.48 respectively) and systolic diameters (r = 0.65; r = -0.55 respectively). Receiver operating characteristic curve analysis established PICP as a better marker (AUC = 0.95; 95% CI = 0.91-0.99; p459 ng/mL for PICP provided 91% sensitivity, 90% specificity and a likelihood ratio of 9 in diagnosing RHD. Histopathology analysis revealed inflammation, scarring, neovascularisation and extensive leaflet fibrosis in diseased mitral valve. Levels of collagen metabolism markers correlated with echocardiographic parameters for RHD diagnosis.

  14. Detection of herpes simplex virus type 1 in rheumatic valvular tissue

    Institute of Scientific and Technical Information of China (English)

    PAN Zhi-gang; WANG Xiu-nan; LI Yan-wen; ZHANG Hong-yi; Leonard C. Archard

    2005-01-01

    Background Rheumatic heart disease (RHD) is the most important sequela of rheumatic fever (RF): evidence that streptococcal infection is aetiological is prominent, but sometimes contradictory. Acute HSV-1 infection in mouse leads to carditis and valvulitis whereas recurrent infection results in inflammatory granulomatous lesions that resemble Aschoff bodies. Cells containing HSV-1 inclusions or virus infected giant cells appear similar to Anitschkow cells or Aschoff cells respectively. We hypothesized that HSV-1 infection also may be involved in RHD. Methods Formalin-fixed, paraffin-embedded valvular tissue samples from 32 patients with RHD were investigated for evidence of HSV-1 infection. HSV-1 antigen was detected by immunohistochemistry, using HSV-1-specific monoclonal and polyclonal antibodies. HSV-1 glycoprotein D gene sequences were amplified by nPCR, using β-globin gene amplification in the same samples as internal control. Valvular tissue from 5 cases of sudden death and 3 cases died of neisseria meningitis without a history of valvular disease was used for comparison. HSV-1-infected lung tissue was used as positive control. Results HSV-1 antigens were detected in valvular tissues from 21 of 32 (65.6%) patients. Fifteen of these 21 (46.9% of cases), but no antigen-negative sample, were positive also for HSV DNA. Nucleotide sequence of PCR products was homologous to the targeted region of the HSV-1 glycoprotein D gene. HSV-1 antigen was present also in one case of sudden death but viral DNA was not found in any tissue sample from the comparison group. Results from reagent and positive controls were as anticipated.Conclusions This is the first study to show the presence of HSV-1 antigen and genomic DNA in valvular tissues from patients with RHD and provides evidence for an association of HSV-1 infection with some cases of rheumatic valvular disease.

  15. HCV and Rheumatic Disease

    Science.gov (United States)

    ... Cryopyrin-Associated Autoinflammatory Syndrome (CAPS) (Juvenile) Dermatomyositis (Juvenile) Familial Mediterranean Fever (Juvenile) Fibromyalgia Giant Cell Arteritis Glucocorticoid-induced Osteoperosis ...

  16. Pregnancy and Rheumatic Disease

    Science.gov (United States)

    ... Cryopyrin-Associated Autoinflammatory Syndrome (CAPS) (Juvenile) Dermatomyositis (Juvenile) Familial Mediterranean Fever (Juvenile) Fibromyalgia Giant Cell Arteritis Glucocorticoid-induced Osteoperosis ...

  17. Non-Steroid Anti-Inflammatory Drugs Are Better than Acetaminophen on Fever Control at Acute Stage of Fracture.

    Directory of Open Access Journals (Sweden)

    Kuang-Ting Yeh

    Full Text Available In addition to adequate surgical fixation and an aggressive rehabilitation program, pain relief is one of the most critical factors in the acute stage of fracture treatment. The most common analgesics are nonsteroid anti-inflammatory drugs and Acetaminophen, both of which relieve pain and reduce body temperature. In clinical experiences, they exhibit effective pain control; however, their influence on body temperature remains controversial. This study is aimed at determining the effects of analgesics at the acute stage of traumatic fracture by performing a clinical retrospective study of patients with fractures and a fracture animal model. The retrospective study revealed that, in the acetaminophen group, the mean value of postmedication body temperature (BT was significantly higher than that of the premedication BT. The change in BT was highly related with the medication rather than other risk factors. Forty eight 12-week-old male Wistar rats were divided into 6 groups: a control group, fracture group, fracture-Acetaminophen group, Acetaminophen group, fracture-Arcoxia group, and Arcoxia group. Fracture rats were prepared by breaking their unilateral tibia and fibula. Their inflammation conditions were evaluated by measuring their serum cytokine level and their physiological status was evaluated by estimating their central temperature, heart rate, and mean blood pressure. The hepatic adverse effects were assessed by measuring the serum levels of aspartate aminotransferase (sGOT and alanine aminotransferase (sGPT. The central temperature in the fracture-Acetaminophen group exceeded that in the groups fed normal saline water or Arcoxia. Accumulated hepatic injury was presented as steadily ascending curves of sGOT and sGPT. Inflammation-related cytokine levels were not higher in the Acetaminophen fracture group and were significantly lower in the fracture-Arcoxia group. Fever appeared to be aggravated by acetaminophen and more related to the

  18. Non-Steroid Anti-Inflammatory Drugs Are Better than Acetaminophen on Fever Control at Acute Stage of Fracture.

    Science.gov (United States)

    Yeh, Kuang-Ting; Wu, Wen-Tien; Subeq, Yi-Maun; Niu, Chi-Chien; Liao, Kuang-Wen; Chen, Ing-Ho; Wang, Jen-Hung; Lee, Ru-Ping

    2015-01-01

    In addition to adequate surgical fixation and an aggressive rehabilitation program, pain relief is one of the most critical factors in the acute stage of fracture treatment. The most common analgesics are nonsteroid anti-inflammatory drugs and Acetaminophen, both of which relieve pain and reduce body temperature. In clinical experiences, they exhibit effective pain control; however, their influence on body temperature remains controversial. This study is aimed at determining the effects of analgesics at the acute stage of traumatic fracture by performing a clinical retrospective study of patients with fractures and a fracture animal model. The retrospective study revealed that, in the acetaminophen group, the mean value of postmedication body temperature (BT) was significantly higher than that of the premedication BT. The change in BT was highly related with the medication rather than other risk factors. Forty eight 12-week-old male Wistar rats were divided into 6 groups: a control group, fracture group, fracture-Acetaminophen group, Acetaminophen group, fracture-Arcoxia group, and Arcoxia group. Fracture rats were prepared by breaking their unilateral tibia and fibula. Their inflammation conditions were evaluated by measuring their serum cytokine level and their physiological status was evaluated by estimating their central temperature, heart rate, and mean blood pressure. The hepatic adverse effects were assessed by measuring the serum levels of aspartate aminotransferase (sGOT) and alanine aminotransferase (sGPT). The central temperature in the fracture-Acetaminophen group exceeded that in the groups fed normal saline water or Arcoxia. Accumulated hepatic injury was presented as steadily ascending curves of sGOT and sGPT. Inflammation-related cytokine levels were not higher in the Acetaminophen fracture group and were significantly lower in the fracture-Arcoxia group. Fever appeared to be aggravated by acetaminophen and more related to the elevation of hepatic

  19. Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré syndrome following dengue fever

    Directory of Open Access Journals (Sweden)

    Eduardo Gonçalves

    2011-08-01

    Full Text Available This paper reports a case of dengue in a six-year-old female child who suddenly developed excruciating headaches, fever, myalgia and paresis. Laboratory examinations included blood count, platelet count, biochemical tests (BUN, creatinine, aminotransferases, and total bilirubin and bilirubin fractions and specific IgM titers (enzyme-immunoassay with recombinant tetravalent dengue. After ten days of hospitalization and having already been in a home environment, a new clinical image emerged, characterized by dysphagia, dysphonia, weakness, peripheral facial palsy and paresthesia. The diagnosis of Guillain-Barré Syndrome was based on clinical findings, cerebrospinal fluid examination, electrophysiological findings and the exclusion of other pathologies. Our case, as some shown in previous reports, calls attention to the possibility that Guillain-Barré Syndrome may occur in association with dengue.

  20. Simulated acute central Mycoplasma infections in rats induce fever, anorexia, body mass stunting and lethargy but spare memory.

    Science.gov (United States)

    Swanepoel, Tanya; Sabbar, Mariam; Baartman, Tamzyn L; Laburn, Helen P; Mitchell, Duncan; Dukhan, Tanusha; Harden, Lois M

    2016-09-01

    Despite the documented post-infectious neurological complications of a central nervous system (CNS) Mycoplasma infection in humans, very few studies have investigated the acute inflammatory responses and sickness behaviours induced by CNS Mycoplasma infections. We therefore determined the effect of acute central administration of fibroblast-stimulating lipopeptide-1 (FSL-1), derived from Mycoplasma salivarium, and FAM-20 from a more pathogenic species, namely Mycoplasma pneumoniae, on behavioural and inflammatory responses in rats. Male Sprague-Dawley rats had radiotransmitters implanted, intra-abdominally, to measure body temperature and cage activity continuously. After recovery from surgery, rats were conditioned in a fear conditioning task and then immediately received an intra-cisterna magna (i.c.m.) injection of either: (1) FSL-1 (10 or 100μg/5μl) or its vehicle (phosphate-buffered saline, 5μl), or (2) FAM-20 (10 or 100μg/5μl) or its vehicle (dimethyl sulfoxide, 5μl). Body mass and food intake were measured daily. Memory was assessed seven days after injection using fear conditioning tests. A single, i.c.m. injection of either FSL-1 or FAM-20 induced profound, dose-dependent fever, anorexia, lethargy and body mass stunting in rats. Moreover, rats that received an i.c.m. injection of 100μg/5μl FAM-20 had a significant increase in the concentration of IL-1β in both the hypothalamus and the hippocampus for ~27h after injection. Seven days after FSL-1 or FAM-20 injection, when body mass of rats still was stunted, they maintained their memory for fear of the context and for fear of the tone, despite the increase in hippocampal IL-1β concentration after FAM-20 administration. Thus, acute simulated CNS Mycoplasma infections caused pronounced sickness responses and brain inflammation in rats, but spared fear memory.

  1. Comparison of acute phase response during attack and attack-free period in children with Familial Mediterranean Fever

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    Erdal Çakmak

    2013-06-01

    Full Text Available Objective: The aim of this study was to compare acutephase reactant (AFR levels at attack period and attackfreeperiod under colchicine treatment in children with FamilialMediterranean Fever (FMF.Methods: The diagnosis of FMF was done based on clinicalcriteria and patients were prospectively followed upfor average of 1.2 years. Symptom-onset age, age at diagnosis,clinical symptoms and features of FMF attackswere recorded. MEFV gene mutations were detected byreverse hybridization (strip assay method. Peripheralblood leukocyte count, erythrocyte sedimentation rate(ESR, C-reactive protein (CRP and blood fibrinogen levelswere measured by standard methods, both at attackperiod and during attack-free period.Results: Totally 105 (55 girls, 50 boys children with FMFwere included. The mean age was 8.9±3.2 years, meansymptom onset age was 5.9 years and mean age at diagnosiswas 8.1 years. MEFV gene mutations were asfollows: E148Q (29.2%, M694V (24.8%, R761H (15.3%and V726A (13.1%. The mean AFR values were overnormal values in attack period and there was at least onehigh AFR level in 80.0% of patients. In attack-free period,although the mean values of all AFRs were within normallimits, 31.4% of patients had at least one high AFR level.Conclusion: Based on these data, one-third of FMF childrenhad a high AFR level, which may be a marker of subclinicalinflammation. In children with continuous inflammationduring attack-free period, a new anti-inflammatorydrug additional to colchicine can be considered in order toprevent complications of chronic inflammation. J Clin ExpInvest 2013; 4 (2: 213-218Key words: Familial Mediterranean Fever, acute phasereactants, children, attack period, attack-free period

  2. Osteoporosis and rheumatic diseases

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    N. Maruotti

    2014-06-01

    Full Text Available Numerous rheumatic diseases, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis/polymyositis and vasculitis are characterized by osteoporosis and fragility fractures. Inflammatory cytokines, glucocorticoid treatment, immobilization and reduced physical activity due to painful joints and muscle weakness are considered the main risk factors that cause low body mass density values in these diseases. Emerging evidence highlights the role of inflammatory cytokines, such as tumor necrosis factor (TNF-α, interleukin (IL-1, IL-6, IL-7 and IL-17, in the regulation of the bone homeostasis. In fact, chronic inflammation is often characterized by an imbalance between bone formation and bone resorption with a net prevalence of osteoclastogenesis, which is an important determinant of bone loss in rheumatic diseases.

  3. Acute psychosis followed by fever: Malignant neuroleptic syndrome or viral encephalitis?

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    Stojanović Zvezdana

    2014-01-01

    Full Text Available Introduction. Neuroleptic malignant syndrome is rare, but potentially fatal idiosyncratic reaction to antipsychotic medications. It is sometimes difficult to diagnose some clinical cases as neuroleptic malignant syndrome and differentiate it from the acute viral encephalitis. Case report. We reported a patient diagnosed with acute psychotic reaction which appeared for the first time. The treatment started with typical antipsychotic, which led to febrility. The clinical presentation of the patient was characterised by the signs and symptoms that might have indicated the neuroleptic malignant syndrome as well as central nervous system viral disease. In order to make a detailed diagnosis additional procedures were performed: electroencephalogram, magnetic resonance imaging of the head, lumbar puncture and a serological test of the cerebrospinal fluid. Considering that after the tests viral encephalitis was ruled out and the diagnosis of neuroleptic malignant syndrome made, antipsychotic therapy was immediately stopped. The patient was initially treated with symptomatic therapy and after that with atypical antipsychotic and electroconvulsive therapy, which led to complete recovery. Conclusion. We present the difficulties of early diagnosis at the first episode of acute psychotic disorder associated with acute febrile condition. Concerning the differential diagnosis it is necessary to consider both neuroleptic malignant syndrome and viral encephalitis, i.e. it is necessary to make the neuroradiological diagnosis and conduct cerebrospinal fluid analysis and blood test. In neuroleptic malignant syndrome treatment a combined use of electroconvulsive therapy and low doses of atypical antipsychotic are confirmed to be successful.

  4. [Febrile responses in patients with pediatric rheumatic diseases].

    Science.gov (United States)

    Yokota, Shumpei; Kikuchi, Masako; Nozawa, Tomo; Kizawa, Toshitaka; Kanetaka, Taichi; Kadota, Keisuke; Miyamae, Takako; Mori, Masaaki

    2012-01-01

    Fever is one of the critical symptoms of patients in pediatrics field. It indicates inflammatory focus somewhere in the body, and the major causes of fever are infectious diseases. Recent progresses of our knowledge about autoinflammatory syndrome promoted the investigation of the mechanism of fever, and suggested that the pro-inflammatory cytokines are the direct causative agents of fever. The basic science revealed that cooperation of IL-6 and IL-1β induces febrile response. Fever of unknown origin (FUO) remains a challenging problem. Rheumatic diseases, rare infectious diseases, and benign tumors and malignancies are diagnoses to be differentiated. FDG-PET is recently proved a valuable tool for the identification of the etiology in patients with FUO. Since the introduction of biological response modifiers into the treatment of patients with pediatric rheumatic diseases has shifted the therapeutic paradigm, a new concept that the blockade of a unique pro-inflammatory cytokine brings cessation of whole inflammatory responses affected tremendously the clinical medicine. A more investigation of inflammation and its pathophisiology will be needed in pediatric rheumatology.

  5. The clinical value of anti-dnase B and antistreptolysin O microtitration test in the diagnosis of rheumatic disease%ASO和抗DNA酶B抗体联合检测对风湿病诊断的临床意义

    Institute of Scientific and Technical Information of China (English)

    陈忠城; 蔡高荣; 邝昱; 许振杰

    2013-01-01

    Objective: To observe the changes and the diagnostic values of anti - Dnase B and Antistreptolysin O in serum of rheumatic disease patients caused by group A streptococcal (GAS) infection. Methods: Thirty patients with acute rheumatic fever (ARF) and 30 patients with Rheumatic activity heart disease and 30 patients with Rheumatic arthritis were included in the present study. Immune scatter nephelometry test was used to detect the level of anti - Dnase B and ASO in serum. Results: The positive rates of ASO in patients with ARF, Rheumatic activity heart disease and Rheumatic arthritis were 80%, 57.3% and 53.3%, respectively. The positive rates of anti -Dnase B in patients with ARF, Rheumatic activity heart disease and Rheumatic arthritis were 70%, 85.7% and 60%, respectively. Other than the group of Rheumatic activity heart disease, there was no statistical difference between the positive rates of ASO and anti - Dnase B in patients with ARF and Rheumatic arthritis. The positive rates of the joint detection of anti - Dnase B and ASO in patients with ARF, Rheumatic activity heart disease and Rheumatic arthritis were 90%, 92.8% and 80%, respectively. There was statistically significant difference in the positive rate between joint detection and any single test. Conclusion: The joint detection of anti - Dnase B and ASO could improve the diagnosis of Rheumatic disease and should be of important clinical value in the diagnosis of rheumatic disease.%目的:研究溶血性链球菌感染引起的风湿病患者抗DNA酶B和ASO的血清学变化及意义.方法:收集30例急性风湿热、30例活动期风湿性心脏病、30例风湿性关节炎患者血清,免疫散射比浊法检测其抗DNA酶B和ASO水平.结果:三组患者的ASO阳性率分别为80%、57.3%、53.3%,抗DNA酶B检测阳性率分别为70%、85.7%、60%.除活动期风湿性心脏病组外,其余两组患者的ASO阳性率与抗DNA酶B检测阳性率间的差异无统计学意义(P>0.05).

  6. Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.

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    Hong Du

    Full Text Available OBJECTIVES: The aim of this study was to investigate the clinical characteristics and outcomes of critical patients with hemorrhagic fever with renal syndrome (HFRS complicated by acute respiratory distress syndrome (ARDS. MATERIALS AND METHODS: To observe the demographic, epidemiological and clinical characteristics, and to explore the predictive effects for prognosis in laboratory findings, we conducted a detailed retrospective analysis of clinical records for critical patients with HFRS complicated by ARDS, treated at the center for infectious diseases, Tangdu Hospital, between January 2008 and December 2012. RESULTS: A total of 48 critical patients with laboratory confirmed HFRS accompanied by ARDS were enrolled in the study, including 27 survivors and 21 non-survivors, with a fatality rate of 43.75%. Thirty-one individuals (64.6% contracted HFRS between the months of September and December. The non-survivors tended to have lower incidence of overlapping phase (P = 0.025. There were no obvious differences in the needs for mechanical ventilation (MV and renal replacement therapy (RRT, except for the need for vasoactive drugs between the survivors and non-survivors (P = 0.001. The non-survivors were found to have higher frequencies of encephalopathy, refractory shock and multiple organ dysfunction syndrome (MODS, lower incidences of acute renal failure (ARF and secondary hypertension (P<0.05. The non-survivors tended to have lower levels of serum creatinine (Scr (P<0.001 and fibrinogen (Fib (P = 0.003, higher incidences of prolonged prothrombin time (PT (P = 0.006 and activated partial thromboplastin time (APTT (P = 0.020 and higher levels of aspartate aminotransferase (AST (P = 0.015, and the laboratory parameters mentioned above reached statistical significance for predicting prognosis (P<0.05. CONCLUSION: The high mortality rate of critical patients with HFRS complicated by ARDS emphasizes the importance of

  7. Severe acute respiratory syndrome (SARS): knowledge, attitudes, practices and sources of information among physicians answering a SARS fever hotline service.

    Science.gov (United States)

    Deng, J-F; Olowokure, B; Kaydos-Daniels, S C; Chang, H-J; Barwick, R S; Lee, M-L; Deng, C-Y; Factor, S H; Chiang, C-E; Maloney, S A

    2006-01-01

    In June 2003, Taiwan introduced a severe acute respiratory syndrome (SARS) telephone hotline service to provide concerned callers with rapid access to information, advice and appropriate referral where necessary. This paper reports an evaluation of the knowledge, attitude, practices and sources of information relating to SARS among physicians who staffed the SARS fever hotline service. A retrospective survey was conducted using a self-administered postal questionnaire. Participants were physicians who staffed a SARS hotline during the SARS epidemic in Taipei, Taiwan from June 1 to 10, 2003. A response rate of 83% was obtained. All respondents knew the causative agent of SARS, and knowledge regarding SARS features and preventive practices was good. However, only 54% of respondents knew the incubation period of SARS. Hospital guidelines and news media were the major information sources. In responding to two case scenarios most physicians were likely to triage callers at high risk of SARS appropriately, but not callers at low risk. Less than half of all respondents answered both scenarios correctly. The results obtained suggest that knowledge of SARS was generally good although obtained from both medical and non-medical sources. Specific knowledge was however lacking in certain areas and this affected the ability to appropriately triage callers. Standardized education and assessment of prior knowledge of SARS could improve the ability of physicians to triage callers in future outbreaks.

  8. [Bloodletting and rheumatism.: a retrospective view].

    Science.gov (United States)

    Kaiser, H

    2011-04-01

    Bloodletting was widely used in antiquity in the setting of a humoral-pathological concept as a general treatment for all ailments, as well as during the middle ages primarily as a remedy for the treatment of inflammatory and infectious diseases. The general population was convinced of the efficacy of this treatment for centuries, even requesting it on occasion on a prophylactic basis. Although questioned early in history, the number of sceptical voices increased in the 17th and 18th centuries. In 1835, P. Louis introduced statistics to medicine in Paris, thereby proving the inefficacy of bloodletting in inflammatory diseases. Today, bloodletting is used in scientific medicine in only a few rare disease.As long as rheumatic diseases remained undifferentiated, all cases were treated with bloodletting. After acute articular rheumatism 1591 was recognised as an independent disease entity, bloodletting remained the treatment of choice for most doctors right up to the end of the 19th century. Bloodletting was also the standard treatment for gout from antiquity up to the beginning of the 19th century. Following its differentiation in 1800, chronic articular rheumatism was no longer treated with venae sectio. Today, there is no indication for bloodletting therapy in rheumatology.

  9. Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: a study using case-control methodology.

    Science.gov (United States)

    Ansah, Evelyn K; Gyapong, Margaret; Narh-Bana, Solomon; Bart-Plange, Constance; Whitty, Christopher J M

    2016-05-25

    Several public health interventions to improve management of patients with fever are largely focused on the public sector yet a high proportion of patients seek care outside the formal healthcare sector. Few studies have provided information on the determinants of utilization of the private sector as against formal public sector. Understanding the differences between those who attend public and private health institutions, and their pathway to care, has significant practical implications. The chemical shop is an important source of care for acute fever in Ghana. Case-control methodology was used to identify factors associated with seeking care for fever in the Dangme West District, Ghana. People presenting to health centres, or hospital outpatients, with a history or current fever were compared to counterparts from the same community with fever visiting a chemical shop. Of 600 patients, 150 each, were recruited from the district hospital and two health centres, respectively, and 300 controls from 51 chemical shops. Overall, 103 (17.2 %) patients tested slide positive for malaria. Specifically, 13.7 % (41/300) of chemical shop patients, 30.7 % (46/150) health centre and 10.7 % (16/150) hospital patients were slide positive. While it was the first option for care for 92.7 % (278/300) chemical shop patients, 42.7 % (64/150) of health centre patients first sought care from a chemical shop. More health centre patients (61.3 %; 92/150) presented with fever after more than 3 days than chemical shop patients (27.7 %; 83/300) [AOR = 0.19; p < 0.001 CI 0.11-0.30]. Although the hospital was the first option for 83.3 % (125/150) of hospital patients, most (63.3 %; 95/150) patients arrived there over 3 days after their symptoms begun. Proximity was significantly associated with utilization of each source of care. Education, but not other socioeconomic or demographic factors were significantly associated with chemical shop use. The private drug retail sector is

  10. Investigating an outbreak of acute fever in Chuuk, Federated States of Micronesia

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    Damian Hoy

    2014-11-01

    Full Text Available Objective: In September 2012, there was an unexpected increase of acute febrile illness (AFI in Chuuk State of the Federated States of Micronesia. At the same time, dengue outbreaks were occurring in two of the Federated States of Micronesia’s other three states. The cause of AFI was suspected to be dengue; however, by the end of October, only one of 39 samples was positive for dengue. The objective of the investigation was to establish the cause of the outbreak. Methods: A line list was created and data analysed by time, place, person and clinical features. Reported symptoms were compared with the published symptoms of several diagnoses and laboratory testing undertaken. Results: Of the 168 suspected cases, 62% were less than 20 years of age and 60% were male. The clinical features of the cases were not typical for dengue but suggestive of respiratory illness. Nasopharyngeal swabs were subsequently collected and found to be positive for influenza. Public health measures were undertaken and the AFI returned to expected levels. Discussion: Clinical diagnosis of acute febrile illness (AFI can often be difficult and misleading. This can mean that opportunities for preventive measures early on in an outbreak are missed. In any outbreak, descriptive epidemiological analyses are valuable in helping to ascertain the cause of the outbreak.

  11. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness

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    Dallel Radhouane

    2010-02-01

    Full Text Available Abstract Background Chikungunya virus (CHIKV is responsible for major epidemics worldwide. Autochthonous cases were recently reported in several European countries. Acute infection is thought to be monophasic. However reports on chronic pain related to CHIKV infection have been made. In particular, the fact that many of these patients do not respond well to usual analgesics suggests that the nature of chronic pain may be not only nociceptive but also neuropathic. Neuropathic pain syndromes require specific treatment and the identification of neuropathic characteristics (NC in a pain syndrome is a major step towards pain control. Methods We carried out a cross-sectional study at the end of the major two-wave outbreak lasting 17 months in Réunion Island. We assessed pain in 106 patients seeking general practitioners with confirmed infection with the CHIK virus, and evaluated its impact on quality of life (QoL. Results The mean intensity of pain on the visual-analogical scale (VAS was 5.8 ± 2.1, and its mean duration was 89 ± 2 days. Fifty-six patients fulfilled the definition of chronic pain. Pain had NC in 18.9% according to the DN4 questionnaire. Conversely, about two thirds (65% of patients with NC had chronic pain. The average pain intensity was similar between patients with or without NC (6.0 ± 1.7 vs 6.1 ± 2.0. However, the total score of the Short Form-McGill Pain Questionnaire (SF-MPQ(15.5 ± 5.2 vs 11.6 ± 5.2; p Conclusions There exists a specific chronic pain condition associated to CHIKV. Pain with NC seems to be associated with more aggressive clinical picture, more intense impact in QoL and more challenging pharmacological treatment.

  12. Effect of administration of Streptococcus salivarius K12 on the occurrence of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media in 3 years old children.

    Science.gov (United States)

    Di Pierro, F; Colombo, M; Giuliani, M G; Danza, M L; Basile, I; Bollani, T; Conti, A M; Zanvit, A; Rottoli, A S

    2016-11-01

    Streptococcus salivarius K12 (BLIS K12) is a probiotic strain strongly antagonistic to the growth of Streptococcus pyogenes, the most important bacterial cause of pharyngeal infections in humans. Shown to colonize the oral cavity and to be safe for human use, BLIS K12 has previously been reported to reduce pharyngo-tonsillitis episodes in children or adults known to have experienced recurrent streptococcal infection. The present study was focussed upon evaluating the role of BLIS K12 in the control of streptococcal disease and acute otitis media in children attending the first year of kindergarten. By randomization, 222 enrolled children attending the first year of kindergarten were divided into a treated group (N = 111) receiving for 6 months a daily treatment with BLIS K12 (Bactoblis®) and a control group (N = 111) who were monitored as untreated controls. During the 6 months of treatment and 3 months of follow-up, the children were evaluated for treatment tolerance, and for episodes of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media. During the 6-month trial (N = 111 per group) the incidence of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media was approximately 16%, 9% and 44% respectively in the treated group and 48%, 4% and 80% in the control group. During the 3-months follow-up (N = 29 per group) the corresponding rates of infection were 15%, 0% and 12% in the treated group and 26%, 6% and 36% in the controls. No apparent side effects were detected in the treated group either during treatment or follow-up. All of the enrolled children completed the study. The daily administration of BLIS K12 to children attending their first year of kindergarten was associated with a significant reduction in episodes of streptococcal pharyngitis and acute otitis media. No protection against scarlet fever was detected.

  13. Hemorrhagic Fevers

    Science.gov (United States)

    ... of viruses. These include the Ebola and Marburg, Lassa fever, and yellow fever viruses. VHFs have common features: ... the animals that carry them live. For example, Lassa fever is limited to rural areas of West Africa ...

  14. Fever without apparent source on clinical examination, lower respiratory infections in children, bacterial infections, and acute gastroenteritis and diarrhea of infancy and early childhood.

    Science.gov (United States)

    McCarthy, P L; Bachman, D T; Shapiro, E D; Baron, M A

    1995-02-01

    This section focuses on issues in infectious disease that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. David Bachman reviews recent literature about lower respiratory tract infection in children and focuses on community-acquired lower respiratory infections and respiratory syncytial virus. Eugene Shapiro discusses literature concerning several infectious diseases commonly seen in office settings and concerning which recent developments are of interest: the hemolytic-uremic syndrome and enterohemorrhagic Escherichia coli. Streptococcus pneumoniae resistant to penicillin, infections in day care centers, and new antimicrobial drugs. Michael Baron reviews recent literature about gastroenteritis and diarrhea of infancy and early childhood and discusses diagnosis, complications, pathogenesis and physiology, epidemiology, and treatment.

  15. Whole-body MR imaging for patients with rheumatism

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    Weckbach, Sabine [Department of Clinical Radiology and Nuclear Medicine, Unversity Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany)], E-mail: sabine.weckbach@umm.de

    2009-06-15

    WB-MRI in rheumatic diseases is still an emerging imaging tool. So far, WB-MRI in rheumatism is mainly used in seronegative spondyloarthropathies. In these diseases it has the ability to visualize the majority of involved joints and soft tissue structures (both active inflammatory changes and chronic structural abnormalities) in one examination, making it suitable for imaging of different forms of spondylopathies, allowing different types of joint involvement to be recognized and assessing both the acute symptoms of disease and the longer-term consequences. Its role in daily practice is not yet clear. WB-MRI is not recommended as a first line investigation in every patient suffering from a form of spondyloarthropathy, but may add important information in difficult cases. Moreover, WB-MRI might obtain a stronger role in the early diagnosis of spondyloarthritides and in the assessment of treatment response. Other rheumatic diseases where WB-MRI may play a role in the future are polymyositis/dermatomyositis, CRMO and certain forms of systemic vasculitis. WB-MRI in rheumatism is a promising tool with great potential, however further systematic evaluation of its abilities and limitations in different forms of rheumatic diseases is awaited.

  16. A clinical review of 192 rheumatic disease cases with fever of unknown origin%以不明原因发热为表现的风湿性疾病192例临床分析

    Institute of Scientific and Technical Information of China (English)

    袁建花; 张莉芸

    2010-01-01

    目的 风湿性疾病是不明原因发热常见的病因之一,其病种众多、临床表现多样,诊断较难,漏诊和误诊率较高.本文探讨风湿性疾病所致不明原因发热(fever ofunknown origin,FUO)的病种,分析临床特点.方法 回顾性分析2004年10月~2009年10月山西医科大学第二医院风湿科住院患者资料,符合FUO标准确诊为风湿性疾病者192例.结果 痛种以系统性红斑狼疮(SLE,18.8%)、原发性干燥综合症(pSS,18.2%)、未分化结缔组织病(UCTD,17.2%)、未分化脊柱关节病(USpA,10.9%)、多肌炎/皮肌炎(PM/DM,10.9%)、白塞病(BD,8.3%)较多见,临床表现不典型;其他疾病较少见,共占30%,6左右.结论 风湿性疾病所致FUO病例中表现不典型的风湿性疾病是主要病种,提高对风湿性疾病的认识,合理进行检查,是诊断风湿性疾病所致FUO的关键.

  17. Filgrastim as a Rescue Therapy for Persistent Neutropenia in a Case of Dengue Hemorrhagic Fever with Acute Respiratory Distress Syndrome and Myocarditis

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    Desh Deepak

    2011-01-01

    Full Text Available Pathogenesis of dengue involves suppression of immune system leading to development of characteristic presentation of haematological picture of thrombocytopenia and leucopenia. Sometimes, this suppression in immune response is responsible for deterioration in clinical status of the patient in spite of all specific and supportive therapy. Certain drugs like steroids are used for rescue therapy in conditions like sepsis. We present a novel use of filgrastim as a rescue therapy in a patient with dengue hemorrhagic fever (DHF with acute respiratory distress syndrome (ARDS, myocarditis, and febrile neutropenia and not responding to standard management.

  18. What a rheumatologist needs to know about yellow fever vaccine.

    Science.gov (United States)

    Oliveira, Ana Cristina Vanderley; Mota, Licia Maria Henrique da; Santos-Neto, Leopoldo Luiz Dos; Tauil, Pedro Luiz

    2013-04-01

    Patients with rheumatic diseases are more susceptible to infection, due to the underlying disease itself or to its treatment. The rheumatologist should prevent infections in those patients, vaccination being one preventive measure to be adopted. Yellow fever is one of such infectious diseases that can be avoided.The yellow fever vaccine is safe and effective for the general population, but, being an attenuated live virus vaccine, it should be avoided whenever possible in rheumatic patients on immunosuppressive drugs. Considering that yellow fever is endemic in a large area of Brazil, and that vaccination against that disease is indicated for those living in such area or travelling there, rheumatologists need to know that disease, as well as the indications for the yellow fever vaccine and contraindications to it. Our paper was aimed at highlighting the major aspects rheumatologists need to know about the yellow fever vaccine to decide about its indication or contraindication in specific situations.

  19. Emergence of Q Fever

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    E Angelakis

    2011-09-01

    Full Text Available Q fever is a worldwide zoonosis with many acute and chronic manifestations caused by the pathogen Coxiella burnetii. Farm animals and pets are the main reservoirs of infection, and transmission to human beings is mainly accomplished through inhalation of contaminated aerosols. Persons at greatest risk are those in contact with farm animals and include farmers, abattoir workers, and veterinarians. The organs most commonly affected during Q fever are the heart, the arteries, the bones and the liver. The most common clinical presentation is an influenza-like illness with varying degrees of pneumonia and hepatitis. Although acute disease is usually self-limiting, people do occasionally die from this condition. Endocarditis is the most serious and most frequent clinical presentation of chronic Q fever. Vascular infection is the second most frequent presentation of Q fever. The diagnosis of Q fever is based on a significant increase in serum antibody titers. The treatment is effective and well tolerated, but must be adapted to the acute or chronic pattern with the tetracyclines to be considered the mainstay of antibiotic therapy. For the treatment of Q fever during pregnancy the use of long-term cotrimoxazole therapy is proposed.

  20. Neurologic Manifestations of Childhood Rheumatic Diseases

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    Reza SHIARI

    2013-01-01

    , Levinson JE, Bass JC, Baum J, Brewer EJJr., Fink CW et al. A study of classification criteria fora diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum. 1986 Feb;29(2:274-81. 34. Ravelli A, Martini A. Juvenile idiopathic arthritis.Lancet. 2007 Mar 3;369(9563:767-78. 35. Farivar S, Shiari R, Hadi E. Genetic susceptibility tojuvenile idiopathic arthritis in Iranian children. Arch Med Res. 2011 May;42(4:301-4. 36. Unal O, Ozçakar L, Cetin A, Kaymak B. Severe bilateral carpal tunnel syndrome in juvenile chronic arthritis.Pediatr Neurol. 2003 Oct;29(4:345-8. 37. Ueno H, Katamura K, Hattori H, Yamaguchi Y,Nakahata T. Acute lethal encephalopathy in systemic juvenile rheumatoid arthritis. Pediatr Neurol. 2002 Apr;26(4:315-7. 38. Duzova A, Bakkaloglu A. Central nervous system involvement in pediatric rheumatic diseases:current concepts in treatment. Curr Pharm Des.2008;14(13:1295-301. 39. Laiho K, Savolainen A, Kautiainen H, Kekki P, Kauppi M. The cervical spine in juvenile chronic arthritis. Spine J. 2002 Mar-Apr;2(2:89-94. 40. De Cunto CL, Liberatore DI, San Román JL, Goldberg JC, Morandi AA, Feldman G. Infantile-onset multisystem inflammatory disease: a differential diagnosis of systemic juvenile rheumatoid arthritis. J Pediatr. 1997 Apr;130(4:551-6. 41. Farivar S, Shiari R, Hadi E. Molecular analysis of MEFV gene in Iranian children with familial Mediterranean fever. Ind J Rheumato. 2010 Jun;5(2:66-8. 42. Kalyoncu U, Eker A, Oguz KK, Kurne A, Kalan I,Topcuoglu AM et al. Familial Mediterranean fever and central nervous system involvement: a case series. Medicine (Baltimore. 2010 Mar;89(2:75-84. 43. Radice A, Sinico RA. Antineutrophil cytoplasmic antibodies (ANCA. Autoimmunity. 2005 Feb;38(1:93-103. 44. Nishino H, Rubino FA, DeRemee RA, Swanson JW,Parisi JE. Neurological involvement in Wegener’s granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic. Ann Neurol. 1993 Jan;33(1:4-9. 45. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA,Arend WP et al

  1. An immunological perspective on rheumatic heart disease pathogenesis: more questions than answers.

    Science.gov (United States)

    Bright, Philip David; Mayosi, Bongani M; Martin, William John

    2016-10-01

    Acute rheumatic fever (ARF) and the related rheumatic heart disease (RHD) are autoimmune diseases thought to be triggered by group A streptococcal (GAS) pharyngitis. RHD is a leading cause of mortality in the developing world. The strong epidemiological association between GAS throat infection and ARF is highly suggestive of causation, but does not exclude other infections as contributory. There is good evidence of both humoral and cellular autoreactivity and GAS/self cross-reactivity in established RHD. RHD pathogenesis could feasibly be triggered and driven by humoral and/or cellular molecular cross-reactivity between GAS and host cardiac tissues (molecular mimicry). However, good evidence of humoral pathogenicity is lacking and the specific triggering event for RHD remains unknown. It is likely that the critical immunological events leading to ARF/RHD occur at the point of contact between GAS and the immune system in the throat, strongly implicating the mucosal immune system in RHD pathogenesis. Additionally, there is circumstantial evidence that continued live GAS may play a role in ARF/RHD pathogenesis. We suggest that future avenues for study should include the exclusion of GAS components directly contributing to RHD pathogenesis; large genome-wide association studies of patients with RHD looking for candidate genes involved in RHD pathogenesis; genome-wide association studies of GAS from patients with ARF taken at diagnosis to look for characteristics of rheumatogenic strains; and performing case/control studies of GAS pharyngitis/ARF/patients with RHD, and controls to identify microbiological, immunological and environmental differences to elucidate RHD pathogenesis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Recurrent Acute Nonrheumatic Streptococcal Myocarditis Mimicking STEMI in a Young Adult

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    Amanda Chikly

    2014-01-01

    Full Text Available Myocarditis consists of an inflammation of the cardiac muscle, definitively diagnosed by endomyocardial biopsy. The causal agents are primarily infectious: in developed countries, viruses appear to be the main cause, whereas in developing countries rheumatic carditis, Chagas disease, and HIV are frequent causes. Furthermore, myocarditis can be indirectly induced by an infectious agent and occurs following a latency period during which antibodies are created. Typically, myocarditis observed in rheumatic fever related to group A streptococcal (GAS infection occurs after 2- to 3-week period of latency. In other instances, myocarditis can occur within few days following a streptococcal infection; thus, it does not fit the criteria for rheumatic fever. Myocarditis classically presents as acute heart failure, and can also be manifested by tachyarrhythmia or chest pain. Likewise, GAS-related myocarditis reportedly mimics myocardial infarction (MI with typical chest pain, electrocardiograph changes, and troponin elevation. Here we describe a case of recurrent myocarditis, 5 years apart, with clinical presentation imitating an acute MI in an otherwise healthy 37-year-old man. Both episodes occurred 3 days after GAS pharyngitis and resolved quickly following medical treatment.

  3. Acute movement disorders in children: experience from a developing country.

    Science.gov (United States)

    Goraya, Jatinder Singh

    2015-03-01

    We describe acute movement disorders in 92 children, aged 5 days to 15 years, from an Indian tertiary hospital. Eighty-nine children had hyperkinetic movement disorders, with myoclonus in 25, dystonia in 21, choreoathetosis in 19, tremors in 15, and tics in 2. Tetany and tetanus were seen in 5 and 2 children, respectively. Hypokinetic movement disorders included acute parkinsonism in 3 children. Noninflammatory and inflammatory etiology were present in 60 and 32 children, respectively. Benign neonatal sleep myoclonus in 16 and opsoclonus myoclonus syndrome in 7 accounted for the majority of myoclonus cases. Vitamin B12 deficiency in 13 infants was the most common cause of tremors. Rheumatic fever and encephalitis were the most common causes of acute choreoathetosis. Acute dystonia had metabolic etiology in 6 and encephalitis and drugs in 3 each. Psychogenic movement disorders were seen in 4 cases only, although these patients may be underreported.

  4. Treatment for rheumatic polymyalgia

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    Azamat Makhmudovich Satybaldyev

    2013-03-01

    Full Text Available Glucocorticosteroids (GCs that provide a good and rapid clinical effect are the drug of choice to treat rheumatic polymyalgia (RP. A review of English language publications on the treatment of RP is given. Thirty (13 randomized and 17 observational studies of 20 and more patients with RP have been analyzed. Particular emphasis is laid on initial therapy with GCs, evaluation of their different daily doses, schemes for their dosage reduction and treatment termination, and on the frequency of recurrences. Studies dealing with the treatment with prednisone, prednisolone, methylprednisolone, and injectable sustained-release GC formulations are considered. The data of clinical trials of glucocorticoid-sparing agents (methotrexate, azathioprine during early and maintenance therapy are analyzed. The genetically engineered agents (infliximab, etanercept investigated in clinical trials are considered to be as alternatives; a case of using rituximab is described. The role of nonsteroidal anti-inflammatory drugs in the treatment of RP is also evaluated. An algorithm is proposed for the management of a patient with RP.

  5. Miscellaneous neurologic, cardiac, pulmonary, and metabolic disorders with rheumatic manifestations.

    Science.gov (United States)

    Larkin, J

    1994-01-01

    The First International Workshop on Hypertrophic Osteoarthropathy crystallized the current knowledge of this puzzling syndrome. Cytokine release by large thrombocytes in the periphery is the favored etiology, although specific therapy remains unavailable. An article on the rheumatologic consequences of alcohol is reviewed, along with a number of case reports of joint problems in rare skin and metabolic diseases. Understanding the mechanisms of rarities, including rheumatic fever, interleukin-2-induced arthritis, and a unique "menstrual arthritis" might give insight into the etiology of more common arthropathies.

  6. IL-10 and ET-1 as biomarkers of rheumatic valve disease

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    Sydney Correia Leão

    2014-03-01

    Full Text Available Objective: To evaluate the immunological profile and gene expression of endothelin-1 (ET-1 in mitral valves of patients with rheumatic fever originated from a reference service in cardiovascular surgery. Methods: This was a quantitative, observational and cross-sectional study. Thirty-five subjects (divided into four groups participated in the study, 25 patients with chronic rheumatic heart disease and ten control subjects. The mean age of the sample studied was 34.5 years. Seventeen of them (48.58% were male and 18 (51.42% were female. Inflammatory cytokines (TNF-α, IL-4 and IL-10 were measured and ten mitral valves of patients who underwent first valve replacement were collected for determination of gene expression of endothelin-1 by real time PCR. Results: Among the groups studied (patients vs. controls, there was a statistically significant difference in IL-10 levels (P=0.002, and no differences in other cytokines. Expression of endothelin-1 was observed in 70% of samples. Quantitatively, average of ET-1 expression was 62.85±25.63%. Conclusion: Inflammatory cytokine IL-10 participates in the maintenance of chronicity of rheumatic fever in patients who underwent valve replacement and those who are undergoing medical treatment. The expression of endothelin-1 in heart valve lesions in patients undergoing mitral valve replacement confirms its association with inflammatory activity in rheumatic fever.

  7. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy.

    Science.gov (United States)

    Kumar, Lovekesh; Singh, Mahendra; Saxena, Ashish; Kolhe, Yuvraj; Karande, Snehal K; Singh, Narendra; Venkatesh, P; Meena, Rambabu

    2015-01-01

    Dengue fever is the most important arbovirus illness with an estimated incidence of 50-100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy.

  8. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

    Directory of Open Access Journals (Sweden)

    Lovekesh Kumar

    2015-01-01

    Full Text Available Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy.

  9. Unusual Presentation of Dengue Fever Leading to Unnecessary Appendectomy

    Science.gov (United States)

    Kumar, Lovekesh; Singh, Mahendra; Saxena, Ashish; Kolhe, Yuvraj; Karande, Snehal K.; Singh, Narendra; Venkatesh, P.; Meena, Rambabu

    2015-01-01

    Dengue fever is the most important arbovirus illness with an estimated incidence of 50–100 million cases per year. The common symptoms of dengue include fever, rash, malaise, nausea, vomiting, and musculoskeletal pain. Dengue fever may present as acute abdomen leading to diagnostic dilemma. The acute surgical complications of dengue fever include acute pancreatitis, acute acalculous cholecystitis, nonspecific peritonitis, and acute appendicitis. We report a case of dengue fever that mimicked acute appendicitis leading to unnecessary appendectomy. A careful history examination for dengue-related signs, and serial hemogram over the first 3-4 days of disease may prevent unnecessary appendectomy. PMID:26167314

  10. Macrophage Activation Syndrome in Paediatric Rheumatic Diseases.

    Science.gov (United States)

    Islam, M I; Talukder, M K; Islam, M M; Laila, K; Rahman, S A

    2017-04-01

    Macrophage activation syndrome (MAS) is a potentially fatal complication of rheumatic disorders, which commonly occurs in systemic juvenile idiopathic arthritis (sJIA).This study was carried out with the aims of describing the clinical features, laboratory findings and outcomes of MAS associated with paediatric rheumatic diseases in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) and compare these results with previous studies on MAS. This retrospective study was conducted in the paediatric rheumatology wing of the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Clinical and laboratory profile of all the diagnosed cases of MAS were analyzed from the medical records from January 2010 to July 2015. Among 10 MAS patients, 6 were female and 4 were male. Seven patients of systemic JIA, two patients of SLE and one patient with Kawasaki Disease developed MAS in their course of primary disease. Mean duration of primary disease prior to development of MAS was 2.9 years and mean age of onset was 9.1 years. High continued fever and new onset hepatosplenomegaly were the hallmark of the clinical presentation. White blood cell count and platelet count came down from the mean of 16.2 to 10.2×10⁹/L and 254 to 90×10⁹/L. Mean erythrocyte sedimentation rate was dropped from 56 to 29 mm/hr. Six patients had abnormal liver enzyme level (ALT) and 5 had evidence of coagulopathy (prolonged prothrombin time and APTT) at the onset of disease. Hyperferritinnemia were found in all the patients. Bone marrow study was done in 5 patients but features of hamophagocytosis were found only in 2 patients. All patients received intravenous steroid and 3 patients who did not respond to steroid received additional cyclosporine. Mortality rate was 30% in this series. Macrophage activation syndrome is a fatal complication of paediatric rheumatic diseases among which s-JIA was predominant. Early diagnosis and

  11. KONSUPREN IN THETHERAPY OF RHEUMATIC DISEASES

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    Z S Alekberova

    2001-01-01

    Full Text Available Summary Aim: to assess the efficacy and tolerability of Consupren (Galena, Chekia in some rheumatic diseases. Material and methods. Three months’ therapy by Consupren was studied in 12 patients: 4 with SLE, 4 with Behcet’s disease, 2 with rheumatoid arthritis with systemic manifestations, 2 with juvenile rheumatoid arthritis. Sandimmune therapy was changed for Consupren in 9 patients. All patients were controlled for the level of serum creatinine and AD and had consultations with ophtalmologist. Results. 3 SLE patients treated by Consupren demonstrated decreasing of proteinuria, disease activity by SLAM and SLEDA1, the fourth patient demonstrated fading of diskoid rash and normalizing of temperature. Patients with Behcet’s disease had no episodes of ulcerous stomatitis and uveitis exacerbation, in one patient stable nodular erythema disappeared. Patients with JRA improved articular syndrome, normalized temperature, reduced acute phase indices. Both patients continue taking Consupren, RA patients had long term of onset of the disease and 111-IV radiological stage , thus the effect on the articular syndrome was not so demonstrative but the activity of the disease reduced. Conclusion: consupren is effective and well tolerable drug for patients with systemic manifestations of rheumatic diseases. No side effects were noticed.

  12. Appendicular perforation in dengue fever: our experience

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    Gunjan Desai

    2014-09-01

    Full Text Available Dengue viral infections have become one of major emerging infectious diseases in the tropics. Acute abdomen occurring in dengue viral infection is not uncommon. The spectrums of acute surgical emergencies which raise suspicion of an abdominal catastrophe in patients presenting with dengue fever include acute pancreatitis, acute acalculous cholecystitis, non-specific peritonitis and very rarely acute appendicitis. The presence of low white cell count and platelet count can raise suspicion of a diagnosis of dengue in a patient presenting with acute abdominal pain, during a dengue epidemic. We herein report three patients with dengue fever who had appendicular perforation during the course of their viral fever.

  13. An acute multispecies episode of sheep-associated malignant catarrhal fever in captive wild animals in an Italian zoo

    Science.gov (United States)

    In July 2011, in a zoological garden in Rome, Italy, malignant catarrhal fever (MCF), a fatal, systemic disease of Artiodactyls, was suspected on the basis of neurological signs and gross lesions observed in a banteng, the first animal to die of this infection. An MCF type-specific, one-step PCR wit...

  14. The macrophages in rheumatic diseases

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    Laria A

    2016-02-01

    Full Text Available Antonella Laria, Alfredomaria Lurati , Mariagrazia Marrazza , Daniela Mazzocchi, Katia Angela Re, Magda Scarpellini Rheumatology Unit, Fornaroli Hospital, Magenta, Italy Abstract: Macrophages belong to the innate immune system giving us protection against pathogens. However it is known that they are also involved in rheumatic diseases. Activated macrophages have two different phenotypes related to different stimuli: M1 (classically activated and M2 (alternatively activated. M1 macrophages release high levels of pro-inflammatory cytokines, reactive nitrogen and oxygen intermediates killing microorganisms and tumor cells; while M2 macrophages are involved in resolution of inflammation through phagocytosis of apoptotic neutrophils, reduced production of pro-inflammatory cytokines, and increased synthesis of mediators important in tissue remodeling, angiogenesis, and wound repair. The role of macrophages in the different rheumatic diseases is different according to their M1/M2 macrophages phenotype. Keywords: macrophage, rheumatic diseases

  15. Valley Fever

    Science.gov (United States)

    Valley Fever is a disease caused by a fungus (or mold) called Coccidioides. The fungi live in the soil ... from person to person. Anyone can get Valley Fever. But it's most common among older adults, especially ...

  16. Familial Mediterranean fever in Russia: Experience of the Federal Rheumatology Center

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    E. S. Fedorov

    2017-01-01

    Full Text Available The paper gives the experience of the V.A. Nasonova Research Institute of Rheumatology in identifying and managing patients with familial Mediterranean fever (FMF. Objective: to describe the features of the disease in patients with FMF in Russia and to compare them with the data obtained in the study of Turkish and Armenian populations with a high incidence of this disease. Patients and methods. The investigation enrolled 23 patients with a documented diagnosis of FMF who met the Turkish pediatric criteria (F. Yalcinkaya et al. and/or the criteria described by A. Livnech et al. and had two identical mutations (homozygosity or two different mutations (compound heterozygosity in the MEFV gene. Among the patients there were 9 men and 14 women. The age of the patients at the time of treatment was 4.5 to 36 years. Their age at onset of FMF was 2 months to 15 years (mean age, 3.2±2.3 years. Results. The examination established that 18 (78.3% patients were Armenians, 3 were representatives of the North Caucasus peoples (a Darghin woman, an Avar man, and an Ingush/Kabardian man, a man from mixed (Greek/Georgian marriage, and a Russian woman whose ancestors were Armenian and Jewish. The most common manifestation of FMF were recurrent episodes of fever (22; 95.7%; abdominal pain with fever ranked second (19; 82.6%, followed by chest pain (11; 47.8%, locomotor apparatus lesion (16; 69.6%, and skin lesions (7; 30.4%. The episodes were accompanied by increased levels of acutephase markers in 100% of the patients. There were a high proportion of patients, in whom FMF was concurrent with other rheumatic and autoinflammatory diseases (juvenile chronic arthritis, chronic recurrent multifocal osteomyelitis, and acute rheumatic fever (7; 30.4%. Twenty-two (95.6% patients received colchicine; the tumor necrosis factor inhibitor etanercept was prescribed in 2 (8.7% patients with comorbidity; there was a pronounced therapeutic effect. Conclusion. Although the

  17. RHEUMATIC MASKS OF PARANEOPLASTIC SYNDROME

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    A. P. Rebrov

    2001-01-01

    Full Text Available Summary Analysis of the prevalence and clinical manifestations of paraneoplastic syndrome in 173 patients with malignant tumors admitted in departments internal medicine of Regional Clinical hospital was done. Paraneoplastic syndromes was found in 13 patients (7% and was characterized by the following rheumatic manifestations: articular syndrome, dermato- and polymyositis, lupus-like syndrome.

  18. [Alternative treatment methods in rheumatic diseases; a literature review].

    Science.gov (United States)

    Jacobs, J W; Rasker, J J; Van Riel, P L; Gribnau, F W; van de Putte, L B

    1991-02-23

    To evaluate the effectiveness of several types of complementary medicine in patients with rheumatic diseases, a literature search was performed. Clinical trials, blind or open, comparing the effectiveness of forms of complementary medicine with that of placebo or another control therapy in patients with rheumatoid arthritis, osteoarthritis, soft tissue rheumatism and the fibromyalgia syndrome were selected until half of 1989, using electronic databases. Abstracts and summaries were excluded. The investigation was performed at the department of rheumatology of the Medisch Spectrum Twente hospital at Enschede in cooperation with the department of internal diseases of the Sint Radboud hospital at Nijmegen. For each type of complementary treatment, the results of all the clinical trials were summarized. Furthermore, the placebo-controlled trials were graded according to convincing trials or trials that seemed to be less valid and/or difficult to interpret. Data concerning acupuncture, balneotherapy, dietary measures, enzymic therapy, Seatone, homeopathy, manual therapy and fever few were found. Of these types of complementary medicine in rheumatic diseases, we found no convincing prove that they are more effective than the control or placebo treatment. A considerable number of the studies however can be criticized. It is necessary to perform further studies on the effect of frequently used types of complementary medicine in patients with rheumatic diseases, by or in cooperation with the physicians or paramedics who prescribe or perform these kinds of treatment. This is nearly always possible; directives are given to realize further studies of this kind. If a particular treatment proves to be no more effective than placebo treatment, its use should be discouraged.

  19. Streptococcal acute pharyngitis

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    Lais Martins Moreira Anjos

    2014-07-01

    Full Text Available Acute pharyngitis/tonsillitis, which is characterized by inflammation of the posterior pharynx and tonsils, is a common disease. Several viruses and bacteria can cause acute pharyngitis; however, Streptococcus pyogenes (also known as Lancefield group A β-hemolytic streptococci is the only agent that requires an etiologic diagnosis and specific treatment. S. pyogenes is of major clinical importance because it can trigger post-infection systemic complications, acute rheumatic fever, and post-streptococcal glomerulonephritis. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate. Cough, coryza, conjunctivitis, and diarrhea are uncommon, and their presence suggests a viral cause. A diagnosis of pharyngitis is supported by the patient's history and by the physical examination. Throat culture is the gold standard for diagnosing streptococcus pharyngitis. However, it has been underused in public health services because of its low availability and because of the 1- to 2-day delay in obtaining results. Rapid antigen detection tests have been used to detect S. pyogenes directly from throat swabs within minutes. Clinical scoring systems have been developed to predict the risk of S. pyogenes infection. The most commonly used scoring system is the modified Centor score. Acute S. pyogenes pharyngitis is often a self-limiting disease. Penicillins are the first-choice treatment. For patients with penicillin allergy, cephalosporins can be an acceptable alternative, although primary hypersensitivity to cephalosporins can occur. Another drug option is the macrolides. Future perspectives to prevent streptococcal pharyngitis and post-infection systemic complications include the development of an anti-Streptococcus pyogenes vaccine.

  20. Primary dengue haemorrhagic fever in patients from northeast of Brazil is associated with high levels of interferon-β during acute phase

    Science.gov (United States)

    Oliveira, Renato Antônio dos Santos; da Silva, Mayara Marques Carneiro; Calzavara-Silva, Carlos Eduardo; Silva, Ana Maria; Cordeiro, Marli Tenório; de Moura, Patrícia Muniz Mendes Freire; Baptista, Paulo Neves; Marques, Ernesto Torres de Azevedo; Gil, Laura Helena Vega Gonzales

    2016-01-01

    Dengue is an acute febrile disease caused by the mosquito-borne dengue virus (DENV) that according to clinical manifestations can be classified as asymptomatic, mild or severe dengue. Severe dengue cases have been associated with an unbalanced immune response characterised by an over secretion of inflammatory cytokines. In the present study we measured type I interferon (IFN-I) transcript and circulating levels in primary and secondary DENV infected patients. We observed that dengue fever (DF) and dengue haemorrhagic fever (DHF) patients express IFN-I differently. While DF and DHF patients express interferon-α similarly (52,71 ± 7,40 and 49,05 ± 7,70, respectively), IFN- β were associated with primary DHF patients. On the other hand, secondary DHF patients were not able to secrete large amounts of IFN- β which in turn may have influenced the high-level of viraemia. Our results suggest that, in patients from our cohort, infection by DENV serotype 3 elicits an innate response characterised by higher levels of IFN- β in the DHF patients with primary infection, which could contribute to control infection evidenced by the low-level of viraemia in these patients. The present findings may contribute to shed light in the role of innate immune response in dengue pathogenesis. PMID:27223651

  1. Haemorrhagic Fevers, Viral

    Science.gov (United States)

    ... is usually applied to disease caused by Arenaviridae (Lassa fever, Junin and Machupo), Bunyaviridae (Crimean-Congo haemorrhagic fever, ... fever Dengue and severe dengue Ebola virus disease Lassa fever Marburg haemorrhagic fever Rift Valley fever Multimedia, features ...

  2. Dengue hemorrhagic fever complicated by pancreatitis

    Directory of Open Access Journals (Sweden)

    Guido Ricardo Gonzalez Fontal

    2011-10-01

    Full Text Available Acute pancreatitis is an atypical complication of dengue fever and is rarely described. We are reporting a case of dengue hemorrhagic fever complicated by acute pancreatitis in a patient with history of diabetes mellitus type 1 and end stage renal disease on hemodialysis.

  3. Kinetics of pro-inflammatory cytokines, interleukin-10, and virus neutralising antibodies during acute ephemeral fever virus infections in Brahman cattle.

    Science.gov (United States)

    Barigye, R; Melville, L F; Davis, S; Walsh, S; Hunt, N; Hunt, R; Elliot, N

    2015-12-15

    While fever and inflammation are hallmark features of bovine ephemeral fever (BEF), the cytokine networks that underlie the acute phase of the disease have not been empirically defined in cattle. This study characterised the plasma kinetics of proinflammatory cytokines (IL-1β, IL-6, TNF-α) and IL-10 during acute BEF and elucidated on the relationship between the onset of the virus neutralizing antibody response and resolution of viraemia in natural BEF virus (BEFV) infections in cattle. Plasma from three BEFV-infected and three uninfected cattle was tested for the study cytokines by a cELISA, viraemia monitored by qRT-PCR, and virus neutralizing antibody titres determined using a standard protocol. Unlike the negative controls, plasma concentrations of IL-1β, TNF-α, IL-6, and IL-10 were consistently increased in the three virus-infected animals. Two of the infected heifers were recumbent and pyrexic on the first day of monitoring and increased cytokine production was already in progress by the time viraemia was detected in all the three infected animals. In all the virus-infected heifers, IL-1β was the most strongly expressed cytokine, IL-6 and IL-10 manifested intermediate plasma concentrations while TNF-α was the least expressed and demonstrated bi-phasic peaks three and five days after the onset of pyrexia. In two of the BEFV-infected heifers, viraemia resolved on the day of seroconversion while in the other infected animal, viral RNA was detectable up to three days after seroconversion. The present data document variable increase in plasma IL-1β, IL-6, TNF-α, and IL-10 during natural BEFV infections and the fact that upregulation of all but TNF-α precedes seroconversion. In addition to virus neutralising antibodies, it is likely that cytokine-mediated cellular mechanisms may be required for resolution of viraemia in BEF. Considering the anti-inflammatory properties of IL-10, its upregulation may potentially antagonise the fever response in BEFV

  4. [Streptococcus pyogenes--much more than the aetiological agent of scarlet fever].

    Science.gov (United States)

    Stock, Ingo

    2009-11-01

    The grampositive bacterium S. pyogenes (beta-haemolytic group A Streptococcus) is a natural colonizer of the human oropharynx mucous membrane and one of the most common agents of infectious diseases in humans. S. pyogenes causes the widest range of disease in humans among all bacterial pathogens. It is responsible for various skin infections such as impetigo contagiosa and erysipelas, and localized mucous membrane infections of the oropharynx (e. g. tonsillitis and pharyngitis). Betahaemolytic group A Streptococcus causes also invasive diseases such as sepses including puerperal sepsis. Additionally, S. pyogenes induces toxin-mediated syndromes, i. e. scarlet fever, streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF). STSS and NF are severe, frequently fatal diseases that have emerged in Europe and Northern America during the last two decades. Finally, some immunpathological diseases such as acute rheumatic fever and glomerulonephritis also result from S. pyogenes infections. Most scientists recommend penicillins (benzylpenicillin, phenoxymethylpenicllin) as drugs of first choice for treatment of Streptococcus tonsillopharyngitis and scarlet fever. Erysipelas and some other skin infections should be treated with benzylpenicillin. Intensive care measurements are needed for treatment of severe toxin-mediated S. pyogenes diseases. These measurements include the elimination of internal bacterial foci, concomitant application of clindamycin and benzylpenicillin and suitable treatment of shock symptoms. Management of immunpathological diseases requires antiphlogistical therapy. Because of the wide distribution of S. pyogenes in the general population and the lack of an effective vaccine, possibilities for prevention allowing a suitable protection for diseases due to S. pyogenes are very limited.

  5. 唑来膦酸治疗女性绝经后骨质疏松所致急性发热临床分析%Analysis of acute fever reaction in postmenopausal women with zoledronic acid treatment for osteoporosis

    Institute of Scientific and Technical Information of China (English)

    杨毅; 刘丽梅; 李蓬秋; 鲜杨; 张学军; 包明晶; 张磊; 杨艳; 朱显军; 曹旭

    2013-01-01

    Objective To analyze the incidence of acute fever reaction after the treatment of intravenous zoledronic acid in postmenopausal women with osteoporosis, and to identify the related factors. Methods Clinical data of 63 postmenopausal women with osteoporosis, who were treated with intravenous infusion of 5mg zoledronic acid from June 2010 to April 2012, were analyzed retrospectively. The incidence of acute fever reaction in these patients was observed. All the patients were divided into fever group and non-fever group according to whether having fever symptoms or not. The age, severity of osteoporosis before zoledronic acid treatment, variations of parathyroid hormone and serum calcium, and the use of anti-osteoporosis drugs before the treatment were compared between the 2 groups. Results Twenty-one patients had acute fever reaction ( 33.3% ). Among these 21 patients, 71% patients ( 15/21 ) had fever on the day of zoledronic acid treatment, and the other patients had fever on the first day after the treatment. The fever lasted for 1 day in 66. 7% of the patients ( 14/21 ), and for 2 days in 5 patients. The average temperature was 38. 8 ±0.5 C. The patients with fever had higher parathyroid hormone level before treatment than those without fever ( P <0.05 ). Serum calcium and bone mineral density showed no significant difference between the 2 groups. Conclusion Acute fever reaction is not rare in postmenopausal patients receiving intravenous zoledronic acid for the treatment of osteoporosis, but it is transient. Parathyroid hormone level before the treatment is associated with the fever.%目的 分析静脉用唑来膦酸治疗女性绝经后骨质疏松患者引起的急性发热反应及其相关因素.方法 回顾性分析我科2010年6月至2012年4月使用静脉用唑来膦酸5mg治疗的绝经后骨质疏松患者共63人.观察急性期发热出现比例.按是否出现发热症状分为发热组与无发热组.比较两组患者年龄、静脉用唑来膦

  6. Yellow fever.

    Science.gov (United States)

    Monath, Thomas P; Vasconcelos, Pedro F C

    2015-03-01

    Yellow fever, a mosquito-borne flavivirus disease occurs in tropical areas of South America and Africa. It is a disease of major historical importance, but remains a threat to travelers to and residents of endemic areas despite the availability of an effective vaccine for nearly 70 years. An important aspect is the receptivity of many non-endemic areas to introduction and spread of yellow fever. This paper reviews the clinical aspects, pathogenesis, and epidemiology of yellow fever, with an emphasis on recent changes in the distribution and incidence of the disease. Recent knowledge about yellow fever 17D vaccine mechanism of action and safety are discussed.

  7. Methotrexato in Rheumatic Disease Treatment

    OpenAIRE

    Sandoval, David; Centro de Enfermedades Articulares y Musculoesqueléticas The University of Alabama at Bimingham Bimingham, Estados Unidos; Alarcón, Graciela; Centro de Enfermedades Articulares y Musculoesqueléticas The University of Alabama at Bimingham Bimingham, Estados Unidos

    2014-01-01

    The authors review methotrexate use in Rheumatic Diseases, specially in Rheumatoid arthritis. Pharmacokinetics, efficacy, toxicity, and treatment monitoring of methotrexate are presented. Los autores revisan el uso del Metrotexate en el tratamiento de las enfermedades reumáticas, con especial énfasis en los recientes conceptos desarrollados como droga de segunda línea en el tratamiento de la artritis reumatoidea. Se presenta una revisión de los aspectos farmacocinóticos, eficacia, toxicida...

  8. Relationship between genetic mutation variations and acute-phase reactants in the attack-free period of children diagnosed with familial Mediterranean fever

    Energy Technology Data Exchange (ETDEWEB)

    Kosan, C. [Department of Pediatric Nephrology, Faculty of Medicine, Ataturk University, Erzurum (Turkey); Cayir, A.; Turan, M.I. [Department of Pediatrics, Faculty of Medicine, Ataturk University, Erzurum (Turkey)

    2013-09-18

    Familial Mediterranean fever (FMF) is a periodic autoinflammatory disease characterized by chronic inflammation. This study investigated the relationship between acute-phase reactants and gene mutations in attack-free periods of childhood FMF. Patients diagnosed with FMF were divided into four groups based on genetic features: no mutation, homozygous, heterozygous, and compound heterozygous. These groups were monitored for 2 years, and blood samples were collected every 6 months during attack-free periods. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and white blood cell count were measured. A disease severity score was determined for each patient. Mean values for erythrocyte sedimentation rate and fibrinogen were significantly different in the homozygous group. White blood cell count and C-reactive protein were similar between the groups. Disease severity score was higher in patients with the M694V mutation than in individuals without the mutation, as well as in those with other mutation groups. Periodic follow-up of patients with FMF MEFV mutations in subjects with acute-phase reactants may be useful in the prevention of morbidity.

  9. Relationship between genetic mutation variations and acute-phase reactants in the attack-free period of children diagnosed with familial Mediterranean fever

    Science.gov (United States)

    Kosan, C.; Cayir, A.; Turan, M.I.

    2013-01-01

    Familial Mediterranean fever (FMF) is a periodic autoinflammatory disease characterized by chronic inflammation. This study investigated the relationship between acute-phase reactants and gene mutations in attack-free periods of childhood FMF. Patients diagnosed with FMF were divided into four groups based on genetic features: no mutation, homozygous, heterozygous, and compound heterozygous. These groups were monitored for 2 years, and blood samples were collected every 6 months during attack-free periods. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and white blood cell count were measured. A disease severity score was determined for each patient. Mean values for erythrocyte sedimentation rate and fibrinogen were significantly different in the homozygous group. White blood cell count and C-reactive protein were similar between the groups. Disease severity score was higher in patients with the M694V mutation than in individuals without the mutation, as well as in those with other mutation groups. Periodic follow-up of patients with FMF MEFV mutations in subjects with acute-phase reactants may be useful in the prevention of morbidity. PMID:24141617

  10. Relationship between genetic mutation variations and acute-phase reactants in the attack-free period of children diagnosed with familial Mediterranean fever

    Directory of Open Access Journals (Sweden)

    C. Kosan

    2013-09-01

    Full Text Available Familial Mediterranean fever (FMF is a periodic autoinflammatory disease characterized by chronic inflammation. This study investigated the relationship between acute-phase reactants and gene mutations in attack-free periods of childhood FMF. Patients diagnosed with FMF were divided into four groups based on genetic features: no mutation, homozygous, heterozygous, and compound heterozygous. These groups were monitored for 2 years, and blood samples were collected every 6 months during attack-free periods. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and white blood cell count were measured. A disease severity score was determined for each patient. Mean values for erythrocyte sedimentation rate and fibrinogen were significantly different in the homozygous group. White blood cell count and C-reactive protein were similar between the groups. Disease severity score was higher in patients with the M694V mutation than in individuals without the mutation, as well as in those with other mutation groups. Periodic follow-up of patients with FMF MEFV mutations in subjects with acute-phase reactants may be useful in the prevention of morbidity.

  11. Plastia mitral cirúrgica em crianças com febre reumática Plastia mitral quirúrgica en niños con fiebre reumática Surgical mitral valve repair in children with rheumatic fever

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    Andréa Rocha e Silva

    2009-06-01

    pacientes (80% y moderada en ocho (20%. Ocurrieron tres óbitos inmediatos (7,5%. Después de tres meses de cirugía, el ecocardiograma mostró que en 35/37 (94,6% no había regurgitación valvular o era leve, y en dos pacientes (5,2% era grave. La clase funcional en el preoperatorio era III y IV en 33 casos (82,5%, y tres meses después de la cirugía los 37 casos (100% estaban en clase funcional I y II. La diferencia entre los datos del grados de regurgitación mitral y clase funcional en el pre y post operatorio fueron estadísticamente significativos (pBACKGROUND: Mitral repair is well accepted in children with rheumatic fever. OBJECTIVE: To analyze the outcomes of surgical mitral repair in children with rheumatic lesions after four years of follow-up. METHODS: Retrospective study of 40 patients younger than 18 years, who underwent surgery in the National Institute of Cardiology (Rio de Janeiro between January 1998 and January 2003. The echocardiographic degree of mitral regurgitation; surgical technique used; pre and postoperative functional class; patient outcome; need for valve replacement; and deaths were analyzed. RESULTS: Twenty one patients (52.5% were females. Severe mitral regurgitation was observed in 32 patients (80% and moderate in eight (20%. Three immediate deaths occurred (7.5%. Three months after surgery, echocardiography showed no valve regurgitation or mild regurgitation in 35 of 37 cases (94.6% patients, and severe regurgitation in two (5.2%. Thirty three cases (82.5% were in functional class III or IV in the preoperative period, and three months after surgery all the 37 cases (100% were in functional class I or II. The differences between the degree of mitral regurgitation and functional class in pre and postoperative periods were statistically significant (p<0.01. Seven (19% patients underwent heart valve replacement before four years of follow-up. CONCLUSION: Mitral valve repair showed favorable results in most of the cases as regards the degree of

  12. The significance of urinary beta-2 microglobulin level for differential diagnosis of familial Mediterranean fever and acute appendicitis.

    Science.gov (United States)

    Ugan, Yunus; Korkmaz, Hakan; Dogru, Atalay; Koca, Yavuz Savas; Balkarlı, Ayse; Aylak, Firdevs; Tunc, Sevket Ercan

    2016-07-01

    The clinical and laboratory parameters widely used are not specific to discriminate the abdominal pain due to FMF attack from that of acute appendicitis. The present study aims to investigate the urinary beta-2 microglobulin (U-β2M) level as a potential parameter to identify these two diseases mimicking each other. A total of 51 patients with established FMF diagnosis due to Tel Hashomer criteria on colchicine treatment (1-1.5 mg/day), 15 patients with acute appendicitis who had appropriate clinical picture and were also supported pathologically after the surgery, and 20 healthy controls were enrolled in the study. Of the 51 patients with FMF, 25 were at an attack period, while remaining 26 were not. For the diagnosis of acute attack, as well as physical examination, laboratory tests including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were performed. From urine specimens U-β2M, microalbumin, and N-acetyl glucosaminidase (U-NAG) were measured. U-β2M levels were significantly higher in acute appendicitis group compared to FMF attack, FMF non-attack, and control groups (p < 0.001, p < 0.001, and p < 0.001, respectively). U-NAG and microalbuminuria were significantly higher in acute appendicitis, FMF attack, and FMF non-attack groups compared to controls (U-NAG p < 0.001, p = 0.016, p = 0.004, microalbuminuria p < 0.001, p < 0.001, p < 0.001, respectively). Microalbuminuria was significantly higher in acute appendicitis group compared to the FMF attack group (p = 0.004). Determination of U-β2M levels may be helpful for differential diagnosis of peritonitis attacks of FMF patients on colchicine treatment and acute appendicitis. However, this finding should be substantiated with other studies.

  13. Acute adrenal crisis mimicking familial Mediterranean fever attack in a renal transplant FMF patient with amyloid goiter.

    Science.gov (United States)

    Emeksiz, Hamdi; Bakkaloglu, Sevcan; Camurdan, Orhun; Boyraz, Mehmet; Soylemezoglu, Oguz; Hasanoglu, Enver; Buyan, Necla

    2010-11-01

    The most devastating complication of familial Mediterranean fever (FMF) is amyloidosis which is capable of resulting in chronic renal failure. Although amyloid deposits are frequent in adrenal glands based on the autopsies of FMF patients however; to our knowledge, symptomatic adrenal insufficiency has not been reported yet. We describe a 21-year-old-FMF amyloidosis case with a well-functioning allograft who presented to the emergency clinic with the complaints of abdominal pain, vomiting and diarrhea mimicking FMF attack. adrenocorticotrophic hormone stimulation test was performed due to resistant hyponatremia and disclosed Addison disease. In countries with a high prevalence of FMF, adrenal crisis should be borne in mind in long standing FMF patients.

  14. THE INCIDENCE AND PREVALENCE OF RHEUMATIC DISEASES IN RUSSIA IN 2012–2013

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    R. M. Balabanova

    2015-01-01

    Full Text Available The incidence of major rheumatic diseases was analyzed inRussia's adult population  in 2012–2013 on the basis of the statistical reports of the Ministry of Health ofRussia(Form No. 12.Among the adult population  ofRussia, the overall incidence of acute rheumatic fever (ARF decreased by 11.6% (from 1666 to 1474 cases. No case of ARF was registered in 11 of the 83 subjects of the Federation in 2013. The inci- dence rates per 100,000 adult population  compared toRussia's ones were higher in theRepublicofIngushetia(21.0%, theChechen Republic(13.2%, and the Chukotka Autonomous District (26.2%. All cases of ARF were first notified. The overall incidence rates of chronic rheumatic heart diseases amongRussia's adult population  tend to reduce slightly [by 5.3% (from 182,286 to 172,687 cases].In the period in question, the total number of patients with musculoskeletal diseases (MSD  slightly rose. The bulk of rheumatic  patients from the MSD group are more than 4 million patients with osteoarthritis  (OA, half of them (2,454,563 being those who are older than able-bodied  age. The incidence of OA tends to increase in all Federal Districts (FD.  The most common  joint inflammatory diseases are rheumatoid  arthritis (RA (286,000 cases, spondylopathies  (90,000 cases, and osteoporosis (152,000 cases. The incidence rates of MSD per 100,000 adult population  are higher in the North-Western (19,397.7, Volga (16,552.6, and Siberian (16,133.4 FD thanRussia's mean rate (14,205.5. There were somewhat higher incidence rates of RA per 100,000 population  in 2013 than in 2012 (241.4 and 245.6, respectively. The rates in the North-Western, Ural, Far Eastern, and Volga FDs are higher than the mean Russian ones.In 2011, the rubric of «Ankylosing spondylitis» (AS was replaced by that of «Spondylopathies» that, besides AS (ICD-10 M45, encompasses other inflammatory spondylopathies  (M46, including infectious one, which does not allow single out the

  15. Inducible nitric oxide synthase (iNOS) expression in monocytes during acute Dengue Fever in patients and during in vitro infection

    Science.gov (United States)

    Neves-Souza, Patrícia CF; Azeredo, Elzinandes L; Zagne, Sonia MO; Valls-de-Souza, Rogério; Reis, Sonia RNI; Cerqueira, Denise IS; Nogueira, Rita MR; Kubelka, Claire F

    2005-01-01

    Abstract Mononuclear phagocytes are considered to be main targets for Dengue Virus (DENV) replication. These cells are activated after infection, producing proinflammatory mediators, including tumour-necrosis factor-α, which has also been detected in vivo. Nitric oxide (NO), usually produced by activated mononuclear phagocytes, has antimicrobial and antiviral activities. Methods The expression of DENV antigens and inducible nitric oxide synthase (iNOS) in human blood isolated monocytes were analysed by flow cytometry using cells either from patients with acute Dengue Fever or after DENV-1 in vitro infection. DENV-1 susceptibility to iNOS inhibition and NO production was investigated using NG-methyl L-Arginine (NGMLA) as an iNOS inhibitor, which was added to DENV-1 infected human monocytes, and sodium nitroprussiate (SNP), a NO donor, added to infected C6/36 mosquito cell clone. Viral antigens after treatments were detected by flow cytometry analysis. Results INOS expression in activated monocytes was observed in 10 out of 21 patients with Dengue Fever and was absent in cells from ten healthy individuals. DENV antigens detected in 25 out of 35 patients, were observed early during in vitro infection (3 days), significantly diminished with time, indicating that virus replicated, however monocytes controlled the infection. On the other hand, the iNOS expression was detected at increasing frequency in in vitro infected monocytes from three to six days, exhibiting an inverse relationship to DENV antigen expression. We demonstrated that the detection of the DENV-1 antigen was enhanced during monocyte treatment with NGMLA. In the mosquito cell line C6/36, virus detection was significantly reduced in the presence of SNP, when compared to that of untreated cells. Conclusion This study is the first to reveal the activation of DENV infected monocytes based on induction of iNOS both in vivo and in vitro, as well as the susceptibility of DENV-1 to a NO production. PMID:16109165

  16. Inducible nitric oxide synthase (iNOS expression in monocytes during acute Dengue Fever in patients and during in vitro infection

    Directory of Open Access Journals (Sweden)

    Cerqueira Denise IS

    2005-08-01

    Full Text Available Abstract Mononuclear phagocytes are considered to be main targets for Dengue Virus (DENV replication. These cells are activated after infection, producing proinflammatory mediators, including tumour-necrosis factor-α, which has also been detected in vivo. Nitric oxide (NO, usually produced by activated mononuclear phagocytes, has antimicrobial and antiviral activities. Methods The expression of DENV antigens and inducible nitric oxide synthase (iNOS in human blood isolated monocytes were analysed by flow cytometry using cells either from patients with acute Dengue Fever or after DENV-1 in vitro infection. DENV-1 susceptibility to iNOS inhibition and NO production was investigated using NG-methyl L-Arginine (NGMLA as an iNOS inhibitor, which was added to DENV-1 infected human monocytes, and sodium nitroprussiate (SNP, a NO donor, added to infected C6/36 mosquito cell clone. Viral antigens after treatments were detected by flow cytometry analysis. Results INOS expression in activated monocytes was observed in 10 out of 21 patients with Dengue Fever and was absent in cells from ten healthy individuals. DENV antigens detected in 25 out of 35 patients, were observed early during in vitro infection (3 days, significantly diminished with time, indicating that virus replicated, however monocytes controlled the infection. On the other hand, the iNOS expression was detected at increasing frequency in in vitro infected monocytes from three to six days, exhibiting an inverse relationship to DENV antigen expression. We demonstrated that the detection of the DENV-1 antigen was enhanced during monocyte treatment with NGMLA. In the mosquito cell line C6/36, virus detection was significantly reduced in the presence of SNP, when compared to that of untreated cells. Conclusion This study is the first to reveal the activation of DENV infected monocytes based on induction of iNOS both in vivo and in vitro, as well as the susceptibility of DENV-1 to a NO production.

  17. Hyperthermia and fever control in brain injury.

    Science.gov (United States)

    Badjatia, Neeraj

    2009-07-01

    Fever in the neurocritical care setting is common and has a negative impact on outcome of all disease types. Meta-analyses have demonstrated that fever at onset and in the acute setting after ischemic brain injury, intracerebral hemorrhage, and cardiac arrest has a negative impact on morbidity and mortality. Data support that the impact of fever is sustained for longer durations after subarachnoid hemorrhage and traumatic brain injury. Recent advances have made eliminating fever and maintaining normothermia feasible. However, there are no prospective randomized trials demonstrating the benefit of fever control in these patient populations, and important questions regarding indications and timing remain. The purpose of this review is to analyze the data surrounding the impact of fever across a range of neurologic injuries to better understand the optimal timing and duration of fever control. Prospective randomized trials are needed to determine whether the beneficial impact of secondary injury prevention is outweighed by the potential risks of prolonged fever control.

  18. Persistent High IgG Phase I Antibody Levels against Coxiella burnetii among Veterinarians Compared to Patients Previously Diagnosed with Acute Q Fever after Three Years of Follow-Up

    Science.gov (United States)

    Wielders, Cornelia C. H.; Boerman, Anneroos W.; Schimmer, Barbara; van den Brom, René; Notermans, Daan W.; van der Hoek, Wim; Schneeberger, Peter M.

    2015-01-01

    Background Little is known about the development of chronic Q fever in occupational risk groups. The aim of this study was to perform long-term follow-up of Coxiella burnetii seropositive veterinarians and investigate the course of IgG phase I and phase II antibodies against C. burnetii antigens and to compare this course with that in patients previously diagnosed with acute Q fever. Methods Veterinarians with IgG phase I ≥1:256 (immunofluorescence assay) that participated in a previous seroprevalence study were asked to provide a second blood sample three years later. IgG antibody profiles were compared to a group of acute Q fever patients who had IgG phase I ≥1:256 twelve months after diagnosis. Results IgG phase I was detected in all veterinarians (n = 76) and in 85% of Q fever patients (n = 98) after three years (pveterinarians and 12% of patients (OR 3.95, 95% CI: 1.84–8.49). Conclusions IgG phase I persists among veterinarians presumably because of continuous exposure to C. burnetii during their work. Serological and clinical follow-up of occupationally exposed risk groups should be considered. PMID:25602602

  19. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia

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    Akhtar Jaweed

    2010-05-01

    Full Text Available Abstract Background Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications between patients of Dengue who have mild/moderate (ALT 23-300 IU/L v/s severe acute hepatitis (ALT > 300 IU/L. Methods A Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (≥ 14 yrs age admitted with diagnosis of Dengue Fever (DF, Dengue Hemorrhagic Fever (DHF or Dengue Shock Syndrome (DSS were included. Chi square test was used to compare categorical variables and fischer exact test where applicable. Survival analysis (Cox regression and log rank for primary outcome was done. Student t test was used to compare continuous variables. A p value of less than or equal to 0.05 was taken as significant. Results Six hundred and ninety nine patients were enrolled, including 87% (605 patients with DF and 13% (94 patients with DHF or DSS. Liver functions tests showed median ALT of 88.50 IU/L; IQR 43.25-188 IU/L, median AST of 174 IU/L; IQR 87-371.5 IU/L and median T.Bil of 0.8 mg/dl; IQR 0.6-1.3 mg/dl. Seventy one percent (496 had mild to moderate hepatitis and 15% (103 had severe hepatitis. Mean length of stay (LOS in patients with mild/moderate hepatitis was 3.63 days v.s 4.3 days in those with severe hepatitis (P value 0.002. Overall mortality was 33.3% (n = 6 in mild/moderate hepatitis vs 66.7% (n = 12 in severe hepatitis group (p value Conclusion Severe hepatitis (SGPT>300IU in Dengue is associated with prolonged LOS, mortality, bleeding and RF.

  20. Digestive comorbidity in patients with rheumatic diseases: Not only NSAID-induced gastropathy

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    A. E. Karateev

    2016-01-01

    Full Text Available Digestive comorbidity is a serious problem that significantly aggravates the course of rheumatic diseases. Diseases of the gastrointestinal tract (GIT, liver, and pancreatobiliary system may present a threat to life and substantially worsen its quality. The incidence of many digestive diseases, such as gastric ulcer (including its complicated forms, cholelithiasis, and acute pancreatitis, in patients with rheumatic diseases (at least in those with rheumatoid arthritis is considerably higher than in the population. The presence of this comorbidity poses substantial challenges during active anti-rheumatic therapy. Rheumatologists are very familiar with issues in the prevention of GIT complications due to the use of nonsteroidal anti-inflammatory drugs. However, new time presents new challenges. The widespread use of immunosuppressive agents and biologic agents requires careful monitoring of complications associated with liver and bowel diseases. This review considers a relationship of rheumatic diseases and anti-rheumatic therapy to comorbidities, such as cholelithiasis, acute pancreatitis, viral hepatitis B and C, and intestinal diverticula. 

  1. Correlation analysis between fever and prognosis in patients with acute carbon monoxide poisoning%急性一氧化碳中毒患者发热情况与预后的相关性分析

    Institute of Scientific and Technical Information of China (English)

    张月战

    2014-01-01

    目的:观察急性一氧化碳中毒(ACOP)患者发热症状的比例,鉴别发热的原因,探讨ACOP发热与其预后的相关性。方法选取我院202例ACOP住院患者,对其发热情况、预后、抗生素的使用及血常规检查等资料表格化登记,随后进行统一数据整理和统计学分析,比较发热组及无发热组的白细胞计数水平,同时比较不同发热组及无发热组间的2周病死率。结果202例ACOP患者中无发热者114例(56.4%),入院后48 h内发热者88例(43.6%);发热组白细胞升高比率明显高于无发热组(P0.05)。结论发热是ACOP常见的伴随症状,引起ACOP患者发热的原因多样,需仔细鉴别,以减少抗生素的不必要使用。中度以上发热是ACOP死亡的危险因素之一,与其预后具有一定的相关性。%Objective To observe the proportion of of fever symptoms in patients with acute carbon monoxide poisoning ( ACOP ), identify the causes of fever and explore the correlation between fever and prognosis in patients with ACOP. Methods 202 cases of hospitalized patients with ACOP in our hospital were selected, whose information on fever, prognosis, use of antibiotics, blood routine examination and so on were registered in form, then followed by a unified data collection and statistical analysis. The count levels of white blood cell were compared between fever group and no fever group , meanwhile the two-weeks mortality was compared among different fever groups and no fever group. Results There were 114 patients without fever (56.5%)and 88 cases with fever (43.5%) in 48h after admission in 202 patients with ACOP. The white blood cell increase ratio of fever group was significantly higher than no fever group (P0.05). Conclusion Fever is a common accompanying symptoms in ACOP. There are a variety of causes leading to fever in ACOP, which needs to identify carefully in order to reduce the unnecessary use of antibiotics

  2. Tai chi and rheumatic diseases.

    Science.gov (United States)

    Wang, Chenchen

    2011-02-01

    Tai chi is a complex multicomponent mind-body exercise. Many studies have provided evidence that tai chi benefits patients with a variety of chronic disorders. This form of mind-body exercise enhances cardiovascular fitness, muscular strength, balance, and physical function and seems to be associated with reduced stress, anxiety, and depression and improved quality of life. Thus, despite certain limitations in the evidence, tai chi can be recommended to patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia as a complementary and alternative medical approach. This article overviews the current knowledge about tai chi to better inform clinical decision making for rheumatic patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Miscellaneous neurologic, cardiac, pulmonary, and metabolic disorders with rheumatic manifestations.

    Science.gov (United States)

    Larkin, J G

    1993-01-01

    Problems both old and new are featured in this year's selection of rheumatologic aspects of miscellaneous diseases. Paralysis of one or more limbs can lead to many musculoskeletal complications, and the approach of Auguste Dejerine-Klumpke in 1918 can be compared with that of the present-day physician. The reappearance of rheumatic fever continues to excite interest. The specificity of the modified Jones criteria has been questioned, as have the benefits of long-term antibiotic prophylaxis following an attack of the disease. Meanwhile, metabolic disorders may be the first diseases to come under novel scrutiny using the techniques of genetic engineering, with outstanding possibilities for advancing both understanding and treatment. Dermatologic diseases other than psoriasis may be associated with arthropathy. Many of these symptom complexes may be variants of the recently described SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome.

  4. COMPLICATED CASE OF RHEUMATIC HEART DISEASE; UNEXPLORED FOR YEARS

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    M. Arif Khan

    2014-01-01

    Full Text Available Rheumatic heart disease is a one of the very common heart problem commonly prevalent among the children of developing countries, may occur in adults in their fourties also, if undiagnosed in early ages, similar in symptoms to ‘rheumatism’ but quite difficult to diagnose or are often misdiagnosed. The main objective of this article is to make acquainted about the disease and its further consequences, since initially it appears to be just a simple general fever but may prove deadly if undiagnosed or misdiagnosed leading to severe heart valve damage and consequent complications. The methods involved in the case include bilateral Femoral Embolectomy (BFE, Fasciotomy and Balloon Mitral Valvotomy (BMV. Through this case study an attempt has been made by the authors to make the people especially from the medical and related field, well acquainted about this deadly, silent, heart disease and its consequent complications.

  5. What is the best acute phase reactant for familial Mediterranean fever follow-up and its role in the prediction of complications? A systematic review.

    Science.gov (United States)

    Erer, Burak; Demirkaya, Erkan; Ozen, Seza; Kallinich, Tilmann

    2016-04-01

    The most dreaded complication of familial Mediterranean fever (FMF) is amyloidosis; controversy exists as to what acute phase reactant (APR) should be monitored in these patients. To analyze the best acute phase reactant for FMF follow-up to help guide physicians to decide on what APR parameter to use, we also attempted to define the best APR in predicting the complications of FMF, specifically the development of amyloidosis. Systematic review based on a sensitive search to capture studies that: (1) included FMF patients; (2) measured serum amyloid A (SAA), CRP (C-reactive protein), proteinuria, or ESR (erythrocyte sedimentation rate); (3) amyloidosis were the outcome measure; (4) sensitivity, specificity, predictive value, and other performance parameters could be calculated; and (5) had a longitudinal design. Of 1905 captured items, 26 were selected for detailed review, of which only two finally met the criteria, and the quality was only moderate; the articles did not analyzed the performance by means of sensitivity and specificity to predict, or even detect, amyloidosis, and thus had to be calculated based on text. The 26 screened studies were very heterogeneous in designs, parameters measured, and results, despite being set from research questions similar to ours. They were mainly descriptive, and it was very difficult to interpret the true performance of the tests. The correlation between the various APR is low. The evidence supporting the monitoring of FMF with any APR over the others is limited. Well designed longitudinal studies with a mixture of outcomes should be undertaken. Until them, recommending an APR over other would be based on expert opinion and indirect evidence.

  6. Typhoid fever

    Science.gov (United States)

    ... most commonly caused due to a bacteria called Salmonella typhi ( S typhi ). Causes S typhi is spread through contaminated food, ... as food handlers. Alternative Names Enteric fever Images Salmonella typhi organism Fly Digestive system organs References Harris JB, ...

  7. Dengue fever

    Science.gov (United States)

    ... the mosquito Aedes aegypti , which is found in tropic and subtropic regions. This area includes parts of: ... encephalitis, St. Louis encephalitis, tick-borne encephalitis, Kyasanur forest disease, Alkhurma hemorrhagic fever, Zika). In: Bennett JE, ...

  8. Recurrent fevers.

    Science.gov (United States)

    Isaacs, David; Kesson, Alison; Lester-Smith, David; Chaitow, Jeffrey

    2013-03-01

    An 11-year-old girl had four episodes of fever in a year, lasting 7-10 days and associated with headache and neck stiffness. She had a long history of recurrent urticaria, usually preceding the fevers. There was also a history of vague pains in her knees and in the small joints of her hands. Her serum C-reactive protein was moderately raised at 41 g/L (normal <8). Her rheumatologist felt the association of recurrent fevers that lasted 7 or more days with headaches, arthralgia and recurrent urticaria suggested one of the periodic fever syndromes. Genetic testing confirmed she had a gene mutation consistent with one of tumour necrosis factor receptor-associated periodic syndrome.

  9. An Acute Multispecies Episode of Sheep-Associated Malignant Catarrhal Fever in Captive Wild Animals in an Italian Zoo.

    Science.gov (United States)

    Frontoso, R; Autorino, G L; Friedrich, K G; Li, H; Eleni, C; Cocumelli, C; Di Cerbo, P; Manna, G; Scicluna, M T

    2016-12-01

    In July 2011, in a zoological garden in Rome, Italy, malignant catarrhal fever (MCF), a fatal, systemic disease of Artiodactyla, was suspected on the basis of neurological signs and gross lesions observed in a banteng, the first animal to die of this infection. An MCF type-specific PCR with subsequent sequencing of the PCR amplicon confirmed the aetiological agent as ovine herpesvirus-2 (OvHV-2). Biological samples were collected from the dead animals for gross, histological, bacteriological, virological and serological examinations. An epidemiological investigation was conducted to identify the source of the outbreak, as further deaths due to OvHV-2 still occurred after the removal of the acknowledged reservoirs, domestic sheep and goats. For this purpose, samples from other susceptible species and reservoir hosts were collected for virological and serological analysis. In conjunction, a retrospective sero-investigation was conducted on sera collected between 1999 and 2010 from some of the species involved in the present episode. In total, 11 animals belonging to four different species (banteng, Himalayan tahr, Nile lechwe and sika deer) died between July 2011 and October 2012. The severe gross and histological lesions were consistent with the disease, namely haemorrhages and congestion of several organs as well as lymphoid cell infiltrates and vasculitis of varying severity. The virological tests confirmed that all animals had died of sheep-associated MCF. The investigation indicated that the OvHV-2 infection could have been due to the arrival of sheep in the petting zoo, with cases commencing after first lambing and subsequent shedding of virus. This was also supported by the serological retrospective study that indicated limited previous MCF virus circulation. Further MCF cases that occurred even after the removal of the domestic sheep and goats were attributed to the mouflon. This episode confirms the importance of biosecurity measures in zoos, which house MCF

  10. Chronic Q fever in the Netherlands 5 years after the start of the Q fever epidemic: results from the Dutch chronic Q fever database

    NARCIS (Netherlands)

    Kampschreur, L.M.; Delsing, C.E.; Groenwold, R.H.; Wegdam-Blans, M.C.; Bleeker-Rovers, C.P.; Jager-Leclercq, M.G. De; Hoepelman, A.I.; Kasteren, M.E.E. van; Buijs, J.; Renders, N.H.; Nabuurs-Franssen, M.H.; Oosterheert, J.J.; Wever, P.C.

    2014-01-01

    Coxiella burnetii causes Q fever, a zoonosis, which has acute and chronic manifestations. From 2007 to 2010, the Netherlands experienced a large Q fever outbreak, which has offered a unique opportunity to analyze chronic Q fever cases. In an observational cohort study, baseline characteristics and

  11. Quadriparesis and dysarthria due to tetrabenazine therapy in a child with rheumatic chorea.

    Science.gov (United States)

    Zaki, Syed Ahmed; Lad, Vijay; Shanbag, Preeti

    2011-09-01

    Tetrabenazine (TBZ) is widely used to treat hyperkinetic movement disorders in adults; however, published experience with the drug in children is limited. Common side effects of TBZ include drowsiness, sedation, weakness, Parkinsonism, depression, and acute akathisia, all of which are reversible with decreased doses. We report here a 7-year-old girl with rheumatic chorea who developed acute akinesia of all four limbs and dysarthria due to TBZ therapy. Withdrawal of the drug led to rapid improvement within 18 hours.

  12. The association between vibration and vascular injury in rheumatic diseases: a review of the literature.

    Science.gov (United States)

    Wang, Yu-Jie; Huang, Xiao-Lei; Yan, Jun-Wei; Wan, Ya-Nan; Wang, Bing-Xiang; Tao, Jin-Hui; Chen, Bing; Li, Bao-Zhu; Yang, Guo-Jun; Wang, Jing

    2015-02-01

    Vascular manifestations can be seen early in the pathogenesis of inflammatory rheumatic diseases. Animal experiments, laboratory and clinical findings indicated that acute or long-term vibration exposure can induce vascular abnormalities. Recent years, in addition to Raynaud's phenomenon (RP), vibration as a risk factor for other rheumatic diseases has also received corresponding considered. This review is concentrated upon the role of vibration in the disease of systemic sclerosis (SSc). In this review, we are going to discuss the main mechanisms which are thought to be important in pathophysiology of vascular injury under the three broad headings of "vascular", "neural" and "intravascular". Aspects on the vibration and vascular inflammation are briefly discussed. And the epidemiological studies related to vibration studies in SSc and other rheumatic diseases are taken into account.

  13. Chronic Q fever in The Netherlands

    NARCIS (Netherlands)

    Kampschreur, L.M.

    2013-01-01

    From 2007-2010, during the recent Q fever epidemic in the Netherlands, over 4000 cases of acute Q fever were registered, which is an underestimation of the total amount of Coxiella burnetii infections due to a high amount of asymptomatic primary infections. In the literature it is stated that 1-5% o

  14. Chronic Q fever in The Netherlands

    NARCIS (Netherlands)

    Kampschreur, L.M.

    2013-01-01

    From 2007-2010, during the recent Q fever epidemic in the Netherlands, over 4000 cases of acute Q fever were registered, which is an underestimation of the total amount of Coxiella burnetii infections due to a high amount of asymptomatic primary infections. In the literature it is stated that 1-5%

  15. [Q fever: a cause of fever of unknown origin in Switzerland].

    Science.gov (United States)

    Fischer, L; Garin, N; Péter, O; Praz, G

    2012-10-10

    We describe two cases of Q fever in previously healthy women presenting with fever of unknown origin. The diagnosis was made after several days of investigations. Symptoms and signs of acute or chronic Coxiella burnetii infection are protean and non-specific. Q fever should be included in the differential diagnosis of fever of unknown origin and appropriate serologic studies should be done. We review the clinical presentation of Q fever. Use of serology for the diagnosis and the follow-up is discussed.

  16. Childhood fever.

    Science.gov (United States)

    Chong, C Y; Allen, D M

    1996-02-01

    Childhood fever is a common symptom, reflective of multiple causes. As the child is often unable to express himself, the physician must rely on parents' observations and the physical examination. The majority of febrile children have non-bacterial upper respiratory tract infection and indiscriminate use of antibiotics is inappropriate, ineffective and leads to drug-resistance such as the emergence of Penicillin-resistant Streptococcus pneumoniae. In this article, we attempt to identify the possible causes of fever by a simple approach using the presence or absence of associated or localising symptoms. Infants less than 3 months constitute a unique group as the fever may be related to perinatal events and as serious bacterial infections can still occur despite unremarkable physical findings. Management of fever needs to take into account the toxicity, immune status and age of the patients as well as the source of the infection. Zealous overprescription of antipyretics needs to be avoided with attention directed to the cause of the fever, the child's capacity to cope with the illness and parental education.

  17. Shifting priorities in the aftermath of a Q fever epidemic in 2007 to 2009 in The Netherlands: from acute to chronic infection.

    NARCIS (Netherlands)

    Hoek, W. van der; Schneeberger, P.M.; Oomen, T.; Wegdam-Blans, M.C.; Dijkstra, F.; Notermans, D.W.; Bijlmer, H.A.; Groeneveld, K.; Wijkmans, C.J.; Rietveld, A.; Kampschreur, L.M.; Duynhoven, Y. Van

    2012-01-01

    From 2007 to 2009, the Netherlands faced large seasonal outbreaks of Q fever, in which infected dairy goat farms were identified as the primary sources. Veterinary measures including vaccination of goats and sheep and culling of pregnant animals on infected farms seem to have brought the Q fever pro

  18. [Rheumatic diseases in colonial Mexico].

    Science.gov (United States)

    Aceves-Avila, F J; Fraga, A

    1997-01-01

    The medical texts published in New Spain between the XVI and XVIII century have not been searched until now for evidence of the existence of rheumatoid arthritis and other rheumatic diseases before the descriptions made by Sydenham. We surveyed most of the medical books written and published in New Spain from the arrival of the Spaniards to the XVIII century, and we divided the diseases with articular manifestations into four groups, according to their main clinical characteristics: pain without swelling in anatomical region; pain without swelling in several joints; pain and swelling in joints, and joint complaints associated with contagious diseases. We found that a difference was established between gout and rheumatoid arthritis one hundred years before Sydenham, according to the different evolutions of both diseases, and we present one of the oldest descriptions of reactive arthritis.

  19. RHEUMATIC MANIFESTATIONS IN VIRAL HEPATITIS

    Directory of Open Access Journals (Sweden)

    L P Anan'eva

    2008-01-01

    Full Text Available Autoimmune reactions are of primary importance in the development of extrahepatic manifestations of viral hepatitis, among which there are rheumatic symptoms and syndromes. The incidence of clinically significant extrahepatic manifestations is shown to be relatively low, but they may be in the foreground in the clinical picture of the disease and are noted for severity. It is concluded that due to the high prevalence of hepatitis and the systemic pattern of their chronic forms, patients with extrahepatic manifestations of viral hepatitis may be encountered in the practice of a therapist and a rheumatologist. The onset of the infection caused by hepatitis viruses may be accompanied by articular lesion therefore the rheumatologist may be the first physician such a patient may resort to.

  20. RHEUMATIC MANIFESTATIONS IN VIRAL HEPATITIS

    Directory of Open Access Journals (Sweden)

    L P Anan'eva

    2008-12-01

    Full Text Available Autoimmune reactions are of primary importance in the development of extrahepatic manifestations of viral hepatitis, among which there are rheumatic symptoms and syndromes. The incidence of clinically significant extrahepatic manifestations is shown to be relatively low, but they may be in the foreground in the clinical picture of the disease and are noted for severity. It is concluded that due to the high prevalence of hepatitis and the systemic pattern of their chronic forms, patients with extrahepatic manifestations of viral hepatitis may be encountered in the practice of a therapist and a rheumatologist. The onset of the infection caused by hepatitis viruses may be accompanied by articular lesion therefore the rheumatologist may be the first physician such a patient may resort to.

  1. Typhoid fever

    DEFF Research Database (Denmark)

    Wain, John; Hendriksen, Rene S.; Mikoleit, Matthew L.

    2015-01-01

    Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas...... with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main...... cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow...

  2. Social implications of rheumatic diseases.

    Science.gov (United States)

    Kłak, Anna; Raciborski, Filip; Samel-Kowalik, Piotr

    2016-01-01

    Social consequences of a disease constitute limitations in performing roles relating to working life as well as family and social life caused by the disease, mainly chronic. The aim of the study was to analyze the social consequences of rheumatic diseases in the aspect of disability pensions with respect to incapacity for work and quality of life. The occurrence of rheumatic diseases is related not only to increased risk of different types of organic changes, but above all disability. In Europe almost 50% of persons suffering from diseases of the musculoskeletal system who are currently unemployed were breadwinners. Nearly 60% of them received legal disability status. The loss of work ability is, among other things, the consequence of progressive disability. In Europe 40% of persons suffering from rheumatoid arthritis (RA) had to stop working due to the disease. Most of the persons diagnosed with RA were of working age. It results in the decrease in the quality of life as well as economic difficulties (decreased incomes and increased disease-related costs). In Poland the results of the analysis of the Social Insurance Institution (ZUS) of first-time disability recognition issued for the purpose of disability pensions in 2014 showed that the incapacity for work was caused by diseases relating to general health condition (65.5%). Diseases of the musculoskeletal system were the cause of partial inability to work of 21.6% of persons who received a disability pension for the first time (as many as 5,349 certificates were issued). Early diagnosis and implementation of effective treatment are the necessary conditions for a patient to sustain activity, both professional and social, which is of crucial importance to reduce the negative effects of the disease.

  3. Rat-bite fever

    Science.gov (United States)

    Streptobacillary fever; Streptobacillosis; Haverhill fever; Epidemic arthritic erythema; Spirillary fever; Sodoku ... Rat-bite fever can be caused by 2 different bacteria, Streptobacillus moniliformis or Spirillum minus. Both of these are found in ...

  4. Kid's Guide to Fever

    Science.gov (United States)

    ... in the Operating Room? A Kid's Guide to Fever KidsHealth > For Kids > A Kid's Guide to Fever ... some lighter-weight pajamas. previous continue Fighting a Fever For almost all kids, fevers aren't a ...

  5. Dengue fever (image)

    Science.gov (United States)

    Dengue fever, or West Nile fever, is a mild viral illness transmitted by mosquitoes which causes fever, ... second exposure to the virus can result in Dengue hemorrhagic fever, a life-threatening illness.

  6. A case of ADEM following Chikungunya fever.

    Science.gov (United States)

    Maity, Pranab; Roy, Pinaki; Basu, Arindam; Das, Biman; Ghosh, U S

    2014-05-01

    Chikungunya most often is a self-limiting febrile illness with polyarthritis and the virus is not known to be neurotropic. We are reporting a case of chikugunya fever presenting as acute demyelinating encephalomyelitis(ADEM) which is very rare.

  7. Rheumatic Diseases: from Theory to Reality

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Serra Valdés

    2013-12-01

    Full Text Available Rheumatic diseases are a significant health problem worldwide because of their morbidity, their resulting disabilities and their economic impact due the high costs they entail for health institutions and patients. They should be included in the non-communicable chronic diseases when considering the following aspects for its definition: risk factors, chronic course, impact on quality of life, incidence and prevalence in the general population, mortality, etc.; aspects that coexists in rheumatic diseases.

  8. Fibronectin in the palatine tonsil as a susceptibility marker in Egyptian rheumatic families: histological and immunohistochemical studies.

    Science.gov (United States)

    Gazia, Maha Abo; Tousson, Ehab; El-Fatah, Mokhtar Abd; Shoheib, Ahmed S

    2015-04-01

    Rheumatic fever (RF) and rheumatic heart disease (RHD) are the multisystem autoimmune sequel of group A streptococci (GAS) infection of the upper respiratory passages, mainly tonsillopharyngitis. The major receptor on the surface of human palatine tonsil for GAS is fibronectin (FN; adhesin receptor). Early detection of RF susceptibility is considered as an important aim of this study. Therefore, the present study aimed to use FN immunoreactivity (FN-ir) as a marker for early detection of rheumatic susceptible children with palatine tonsil crypts surface epithelium. A total of 30 palatine tonsillar specimens were obtained from children aged from 3 to 15 years. Histological studies showed moderate vascular changes and more than four apparent epithelial disruptions in the crypt epithelium. FN-ir showed a significant increase in FN in the basal layers of surface epithelium, subepithelial connective tissue and interfollicular areas. Tonsils of children in rheumatic families showed significant increase in FN in subepithelial connective tissue areas with more than one apparent crypt epithelial disruption compared to normal children. We can conclude that FN plays a central role in the RF and differentially distributed in the functional compartments of the palatine tonsil in children with RHD, so FN-ir can be used as a marker for rheumatic susceptibility.

  9. [Music for rheumatism--a historical overview].

    Science.gov (United States)

    Evers, S

    1990-01-01

    The history of the use of music to lessen the pain of rheumatism is seen in the use of musical therapy in medicine as a whole. Sources citing the use of music specifically in rheumatism are rare; often, rather than rheumatism, terms like "gout (podagra)" or "joint-pain" are mentioned. This is connected with the obscure and pathognomic perceptions of rheumatism. In the archeo-medicine and for primitive cultures the considered potency of music was primarily dominated by animistic thinking. In antiquity humoral pathology developed a philosophy that tried to explain the benefits of music, even for rheumatism, but found little acceptance. In the Middle Ages and in the Baroque period iatromechanistic conceptions determined music as useful in fight against pain. In the Romantic period there was speculation about music as a causal therapy, but it was shortlived. In the 20th century music is applied as an active therapy in the care of persons suffering from rheumatism; its empiric success as a remedy in rehabilitative and palliative therapy is recognized.

  10. Persisting eicosanoid pathways in rheumatic diseases.

    Science.gov (United States)

    Korotkova, Marina; Jakobsson, Per-Johan

    2014-04-01

    An unmet clinical need exists for early treatment of rheumatic diseases and improved treatment strategies that can better maintain remission with reduced ongoing subclinical inflammation and bone destruction. Eicosanoids form one of the most complex networks in the body controlling many physiological and pathophysiological processes, including inflammation, autoimmunity and cancer. Persisting eicosanoid pathways are thought to be involved in the development of rheumatic diseases, and targeting this pathway might enable improved treatment strategies. Several enzymes of the arachidonic acid cascade as well as eicosanoid receptors (all part of the eicosanoid pathway) are today well-recognized targets for anti-inflammatory drugs that can reduce symptoms of inflammation in rheumatic diseases. In this Review, we outline the evidence supporting pivotal roles of eicosanoid signalling in the pathogenesis of rheumatic diseases and discuss findings from studies in animals and humans. We focus first on rheumatoid arthritis and discuss the upregulation of the cyclooxygenase and lipoxygenase pathways as most data are available in this condition. Research into the roles of eicosanoids in other rheumatic diseases (osteoarthritis, idiopathic inflammatory myopathies, systemic lupus erythematosus and gout) is also progressing rapidly and is discussed. Finally, we summarize the prospects of targeting eicosanoid pathways as anti-inflammatory treatment strategies for patients with rheumatic diseases.

  11. 抗DNA酶B和抗链"O"在风湿热诊断中的应用%The Application of Anti-Dnase B and Antistreptolysin "O" Microtitration Test in the Diagnosis of Acute Rheumatic Fever

    Institute of Scientific and Technical Information of China (English)

    焦路阳

    2005-01-01

    目的:评估抗DNA酶B和抗链"O"(ASO)在溶血性链球菌感染的血清学检测对风湿热的诊断价值.方法:抗DNA酶B用微量法,ASO用速率散射比浊法,测定77例急性风湿热患者,35例活动期风湿性心脏病患者,50例对照组.结果:急性风湿热组ASO阳性率76.6%,与抗DNA酶B71.4%差异无显著性(χ2=0.8310,P>0.05),二者同时检测阳性率为92.2%,显著高于单一检测(χ2分别为7.1077、12.2775,P0.05).结论:ASO和抗DNA酶B联合检测可提高诊断阳性率,对风湿热的诊断具有重要的临床价值.

  12. 风湿热患儿血清肿瘤坏死因子α水平测定及其意义%The significance of serum TNF - α measurement in the sick children with acute rheumatic fever

    Institute of Scientific and Technical Information of China (English)

    褚茂平; 陈其; 吴蓉洲; 陆文文; 张园海; 项如莲

    2000-01-01

    目的探讨血清肿瘤坏死因子α(TNF-α)在风湿热发病中的作用机制及其临床意义.方法应用单克隆抗体夹心法对32例风湿活动期(活动组)及30例风湿静止期(静止组)患儿进行血清TNF-α水平检测,并与30名健康儿童(正常组)进行比较.结果血清TNF-α水平活动组明显高于静止组和正常组(均P<0.01),静止组明显高于正常组(P<0.01);活动组心功能Ⅲ、Ⅳ级患者明显高于心功能Ⅰ、Ⅱ级患者(P<0.01);活动组治疗后较治疗前明显下降(P<0.01);与血沉、G-反应蛋白水平呈明显正相关(r=3.56、2.97,均P<0.01).结论TNF-α参与风湿热的发病过程,与病情严重程度和风湿活动有关.

  13. Scarlet Fever

    Centers for Disease Control (CDC) Podcasts

    2011-06-09

    Katherine Fleming-Dutra, pediatrician, discusses scarlet fever, its cause, how to treat it, and how to prevent its spread.  Created: 6/9/2011 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 6/9/2011.

  14. Yellow fever

    Directory of Open Access Journals (Sweden)

    Prata Aluízio

    2000-01-01

    Full Text Available With the infestation by Aedes aegypti, urban yellow fever might already exist. This did not occur because of either the lacking of a sufficient contact between the diseased individual and the A. aegypti or perhaps because this, after sixty years without transmitting the virus, needs an adaptation phase to infecting again.

  15. Q fever

    Science.gov (United States)

    ... Coxiella burnetii . These bacteria can infect: Sheep Goats Cattle Dogs Cats Birds Rodents Ticks Infected animals shed ... The main treatment for Q fever is antibiotics. For early-stage Q ... If you have the infection for more than 6 months, it is called ...

  16. Central nervous system involvement in pediatric rheumatic diseases: current concepts in treatment.

    Science.gov (United States)

    Duzova, Ali; Bakkaloglu, Aysin

    2008-01-01

    Central nervous system (CNS) manifestations are not rare in pediatric rheumatic diseases. They may be a relatively common feature of the disease, as in systemic lupus erythematosus (SLE) and Behçet's disease. Direct CNS involvement of a systemic rheumatic disease, primary CNS vasculitis, indirect involvement secondary to hypertension, hypoxia and metabolic changes, and drug associated adverse events may all result in CNS involvement. We have reviewed the CNS manifestations of SLE, Behçet's disease, Henoch-Schönlein purpura, polyarteritis nodosa, juvenile idiopathic arthritis, juvenile ankylosing spondylitis, familial Mediterranean fever, scleroderma, sarcoidosis, Wegener's granulomatosis, Takayasu's arteritis, CINCA syndrome, Kawasaki disease, and primary CNS vasculitis; and adverse CNS effects of anti-rheumatic drugs in pediatric patients. The manifestations are diverse; ranging from headache, seizures, chorea, changes in personality, depression, memory and concentration problems, cognitive impairment, cerebrovascular accidents to coma, and death. The value of cerebrospinal fluid (CSF) examination (pleocytosis, high level of protein), auto-antibodies in serum and CSF, electroencephalography, neuroimaging with computerized tomography, magnetic resonance imaging, SPECT, PET, and angiography depends on the disease. Brain biopsy is gold standard for the diagnosis of CNS vasculitis, however it may be inconclusive in 25% of cases. A thorough knowledge of the rheumatic diseases and therapy-related adverse events is mandatory for the management of a patient with rheumatic disease and CNS involvement. Severe CNS involvement is associated with poor prognosis, and high mortality rate. High dose steroid and cyclophosphamide (oral or intravenous) are first choice drugs in the treatment; plasmapheresis, IVIG, thalidomide, and intratechal treatment may be valuable in treatment-resistant, and serious cases.

  17. The new face of rheumatic heart disease in South West Nigeria

    Directory of Open Access Journals (Sweden)

    Akinwusi PO

    2013-05-01

    of appropriate antibiotic therapy for sore throats resulting in the prevention of rheumatic fever and RHD. However, late presentation is still very common, hence we advocate a more aggressive drive to make the Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease functional in our practice area.Keywords: rheumatic fever, group A β-hemolytic streptococcal pharyngitis, valvular lesions, heart failure

  18. [Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician's office].

    Science.gov (United States)

    Vicedomini, D; Lalinga, G; Lugli, N; D'Avino, A

    2014-02-01

    Acute pharyngotonsillitis is one of the most frequent causes of visits in the primary care pediatrician'office. Group A b-hemolytic streptococci (GABHS) or Streptococcus pyogenes causes 15-30% of cases of acute pharyngotonsillitis in pediatric age. Children with pharyngotonsillitis due to GABHS commonly present sore throat, fever more than 38 °C, tonsillar exudate, and tender cervical adenopathy, but the severity of illness ranges from mild throat pain to classic exudative tonsillitis with high fever. The McIsaac criteria is a clinical scoring system to predict the likelihood of streptococcal infection among children. This score is based on 5 clinical criteria: age 3-14 years, fever more than 38°C, tonsillar swelling or exudate, tender and enlarged anterior cervical lymph nodes, and absence of cough, but none of these findings is specific for GABHS pharyngotonsillitis. Culture of a throat swab on a blood agar plate (BAP) remains the gold standard for the diagnosis of acute streptococcal pharyngotonsillitis. Because of the major disadvantage of culturing throat swabs on BAP culture is the delay in obtaining the results (at least 1 day), in the past decades rapid antigen detection test (RAD) were introduced for the rapid identification of GABHS directly from throat swabs. Accurate diagnosis and treatment of GABHS pharyngotonsillitis provides positive benefits, including prevention of complications, such as acute rheumatic fever and peritonsillar abscess and reduce the acute morbidity associated with the illness. Conversely, improper diagnosis may result in negative consequences, including unnecessary antibiotic prescriptions that confer increased health care costs and contibute to the development of bacterial resistance.

  19. 急性缺血性脑血管疾病病人发热与病死率的关系%The Acute Ischemic Cerebrovascular Stroke Patient Fever with Mortality Relations

    Institute of Scientific and Technical Information of China (English)

    卢红

    2009-01-01

    目的 探讨急性缺血性脑血管疾病病人病死率与体温的关系.方法 对220例急性缺血性脑血管疾病病人入院第1,2天和出院或死亡当天及前一天体温进行比较,观察急性缺血性脑血管疾病病人发热与病死率的关系.结果 发热病人病死率比体温正常病人病死率明显增加(52.9%和4.9%,P<0.01).结论 发热是急性缺血性脑血管疾病病人死亡的主要原因.因此早期控制体温,预防感染,加强护理,可以有效降低其病死率.%Objective To investigate the acute isehemic cerebrovascular stroke patient case fatality rate and the body temperature relations. Methods 220 cases of isehemic cerebrovascular disease patients admitted to hospital and discharged the same day or the day temperature to compare death. Observation The acute iachemic cerebrovascular stroke patient fever with mortality relations. Results Fever Patients mortality than normal body temperature mortality significantly increased(52.9% and 4.9%,P< 0.01). Conclusion Fever is the leading cause of death of acute ischemic cerebrovaseular disease patients. Hence,early control body temperature,prevent infection,to strengthen care,can effectively reduce the mortality.

  20. Sensorineural hearing loss in Lassa fever: two case reports

    Directory of Open Access Journals (Sweden)

    Okokhere Peter O

    2009-01-01

    Full Text Available Abstract Introduction Lassa fever is an acute arena viral haemorrhagic fever with varied neurological sequelae. Sensorineural hearing loss is one of the rare complications which occur usually during the convalescent stage of the infection. Case presentation The cases of two female patients aged 19 and 43 years old, respectively, with clinical features suggestive of Lassa fever and confirmed by immunoserological/Lassa-virus-specific reverse transcriptase polymerase chain reaction are presented. Both patients developed severe sensorineural hearing loss at acute phases of the infections. Conclusion Sensorineural hearing loss from Lassa fever infections can occur in both acute and convalescent stages and is probably induced by an immune response.

  1. OPPORTUNISTIC MICROORGANISMS IN RHEUMATIC DISEASES

    Directory of Open Access Journals (Sweden)

    M. Yu. Gulneva

    2016-01-01

    Full Text Available The paper gives the data available in the literature on the role of opportunistic microorganisms (OMs in rheumatic diseases (RDs. OMs are anticipated to be involved as triggers initiating the development of chronic inflammation. Along with this, OMs in autoimmune diseases may play a defensive role through the interaction with Toll-like receptors and the activation of T cells that have suppressor activity. The possible involvement of OMs in the pathogenesis of RDs provides support not only the isolation of microorganisms, but also the detection of antibacterial antibodies of different classes. Of great importance are OMs in the etiology of comorbid infections, the risk of which is due to both the presence of autoimmune RDs and the necessity of using the drugs having immunosuppressive activity. The active clinical introduction of biological agents is followed by a rise in the rate and severity of different infections, including those caused by OMs. Having a marked biological and environmental plasticity, OMs are able to persist long when there are changes in the immune defense of patients with RDs. There is evidence for the higher adhesive properties and persistent potential of the microorganisms that colonize the body of patients with RDs. In the latter, OMs that are distinguished by pronounced antibiotic polyresistance are isolated, making the treatment and prevention of opportunistic infections more difficult in rheumatology. The results of the papers analyzed in the review suggest that the study of OMs in RDs is of practical importance.

  2. [Soft tissue rheumatism in erderly].

    Science.gov (United States)

    Szczepański, Leszek

    2008-01-01

    Disorders of soft, peri-articular tissues are a common cause of musculoskeletal pain in elderly patients. Nevertheless, most physicians underestimate the role of soft tissue rheumatism in the pathomechanism of the pain. The impairments of soft tissue can not be diagnosed by X-rays examinations, whereas degenerative lesions of joints are easy diagnosed using this method even despite of their uncertain role in producing the symptoms. The incidence of pain syndromes originated from soft tissues differ regarding to the age of patients. In young subjects the incidence of all of them is generally low. Syndromes provoked by overloading during work: repetitive strain syndrome, canal tunnel syndrome, tennis elbow, golfers elbow, shoulder tendon coin disorders and myofascial pain syndrome are common in middle-aged patients. The morbidity of fibromialgia syndrome is also lower in old people probably as the result of diminished numbers and degenerative changes in nociceptive fibers. The syndromes prevailing in elderly patients include trochanteric syndrome and the pain syndromes provoked by muscle spasm depended on posture abnormalities. In the soft tissue pain syndrome prevention adapted to old age kinesitherapy and avoiding muscle overloading are recommended. Soft tissue pain syndromes are usually treated with non steroidal anti inflammatory drugs. In local pain syndromes better results can be obtained by local treatment. Local injections of glikocorticosteroids are usually very effective and safe.

  3. [Milk fever].

    Science.gov (United States)

    Dumont, M

    1989-05-01

    Infectious complications following delivery were, in the past, attributed to "milk fever": these were milk congestion, milk deposits, rancid milk, etc., that were held responsible. The milk was reabsorbed into the blood of the patient and settled in the peritoneum ("milk peritonitis"), in the broad ligaments (pelvic abscess), in the thighs (phlebitis) and also in the breasts (breast abscess). This belief, originated by Aristotle, was accepted by excellent authors like Andre Levret (1703-1780), one of the most famous French obstetricians and Nicolas Puzos, at the same time. More recently, authors alluded to it and blamed "milk fever" for being at the origin of dramatic pictures which they described in their novels, like Victor Hugo and Guy de Maupassant, for instance.

  4. Recurrent fever of unknown origin (FUO): aseptic meningitis, hepatosplenomegaly, pericarditis and a double quotidian fever due to juvenile rheumatoid arthritis (JRA).

    Science.gov (United States)

    Cunha, Burke A; Hage, Jean E; Nouri, Yelda

    2012-01-01

    exclusion of infectious and neoplastic disorders in a young adult with hepatosplenomegaly, aseptic meningitis, pericarditis, and a double quotidian fever. With JRA, tests for rheumatic diseases are negative, as they were in this case. The only laboratory abnormalities in this patient included elevated serum transaminases, a mildly elevated erythrocyte sedimentation rate, and a moderately elevated level of serum ferritin. Diagnostic fever curves are most helpful in cases where the diagnosis is most elusive, as was the case here. Relatively few disorders are associated with a double quotidian fever, ie, visceral leishmaniasis, mixed malarial infections, right-sided gonococcal acute bacterial endocarditis, and JRA. Because the patient received antipyretics during the first week of admission, fever was not present. After infectious disease consultation during week 2 of hospitalization, antipyretics were discontinued, and a double quotidian fever was present, which provided the key diagnostic clue in this case. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Animal models to investigate the pathogenesis of rheumatic heart disease

    Directory of Open Access Journals (Sweden)

    Catherine M Rush

    2014-11-01

    Full Text Available Rheumatic fever (RF and rheumatic heart disease (RHD are sequelae of group A streptococcal (GAS infection. Although an autoimmune process has long been considered to be responsible for the initiation of RF/RHD, it is only in the last few decades that the mechanisms involved in the pathogenesis of the inflammatory condition have been unravelled partly due to experimentation on animal models.RF/RHD is a uniquely human condition and modelling this disease in animals is challenging. Antibody and T cell responses to recombinant GAS M protein (rM and the subsequent interactions with cardiac tissue have been predominantly investigated using a rat autoimmune valvulitis model. In Lewis rats immunized with rM, the development of hallmark histological features akin to RF/RHD, both in the myocardial and in valvular tissue have been reported, with the generation of heart tissue cross reactive antibodies and T cells. However, studies of cardiac function are more challenging in such a model. Recently a Lewis rat model of Sydenham’s chorea (SC and related neuropsychiatric disorders has also been described. Rodent models are very useful for assessing disease mechanisms due to the availability of reagents to precisely determine sequential events following infection with GAS or post-challenge with specific proteins and or carbohydrate preparations from GAS. However, studies of cardiac function are more problematic in such models. In this review an historical overview of animal models previously used and those that are currently available will be discussed in terms of their usefulness in modelling different aspects of the disease process. Ultimately, cardiologists, microbiologists, immunologists and physiologists may have to resort to diverse models to investigate different aspects of RF/RHD.

  6. Typhoid fever.

    Science.gov (United States)

    Wain, John; Hendriksen, Rene S; Mikoleit, Matthew L; Keddy, Karen H; Ochiai, R Leon

    2015-03-21

    Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas, especially those in Africa. The main barriers to control are vaccines that are not immunogenic in very young children and the development of multidrug resistance, which threatens efficacy of antimicrobial chemotherapy. Clinicians, microbiologists, and epidemiologists worldwide need to be familiar with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow surveillance and to implement control measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Mucocutaneous manifestations of Chikungunya fever

    Directory of Open Access Journals (Sweden)

    Bandyopadhyay Debabrata

    2010-01-01

    Full Text Available Chikungunya fever (CF is an arboviral acute febrile illness transmitted by the bite of infected Aedes mosquitoes. After a quiescence of more than three decades, CF has recently re-emerged as a major public health problem of global scale. CF is characterized by an acute onset of high fever associated with a severe disabling arthritis often accompanied by prominent mucocutaneous manifestations. The disease is usually self-limiting, but the joint symptoms and some of the cutaneous features may persist after the defervescence. A wide range of mucocutaneous changes has been described to occur in association with CF during the current epidemic. Besides a morbilliform erythema, hyperpigmentation, xerosis, excoriated papules, aphthous-like ulcers, vesiculobullous and lichenoid eruptions, and exacerbation of pre-existing or quiescent dermatoses had been observed frequently. These unusual features may help in the clinical differential diagnosis of acute viral exanthems mimicking CF.

  8. Air pollution in autoimmune rheumatic diseases: a review.

    Science.gov (United States)

    Farhat, Sylvia C L; Silva, Clovis A; Orione, Maria Angelica M; Campos, Lucia M A; Sallum, Adriana M E; Braga, Alfésio L F

    2011-11-01

    Air pollution consists of a heterogeneous mixture of gasses and particles that include carbon monoxide, nitrates, sulfur dioxide, ozone, lead, toxic by-product of tobacco smoke and particulate matter. Oxidative stress and inflammation induced by inhaled pollutants may result in acute and chronic disorders in the respiratory system, as well as contribute to a state of systemic inflammation and autoimmunity. This paper reviews the mechanisms of air contaminants influencing the immune response and autoimmunity, and it focuses on studies of inhaled pollutants triggering and/or exacerbating rheumatic diseases in cities around the world. Remarkably, environmental factors contribute to the onset of autoimmune diseases, especially smoking and occupational exposure to silica in rheumatoid arthritis and systemic lupus erythematosus. Other diseases such as scleroderma may be triggered by the inhalation of chemical solvents, herbicides and silica. Likewise, primary vasculitis associated with anti-neutrophil cytoplasmic antibody (ANCA) may be triggered by silica exposure. Only few studies showed that air pollutants could trigger or exacerbate juvenile idiopathic arthritis and systemic lupus erythematosus. In contrast, no studies of tropospheric pollution triggering inflammatory myopathies and spondyloarthropathies were carried out. In conclusion, air pollution is one of the environmental factors involved in systemic inflammation and autoimmunity. Further studies are needed in order to evaluate air pollutants and their potentially serious effects on autoimmune rheumatic diseases and the mechanisms involved in the onset and the exacerbation of these diseases.

  9. Interaction of pregnancy and autoimmune rheumatic disease.

    Science.gov (United States)

    Østensen, Monika; Villiger, Peter M; Förger, Frauke

    2012-05-01

    During pregnancy, the fetus represents a natural allograft that is not normally rejected. While the maternal immune system retains the ability to respond to foreign antigens, tolerance mechanisms are up-regulated to protect the fetus from immunologic attacks by the mother. The profound immunologic adaptations during and after pregnancy do influence maternal autoimmune rheumatic diseases in several ways. One is triggering the onset of a rheumatic disease in the post partum period, the other influencing disease activity of established rheumatic disease. The review will discuss the mechanisms of increased susceptibility of rheumatoid arthritis (RA) in the first year post partum with a specific emphasis on the role of fetal cells or antigens persisting in the maternal circulation (so called microchimerism). Furthermore, the different influences of pregnancy on established rheumatic diseases will be highlighted. A marked beneficial effect of pregnancy is observed on RA whereas several other rheumatic diseases as ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) show either no particular effect or an aggravation of symptoms during pregnancy. Differences emerging in regard to modulation of disease symptoms during pregnancy seem related to response to hormones, the type of cytokine profile and immune response prevailing as well as further downstream interactions of molecular pathways that are important in disease pathogenesis.

  10. Rheumatic manifestations of diabetes mellitus.

    Science.gov (United States)

    Lebiedz-Odrobina, Dorota; Kay, Jonathan

    2010-11-01

    additional treatments for these and other rheumatic diseases.

  11. Fever in a traveler returning from the Amazon. Do not forget hepatitis A.

    Science.gov (United States)

    Cunha, Burke A; Teper, Rina Seerke; Raza, Muhammad

    2016-01-01

    Travelers returning from the tropics with fever remain a diagnostic challenge. Fever and chills suggest malaria, but may be present in dengue, chikungunya and influenza, and splenomegaly favors malaria or typhoid fever. In terms of laboratory tests, leukopenia suggests dengue fever, chikungunya fever or influenza. Atypical lymphocytes are present in malaria, dengue fever, chikungunya fever and influenza HAV, but not typhoid fever. Thrombocytopenia is profound in dengue fever, is also present in influenza and malaria. Mildly increased serum transaminases are common in malaria, typhoid fever, dengue fever, chikungunya fever and influenza while very high serum transaminases point to HAV. We present a case of a young woman traveler returning from the Amazon with splenomegaly, leukopenia, atypical lymphocytes, elevated LDH and minimally elevated serum transaminases who was found to have acute hepatitis A infection.

  12. Fever in a traveler returning from the Amazon. Do not forget hepatitis A

    Directory of Open Access Journals (Sweden)

    Burke A. Cunha

    2016-01-01

    Full Text Available Travelers returning from the tropics with fever remain a diagnostic challenge. Fever and chills suggest malaria, but may be present in dengue, chikungunya and influenza, and splenomegaly favors malaria or typhoid fever. In terms of laboratory tests, leukopenia suggests dengue fever, chikungunya fever or influenza. Atypical lymphocytes are present in malaria, dengue fever, chikungunya fever and influenza HAV, but not typhoid fever. Thrombocytopenia is profound in dengue fever, is also present in influenza and malaria. Mildly increased serum transaminases are common in malaria, typhoid fever, dengue fever, chikungunya fever and influenza while very high serum transaminases point to HAV. We present a case of a young woman traveler returning from the Amazon with splenomegaly, leukopenia, atypical lymphocytes, elevated LDH and minimally elevated serum transaminases who was found to have acute hepatitis A infection.

  13. Demgue Fever

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    登革热的病名源于西班牙语,是形容患者由于发烧、关节疼痛导致走路时步履蹒跚、步态造作。研究者根据其症状,称其为"关节热"或"碎骨热"。1869年,英国伦敦皇家内科学会正式将其命名为"登革热"(dengue fever,DF)。

  14. [Typhoid fever].

    Science.gov (United States)

    Marchou, B

    1996-01-15

    Endemic in regions with poor hygienic conditions, Enteric fevers are imported in France by returning travellers. They are caused by Salmonella strains, mainly S. Typhi, transmitted via fecal-oral route. Salmonella reach the blood stream after proliferating in mesenteric lymph nodes. At an initial stage blood and bone marrow cultures, later on Widal-Felix serology permit diagnosis. Antibiotics have rendered death exceptional. Quinolones and ceftriaxone allow treatments shorter than 10 days. Immunization (Typhim Vi) and improvement of hygienic standards are the cornerstone of prevention.

  15. Allergies and Hay Fever

    Science.gov (United States)

    ... an ENT Doctor Near You Allergies and Hay Fever Allergies and Hay Fever Patient Health Information News media interested in covering ... suffer from nasal allergies, commonly known as hay fever. An ear, nose, and throat specialist can help ...

  16. Rocky Mountain Spotted Fever

    Science.gov (United States)

    ... facebook share with twitter share with linkedin Rocky Mountain Spotted Fever Rocky Mountain spotted fever is a ... New Mexico. Why Is the Study of Rocky Mountain Spotted Fever a Priority for NIAID? Tickborne diseases ...

  17. Viral Hemorrhagic Fevers

    Science.gov (United States)

    ... 4 viruses that cause two other hemorrhagic fevers, dengue hemorrhagic fever and yellow fever. Virus Families Information ... 2014 Content source: Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases ( ...

  18. Dengue Fever Testing

    Science.gov (United States)

    ... AACC products and services. Advertising & Sponsorship: Policy | Opportunities Dengue Fever Testing Share this page: Was this page helpful? Also known as: Dengue Fever Antibodies; Dengue Fever Virus Formal name: Dengue ...

  19. Autoimmunity in Rheumatic Diseases Is Induced by Microbial Infections via Crossreactivity or Molecular Mimicry

    Directory of Open Access Journals (Sweden)

    Taha Rashid

    2012-01-01

    Full Text Available A general consensus supports fundamental roles for both genetic and environmental, mainly microbial, factors in the development of autoimmune diseases. One form of autoimmune rheumatic diseases is confined to a group of nonpyogenic conditions which are usually preceded by or associated with either explicit or occult infections. A previous history of clinical pharyngitis, gastroenteritis/urethritis, or tick-borne skin manifestation can be obtained from patients with rheumatic fever, reactive arthritis, or Lyme disease, respectively, whilst, other rheumatic diseases like rheumatoid arthritis (RA, ankylosing spondylitis (AS, and Crohn’s disease (CD are usually lacking such an association with a noticeable microbial infection. A great amount of data supports the notion that RA is most likely caused by Proteus asymptomatic urinary tract infections, whilst AS and CD are caused by subclinical bowel infections with Klebsiella microbes. Molecular mimicry is the main pathogenetic mechanism that can explain these forms of microbe-disease associations, where the causative microbes can initiate the disease with consequent productions of antibacterial and crossreactive autoantibodies which have a great impact in the propagation and the development of these diseases.

  20. The fight against rheumatism: from willow bark to COX-1 sparing drugs.

    Science.gov (United States)

    Vane, J R

    2000-12-01

    Man has been fighting rheumatism for thousands of years. Early therapy began with the use around the world of decoctions or extracts of herbs or plants such as willow bark or leaves. Most or all of these turned out to contain salicylates. The first record was about 3,500 years ago in the Ebers papyrus. Hippocrates, Celsus, Pliny the Elder, Dioscorides and Galen all recommended decoctions containing salicylate for rheumatic pain. A country parson, the Reverend Edward Stone of Chipping Norton in Oxfordshire, made the first "clinical trial" of willow bark (1). He was surprised by its bitter taste, which reminded him of cinchona bark (containing quinine), then being used to treat malaria. He harvested a pound of willow bark, dried it, pulverized it and dispersed it in tea, small beer or water. He found in 50 patients that doses of 1 dram (1.8g) cured their fever. He concluded "I have no other motives for publishing this valuable specific, than that it may have a fair and full trial in all its variety of circumstances and situations, and that the world may reap the benefits accruing from it". Salicylic acid was chemically synthesised in 1860 by Kolbe in Germany and its ready supply led to even more extended usage as an external antiseptic, as an antipyretic and in the treatment of rheumatism.

  1. Acute liver failure caused by drug-induced hypersensitivity syndrome associated with hyperferritinemia

    Institute of Scientific and Technical Information of China (English)

    Masayuki Miyazaki; Masatake Tanaka; Akihiro Ueda; Tsuyoshi Yoshimoto; Masaki Kato; Makoto Nakamuta; Kazuhiro Kotoh; Ryoichi Takayanagi

    2011-01-01

    Drug-induced hypersensitivity syndrome (DIHS) is a se-vere reaction usually characterized by fever, rash, and multiorgan failure, occurring 2-6 wk after drug introduction.It is an immune-mediated reaction involving macrophage and T-lymphocyte activation and cytokine release. A 54-year-old woman was diagnosed with rheumatic arthritis and initiated salazosulfapyridine by mouth. About 10 d later, she had a high fever, skin rash and liver dysfunction. She was admitted to hospital and diagnosed with a drug eruption. She was treated with oral prednisolone 30 mg/d; however, she developed high fever again and her blood tests showed acute liver failure and cytopenia associated with hyperferritinemia. She was diagnosed with acute liver failure and hemophagocytosis caused by DIHS. She was transferred to the Department of Medicine and Bioregulatory Science, Kyushu University, where she was treated with arterial steroid injection therapy. Following this treatment, her liver function improved and serum ferritin immediately decreased. We hypothesized that an immune-mediated reaction in DIHS may have generated over-activation of macrophages and T-lymphocytes, followed by a cytokine storm that affected various organs. The measurement of serum ferritin might be a useful marker of the severity of DIHS.

  2. Rheumatic diseases presenting as sports-related injuries.

    Science.gov (United States)

    Jennings, Fabio; Lambert, Elaine; Fredericson, Michael

    2008-01-01

    Most individuals seeking consultation at sports medicine clinics are young, healthy athletes with injuries related to a specific activity. However, these athletes may have other systemic pathologies, such as rheumatic diseases, that may initially mimic sports-related injuries. As rheumatic diseases often affect the musculoskeletal system, they may masquerade as traumatic or mechanical conditions. A systematic review of the literature found numerous case reports of athletes who presented with apparent mechanical low back pain, sciatica pain, hip pain, meniscal tear, ankle sprain, rotator cuff syndrome and stress fractures and who, on further investigation, were found to have manifestations of rheumatic diseases. Common systemic, inflammatory causes of these musculoskeletal complaints include ankylosing spondylitis (AS), gout, chondrocalcinosis, psoriatic enthesopathy and early rheumatoid arthritis (RA). Low back pain is often mechanical among athletes, but cases have been described where spondyloarthritis, especially AS, has been diagnosed. Neck pain, another common mechanical symptom in athletes, can be an atypical presentation of AS or early RA. Hip or groin pain is frequently related to injuries in the hip joint and its surrounding structures. However, differential diagnosis should be made with AS, RA, gout, psudeogout, and less often with haemochromatosis and synovial chondochromatosis. In athletes presenting with peripheral arthropathy, it is mandatory to investigate autoimmune arthritis (AS, RA, juvenile idiopathic arthritis and systemic lupus erythematosus), crystal-induced arthritis, Lyme disease and pigmented villonodular synovitis. Musculoskeletal soft tissue disorders (bursitis, tendinopathies, enthesitis and carpal tunnel syndrome) are a frequent cause of pain and disability in both competitive and recreational athletes, and are related to acute injuries or overuse. However, these disorders may occasionally be a manifestation of RA, spondyloarthritis

  3. Estimation of acute and chronic Q fever incidence in children during a three-year outbreak in the Netherlands and a comparison with international literature

    NARCIS (Netherlands)

    Slok, Edwin N E; Dijkstra, Frederika; de Vries, Esther; Rietveld, Ariene; Wong, Albert; Notermans, Daan W; van Steenbergen, Jim E

    2015-01-01

    BACKGROUND: In the Dutch 2007-2009 Q fever outbreak Coxiella burnetii was transmitted aerogenically from dairy goat farms to those living in the surrounding areas. Relatively few children were reported. The true number of pediatric infections is unknown. In this study, we estimate the expected numbe

  4. Viral haemorrhagic fevers in healthcare settings.

    Science.gov (United States)

    Ftika, L; Maltezou, H C

    2013-03-01

    Viral haemorrhagic fevers (VHFs) typically manifest as rapidly progressing acute febrile syndromes with profound haemorrhagic manifestations and very high fatality rates. VHFs that have the potential for human-to-human transmission and onset of large nosocomial outbreaks include Crimean-Congo haemorrhagic fever, Ebola haemorrhagic fever, Marburg haemorrhagic fever and Lassa fever. Nosocomial outbreaks of VHFs are increasingly reported nowadays, which likely reflects the dynamics of emergence of VHFs. Such outbreaks are associated with an enormous impact in terms of human lives and costs for the management of cases, contact tracing and containment. Surveillance, diagnostic capacity, infection control and the overall preparedness level for management of a hospital-based VHF event are very limited in most endemic countries. Diagnostic capacities for VHFs should increase in the field and become affordable. Availability of appropriate protective equipment and education of healthcare workers about safe clinical practices and infection control is the mainstay for the prevention of nosocomial spread of VHFs.

  5. 川西平原中小学生风湿热及风湿性心脏病流行病学调查%An Epidemiologic Investigation of Acute Rheumatic Fever and Rheumatic Heart Disease Among Students Aged 5-18 in West Area of Sichuan Province

    Institute of Scientific and Technical Information of China (English)

    陈晓平; 章茂顺; 黄德嘉; 黄明慧; 熊运文; 解曼蓉; 寿裕蓉; 李明龙; 吴诚; 曾焕琼; 李秀蓉; 郑明霞

    2003-01-01

    目的了解川西地区风湿热及风心病流行情况.方法按照全国统一方案对5~18岁学生进行风湿热发病监测及风心病患病率调查.结果川西平原地区风湿热发病率为12.87/10万.城市与农村无明显差异(分别为12.74/10万及12.94/10万),男女间无明显差异.该病以9~15岁多发,主要见于秋冬季,且全部病例均患有关节炎,其中83.3%合并心脏损害.风心病患病率为11‰.结论对川西地区中小学生进行风湿热发病监测及社区控制是必要和有效的.

  6. Tendencia en la mortalidad por fiebre reumática aguda y cardiopatía reumática crónica en Venezuela, 1955-1994 Mortality trends for acute rheumatic fever and chronic rheumatic heart disease in Venezuela, 1955-1994

    OpenAIRE

    1998-01-01

    Este estudio incluye defunciones por fiebre reumática aguda (FRA) y cardiopatía reumática crónica (CRC) registradas en Venezuela de 1955 a 1994, según edad y sexo. Se calcularon tasas de mortalidad por 100.000 habitantes, ajustadas según método directo a la población mundial estándar de la OMS. Se produjo un descenso en la tasa ajustada de mortalidad (TAM) por FR para ambos sexos de 7,68 a 1,08 (Variación Porcentual [VP] -85,9%); sexo masculino de 7,53 a 0,84 (VP -88,8%) y sexo femenino de 7,...

  7. Typhoid fever in a 7 month old infant.

    Directory of Open Access Journals (Sweden)

    Karande S

    1995-10-01

    Full Text Available The clinical profile of typhoid fever in an infant is variable and non-specific. A rare case of typhoid fever in a 7 month old infant is reported. The child presented with only a day′s history of fever and loose motions which resulted in severe dehydration, acute tubular necrosis and death. The diagnosis of typhoid fever was made only on post-mortem study. The problem in diagnosing typhoid fever in a young infant is highlighted with a brief literature review on the subject.

  8. Dengue Fever with rectus sheath hematoma: a case report.

    Science.gov (United States)

    Sharma, Anurag; Bhatia, Sonia; Singh, Rajendra Pratap; Malik, Gaurav

    2014-04-01

    Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the Dengue virus. It is associated with a number of complications, which are well documented. However, Dengue fever associated with rectus sheath hematoma (RSH) is a very rare complication. Only one case report has been published prior supporting the association of Dengue fever with RSH. We report a case of Dengue fever who presented with RSH and was successfully treated conservatively. RSH is also an uncommon cause of acute abdominal pain. It is accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear.

  9. Dengue fever with rectus sheath hematoma: A case report

    Directory of Open Access Journals (Sweden)

    Anurag Sharma

    2014-01-01

    Full Text Available Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the Dengue virus. It is associated with a number of complications, which are well documented. However, Dengue fever associated with rectus sheath hematoma (RSH is a very rare complication. Only one case report has been published prior supporting the association of Dengue fever with RSH. We report a case of Dengue fever who presented with RSH and was successfully treated conservatively. RSH is also an uncommon cause of acute abdominal pain. It is accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear.

  10. Rheumatic manifestations associated with lung diseases

    Directory of Open Access Journals (Sweden)

    Marco Aurelio Scarpinella Bueno

    2008-03-01

    Full Text Available Rheumatic manifestations in the more prevalent lung diseasessuch as asthma, chronic pulmonary disease or pneumonia are notfrequent. Exceptions to this rule are represented by lung cancerand sarcoidosis, where the appearance of the digital clubbing,hypertrophic osteoarthropathy, and arthtritis can correspond to thefi rst symptoms of the illness.

  11. [The temporomandibular joint and inflammatory rheumatic diseases].

    Science.gov (United States)

    Marotte, H

    2016-09-01

    Some inflammatory rheumatic diseases can involve the temporomandibular joint, such as rheumatoid arthritis and spondylarthritis. The aim of our work was to evaluate the current prevalence of these inflammatory TMJ diseases, to indicate the new therapeutics and to describe the collaboration between rheumatologist and maxillofacial surgeon in these pathologies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Perspectives for uveitis treatment in rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Alla Aleksandrovna Godzenko

    2011-01-01

    Full Text Available The paper describes current approaches to treating uveitis in rheumatic diseases and theoretical backgrounds for using tumor necrosis factor-α (TNF-α inhibitors. The data available in the literature suggest that anti-TNF-α therapy is highly effective in relieving and preventing uveitis attacks.

  13. Major histocompatibility complex: its role in the pathogenesis of autoimmune rheumatic diseases - doi:10.5020/18061230.2006.p155

    Directory of Open Access Journals (Sweden)

    Crésio Alves

    2012-01-01

    Full Text Available In order to allow early diagnosis and more efficient treatments, many studies have been trying to define genetic markers of rheumatic diseases. Amongst them, antigens and alleles of the HLA (Human Leukocyte Antigens system are distinguished. Located in the short arm of chromosome 6, the HLA system exerts genetic influence on the susceptibility and severity of these diseases. The discovery of new molecular methods to typify HLA alleles and the recent nomenclature updates have been contributing to a better understanding of this system. Unfortunately, this information has not been adequately published in the clinical literature. The present work aimed at presenting the function, nomenclature and methods of detection of the HLA polymorphism; and to review its associations with rheumatic fever, systemic erythematosus lupus, rheumatoid arthritis, juvenile idiopathic arthritis and spondyloarthropathies. Articles that were published between 1980 and 2005 were searched in the MEDLINE and LILACS data basis. This review demonstrated that although the HLA association is well established for some rheumatic diseases (e.g., HLA-B27 and spondyloarthropathies, HLA DR-3 and HLA-DR4 with rheumatoid arthritis, HLA-DR4 and lupus others vary in different ethnic-racial group and illnesses, due to its polymorphism. It is necessary to study populations from different ethnic backgrounds to identify new associations or to strengthen associations with the ones already identified. This knowledge will contribute to future prophylactic or therapeutic interventions in patients with rheumatic disorders or at risk to develop them.

  14. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    OpenAIRE

    Olfa Kassar; Feten Kallel; Manel Ghorbel; Hatem. Bellaaj; Zeineb Mnif; Moez Elloumi

    2015-01-01

    Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patie...

  15. Familial Mediterranean Fever and Hypercoagulability

    Science.gov (United States)

    Tayer-Shifman, Oshrat E.; Ben-Chetrit, Eldad

    2011-01-01

    Familial Mediterranean fever (FMF) is an autosomal recessive hereditary disease which is characterized by recurrent attacks of fever and peritonitis, pleuritis, arthritis, or erysipelas-like skin disease. As such, FMF is a prototype of autoinflammatory diseases where genetic changes lead to acute inflammatory episodes. Systemic inflammation – in general - may increase procoagulant factors, and decrease natural anticoagulants and fibrinolytic activity. Therefore, it is anticipated to see more thrombotic events among FMF patients compared with healthy subjects. However, reviewing the current available literature and based upon our personal experience, thrombotic events related purely to FMF are very rare. Possible explanation for this discrepancy is that along with the procoagulant activity during FMF acute attacks, anticoagulant and fibrinolytic changes are also taking place. Colchicine which is the treatment of choice in FMF may also play a role in reducing inflammation thereby decreasing hypercoagulability. PMID:21713077

  16. A short history of anti-rheumatic therapy. II. Aspirin

    Directory of Open Access Journals (Sweden)

    P. Marson

    2011-06-01

    Full Text Available The discovery of aspirin, an antipyretic, anti-inflammatory and analgesic drug, undoubtedly represents a milestone in the history of medical therapy. Since ancient times the derivatives of willow (Salix alba were used to treat a variety of fevers and pain syndromes, although the first report dates back to 1763 when the English Reverend Edward Stone described the effect of an extract of the bark willow in treating malaria. In the XIX century many apothecaries and chemists, including the Italian Raffaele Piria and Cesare Bertagnini, developed the biological processes of extraction and chemical synthesis of salicylates, and then analyzed their therapeutic properties and pharmacokinetic and pharmacodynamic characteristics. In 1899 the Bayer Company, where Felix Hoffmann, Heinrich Dreser and Arthur Eichengrün worked, recorded acetyl-salicylic acid under the name “Aspirin”. In the XX century, besides the definition of the correct applications of aspirin in the anti-rheumatic therapy being defined, Lawrence L. Crawen identified the property of this drug as an anti-platelet agent, thus opening the way for more widespread uses in cardiovascular diseases.

  17. Fever of unknown origin: Most frequent causes in adults patients.

    Science.gov (United States)

    Popovska-Jovicić, Biljana; Canović, Predrag; Gajović, Olgica; Raković, Ivana; Mijailović, Zeljko

    2016-01-01

    The differential diagnosis of fever of unknown origin (FUO) includes more than 200 different diseases and conditions. The aim of this study was to identify the most frequent causes of FUO among adult patients according to gender and age. The study included 74 patients examined from June 2010 to June 2013 at the Infectious Disease Clinic, Clinical Center Kragujevac in Serbia, according to the defined criteria for FUO. The patients were divided according to the diagnosis into four groups: infectious, malignant, rheumatic and "other diseases". A cause of febricity could not be estabilshed in a portion of subjects, and they comprised the group of undiagnosed cases. Infectious diseases were dominant in the study, followed by rheumatic diseases, which were most frequently found in women and the elderly. The diseases recognised as the most common causes of febricity were subacute thyroiditis, subacute endocarditis, Still's disease, rheumatic polymyalgia with or without temporal arteritis, and cytomegalovirus infection. In 44% of the patients, the final diagnosis was composed of only six clinical entities. The importance of establishing the diagnosis of rheumatic disease is especially emphasised, in line with other authors' research indicating the number of these diseases is on the rise. The diagnostic approach to FUO should always be directed to the known frequency of diseases.

  18. Pregnancy and rheumatic disease: "by the book" or "by the doc".

    Science.gov (United States)

    Keeling, Stephanie O; Oswald, Anna E

    2009-01-01

    Pregnancy is an important condition that can affect and be affected by rheumatic disease. Overall, pregnancy is viewed as a Th2-predominant state, but several Th1-related cytokines are vital to early pregnancy. In rheumatoid arthritis for example, the majority of women improve by the beginning of the second trimester, but the majority (90%) will flare in the first 3 to 4 months postpartum. In contrast, systemic lupus erythematosus has an unpredictable course in pregnancy, leaving most rheumatologists to recommend a disease-quiescent state prior to conception. Other diseases such as scleroderma are less clear because the disease less commonly presents in the childbearing period. Many immunosuppressive medications for the rheumatic diseases are contraindicated in pregnancy because of their mechanisms of action leaving only a select few "safe" medications. Significant heterogeneity between the Food and Drug Administration (FDA) category for a medication and what a rheumatologist does in clinic leads to confusion on how a patient should be treated for active rheumatic disease both peripartum and postpartum, particularly if the patient is breastfeeding. We review the general state of pregnancy and how it is affected by prototypical rheumatic diseases including rheumatoid arthritis and systemic lupus erythematosus. In addition, we present the most commonly used disease-modifying antirheumatic drugs and immunosuppressants and explain the difference between the FDA category and clinical practice among rheumatologists. Finally, we provide some general recommendations on how to manage a rheumatic disease during pregnancy including: (a) preconception planning to ensure no teratogenic medications on board, (b) early disclosure of pregnancy to all caregivers including the rheumatologist, family physician, obstetrician, and maternal-fetal medicine specialist, and (c) planning of safe medication use for acute flare-ups and disease suppression peripartum and postpartum.

  19. Post-epidemic Chikungunya disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period.

    Directory of Open Access Journals (Sweden)

    Daouda Sissoko

    Full Text Available Although the acute manifestations of Chikungunya virus (CHIKV illness are well-documented, few data exist about the long-term rheumatic outcomes of CHIKV-infected patients. We undertook between June and September 2006 a retrospective cohort study aimed at assessing the course of late rheumatic manifestations and investigating potential risk factors associated with the persistence of these rheumatic manifestations over 15 months. 147 participants (>16 yrs with laboratory-confirmed CHIKV disease diagnosed between March 1 and June 30, 2005, were identified through a surveillance database and interviewed by telephone. At the 15-month-period evaluation after diagnosis, 84 of 147 participants (57% self-reported rheumatic symptoms. Of these 84 patients, 53 (63% reported permanent trouble while 31 (37% had recurrent symptoms. Age > or=45 years (OR = 3.9, 95% CI 1.7-9.7, severe initial joint pain (OR = 4.8, 95% CI 1.9-12.1, and presence of underlying osteoarthritis comorbidity (OR = 2.9, 95% CI 1.1-7.4 were predictors of nonrecovery. Our findings suggest that long-term CHIKV rheumatic manifestations seem to be a frequent underlying post-epidemic condition. Three independent risk factors that may aid in early recognition of patients with the highest risk of presenting prolonged CHIKV illness were identified. Such findings may be particularly useful in the development of future prevention and care strategies for this emerging virus infection.

  20. Human heart sarcolemmal sheath antibodies in children with non-suppurative sequelae of group A streptococcal infections: a follow up study.

    OpenAIRE

    1991-01-01

    The kinetics of the human heart sarcolemmal sheath antibody were studied in children with acute rheumatic fever who had no carditis, children with acute rheumatic fever who had carditis and developed rheumatic heart disease, and in children with acute poststreptococcal glomerulonephritis. The children with rheumatic fever and those who developed valvular heart disease were given continuous secondary antistreptococcal prophylaxis. The titre of antibody at onset was significantly higher than th...

  1. Fever: First Aid

    Science.gov (United States)

    First aid Fever: First aid Fever: First aid By Mayo Clinic Staff A fever is a rise in body temperature. It's usually a sign of infection. The ... 2 C) or higher Should I treat a fever? When you or your child is sick, the ...

  2. Quadriparesis and dysarthria due to tetrabenazine therapy in a child with rheumatic chorea

    Directory of Open Access Journals (Sweden)

    Syed Ahmed Zaki

    2011-01-01

    Full Text Available Tetrabenazine (TBZ is widely used to treat hyperkinetic movement disorders in adults; however, published experience with the drug in children is limited. Common side effects of TBZ include drowsiness, sedation, weakness, Parkinsonism, depression, and acute akathisia, all of which are reversible with decreased doses. We report here a 7-year-old girl with rheumatic chorea who developed acute akinesia of all four limbs and dysarthria due to TBZ therapy. Withdrawal of the drug led to rapid improvement within 18 hours.

  3. Acute cholecystitis

    OpenAIRE

    Halpin, Valerie

    2014-01-01

    Acute cholecystitis causes unremitting right upper quadrant pain, anorexia, nausea, vomiting, and fever, and if untreated can lead to perforations, abscess formation, or fistulae. About 95% of people with acute cholecystitis have gallstones.It is thought that blockage of the cystic duct by a gallstone or local inflammation can lead to acute cholecystitis, but we don't know whether bacterial infection is also necessary.

  4. Q Fever: An Old but Still a Poorly Understood Disease

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    Hamidreza Honarmand

    2012-01-01

    Full Text Available Q fever is a bacterial infection affecting mainly the lungs, liver, and heart. It is found around the world and is caused by the bacteria Coxiella burnetii. The bacteria affects sheep, goats, cattle, dogs, cats, birds, rodents, and ticks. Infected animals shed this bacteria in birth products, feces, milk, and urine. Humans usually get Q fever by breathing in contaminated droplets released by infected animals and drinking raw milk. People at highest risk for this infection are farmers, laboratory workers, sheep and dairy workers, and veterinarians. Chronic Q fever develops in people who have been infected for more than 6 months. It usually takes about 20 days after exposure to the bacteria for symptoms to occur. Most cases are mild, yet some severe cases have been reported. Symptoms of acute Q fever may include: chest pain with breathing, cough, fever, headache, jaundice, muscle pains, and shortness of breath. Symptoms of chronic Q fever may include chills, fatigue, night sweats, prolonged fever, and shortness of breath. Q fever is diagnosed with a blood antibody test. The main treatment for the disease is with antibiotics. For acute Q fever, doxycycline is recommended. For chronic Q fever, a combination of doxycycline and hydroxychloroquine is often used long term. Complications are cirrhosis, hepatitis, encephalitis, endocarditis, pericarditis, myocarditis, interstitial pulmonary fibrosis, meningitis, and pneumonia. People at risk should always: carefully dispose of animal products that may be infected, disinfect any contaminated areas, and thoroughly wash their hands. Pasteurizing milk can also help prevent Q fever.

  5. Q fever endocarditis with multi-organ complication: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-juan; FU Xiu-ping; ZHANG Jing-shan

    2006-01-01

    @@ Qfever is a worldwide zoonosis and its agent is Coxiella burnetii (C. burnetii).1 There are two forms of Q fever: acute and chronic. Acute Q fever is caused by primary infection with C. burnetii and its main clinical features are high fever, granulomatous hepatitis and atypical pneumonia.2,3 Acute Q fever is extremely prone to develop chronic infection if it is improperly treated. Endocarditis is the main characteristic of chronic Q fever and it accounts for 3% to 5% of all cases of endocarditis.4,5

  6. Miliaria-rash after neutropenic fever and induction chemotherapy for acute myelogenous leukemia Miliária 'rash' após neutropenia febril e quimioterapia de indução para a leucemia mielóide aguda

    Directory of Open Access Journals (Sweden)

    Tuyet A Nguyen

    2011-08-01

    Full Text Available Miliaria is a disorder of the eccrine sweat glands which occurs in conditions of increased heat and humidity. It can be associated with persistent febrile states as well as with certain drugs. We presented a 40 year-old female with myelodysplastic syndrome and progression to acute myelogenous leukemia who was admitted to the hospital for chemotherapy induction. The patient was treated with idarubicin and cytarabine. She became pancytopenic and developed neutropenic fever and was started on vancomycin and cefepime, but was persistently febrile with night sweats. Five days into her fevers, she developed diffuse, nonpruritic and fragile vesicles together with drenching nightsweats. The patient's exanthem was diagnosed as Miliaria crystallina, most probably induced by neutropenic fever and idarubucin exposureMiliária é uma desordem das glândulas sudoríparas écrinas, que ocorre em condições de aumento de calor e umidade. Miliária pode ser associada com estados febris persistentes bem como com certos medicamentos. Apresentamos o caso de uma mulher de 40 anos com síndrome mielodisplásica e progressão para leucemia mielóide aguda que foi admitida no hospital para quimioterapia de indução. A paciente foi tratada com idarrubicina e citarabina. Ela se tornou pancitopênica e desenvolveu neutropenia febril. Iniciou tratamento com vancomicina e cefepime, mas a febre com sudorese noturna continou. Cinco dias depois a paciente desenvolveu vesículas difusas, não pruríticas e frágeis juntamente com a persistência de sudorese noturna. O exantema do paciente foi diagnosticado como Miliária cristalina, provavelmente induzida por neutropenia febril e exposição a idarubucin

  7. Fever during anaesthesia.

    Science.gov (United States)

    Negishi, Chiharu; Lenhardt, Rainer

    2003-12-01

    Fever occurs when pyrogenic stimulation activates thermal control centres. Fever is common during the perioperative period, but rare during anaesthesia. Although only a limited number of studies are available to explain how anaesthesia affects fever, general anaesthesia seems to inhibit fever by decreasing the thermoregulatory-response thresholds to cold. Opioids also inhibit fever; however, the effect is slightly less than that of general anaesthesia. In contrast, epidural anaesthesia does not affect fever. This suggests that hyperthermia, which is often associated with epidural infusions during labour or in the post-operative period, may be a true fever caused by inflammatory activation. Accordingly, this fever might be diminished in patients who receive opioids for pain treatment. Post-operative fever is a normal thermoregulatory response usually of non-infectious aetiology. Fever may be important in the host defence mechanisms and should not be routinely treated lest the associated risks exceed the benefits.

  8. Acute tonsillitis at infectious patients

    Directory of Open Access Journals (Sweden)

    Y. P. Finogeev

    2011-01-01

    Full Text Available We examined 1824 patients with diphtheria treated in Clinical Infectious Diseases Hospital Botkin (St. Petersburg in 1993 – 1994, and more than 500 patients referred to the clinic with a diagnosis of «angina». Based on published data and our own research observations investigated the etiology of acute tonsillitis. Bacterial tonsillitis should be treated with antibiotics, and this is important aetiological interpretation of these diseases. Streptococcal tonsillitis should always be a sore throat syndrome as a diagnostic sign of support. For other forms of lymphoma lesion of the tonsils should not be defined as «angina», and called «tonsillitis». Аngina as β-hemolytic streptococcus group A infection is recognized as the leader in the development of rheumatic fever. On the basis of a large clinical material briefly analyzed the clinical manifestations of various forms of diphtheria with membranous tonsillitis. Also presented with a syndrome of infectious diseases as tonsillitis, therapeutic and surgical «mask» of infectious diseases.

  9. Thought barriers to understanding rheumatic diseases--Halstead R. Holman revisited.

    Science.gov (United States)

    Yazici, Hasan

    2010-01-01

    Halsted R. Holman, in a 1994 Arthritis & Rheumatism editorial, discusses how "thought barriers" can make our understanding of rheumatic diseases more difficult. The medical teaching-practice has traditionally been centered on acute disease; however, most rheumatic diseases are chronic. There is also the prevailing notion of a single lesion for each disease, a concept stemming from infectious diseases. Related to this is an investigative strategy of reductionism. We commonly overlook interactive biological pathways, which make up many of our diseases. In this regard, Holman advises us that 1. abnormalities are not necessarily harmful; 2. in rheumatological diseases, not only are multivariate causes-pathways operative, but the same pathways can be influenced by separate influences; 3. in chronic disease, "the task of the physician is to manage the course of disease over time," a scheme where the patient is at the center of achieving and monitoring progress; and 4. our current medical care system is mainly based on acute care, and needs to be adopted more to the needs of chronic care. In the current manuscript, three additional "thought barriers" are proposed: 1. our urge to lump diseases is too simplistic and hinders progress; 2. the same is true for our resistance in not including diseased control groups in genetic association studies; and 3. misuse of the controlled clinical trial. The popular inductive reasoning with the propensity to prove rather than to falsify one's self might be the common denominator in many of the barriers discussed.

  10. Effect of familial Mediterranean fever on sexual and reproductive health in women.

    Science.gov (United States)

    Karakaş Uğurlu, Görkem; Uğurlu, Mustafa; Erten, Şükran; Can, Serdar Süleyman; Ulusoy Kaymak, Semra; Çayköylü, Ali

    2017-04-18

    The aim of this study was to investigate the relationship between familial Mediterranean fever and female sexual dysfunction and premenstrual syndrome. This study included 36 patients with familial Mediterranean fever and 33 healthy volunteers. Familial Mediterranean fever was diagnosed according to the Tel Hashomer criteria and familial Mediterranean fever mutations were identified in all of the patients. The patients and healthy volunteers were compared in terms of anxiety, depression, sexual dysfunction, and premenstrual syndrome, and a model was created that describes the relationships among these variables. We found statistically significant differences between the groups in terms of anxiety, premenstrual syndrome, and Golombok Rust Inventory of Sexual Satisfaction frequency and vaginismus subscale scores. There was no difference in depression scores between the groups. Familial Mediterranean fever is a rheumatic disease that predisposes patients to sexual dysfunction and premenstrual syndrome, which emerges as direct and indirect psychological factors.

  11. Haematological Alterations Due to Typhoid Fever in Enugu Urban- Nigeria

    Directory of Open Access Journals (Sweden)

    Okafor, A. I.

    2007-01-01

    Full Text Available Some specific haematological changes that accompany chronic and severe typhoid fever were investigated in an endemic area of Enugu Urban-Nigeria. The results established that typhoid fever infections led to a statistically significant leucopenia (p < 0.05. In acute, chronic cases, leucopenia is accompanied with significant oligocythaemia, thrombocytopenia, anaemia and lowered haematocrit (p < 0.05. The importance of the results in the diagnosis and treatment of typhoid fever are discussed.

  12. The management of rheumatic diseases in pregnancy.

    Science.gov (United States)

    Mitchell, K; Kaul, M; Clowse, Megan E B

    2010-03-01

    Pregnancy can create a challenge for physicians caring for women with rheumatic diseases. For many women with rheumatoid arthritis (RA), pregnancy can provide a reprieve from long-term joint pain and inflammation, but others will not experience remission and will continue to need medication. Systemic lupus erythematosus (SLE) may remain quiet in some women, but in others may become more aggressive during pregnancy, putting both mother and foetus at risk. Women with limited scleroderma can do remarkably well, but scleroderma renal crises can be difficult to manage. A third of pregnancies in women with antiphospholipid syndrome (APS) may be refractory to our best therapy. In general, active inflammation from rheumatic diseases poses a stronger threat to the well-being of both mother and foetus than many immunosuppressant medications. Therefore, continued immunosuppression with the least risky medications will allow for the most optimal pregnancy outcomes.

  13. Management of rheumatic chorea: an observational study

    Directory of Open Access Journals (Sweden)

    Araújo Alexandra Prufer de Queiroz Campos

    2002-01-01

    Full Text Available BACKGROUND: Rheumatic chorea (RC has recently been linked to an antibody-mediated immune mechanism. OBJECTIVE/METHOD: To verify if this knowledge reflected in management changes we conceived a descriptive study. RESULTS: The medical charts of 20 children (13 females aged 6 to 12 years (mean 8 years, diagnosed as RC from June 1996 to June 1999, were reviewed. All patients received some medical treatment. Haloperidol was the most prescribed medication (15 patients - 75 %. Sulpiride, diazepam and valproate were also used as symptomatic treatment. Imune-modulating therapy with prednisone was prescribed for seven children. The shortest course of chorea (16 days occurred in a patient treated with prednisone. CONCLUSION: Prednisone has been prescribed for rheumatic chorea besides the traditional symptomatic approach. A great variety of antichoreic drugs are being employed.

  14. Autoimmune neuropathies associated to rheumatic diseases.

    Science.gov (United States)

    Martinez, Alberto R M; Faber, Ingrid; Nucci, Anamarli; Appenzeller, Simone; França, Marcondes C

    2017-04-01

    Systemic manifestations are frequent in autoimmune rheumatic diseases and include peripheral nervous system damage. Neuron cell body, axons and myelin sheath may all be affected in this context. This involvement results in severe and sometimes disabling symptoms. Sensory, motor and autonomic features may be present in different patterns that emerge as peculiar clinical pictures. Prompt recognition of these neuropathies is pivotal to guide treatment and reduce the risks of long term disability. In this review, we aim to describe the main immune-mediated neuropathies associated to rheumatic diseases: sensory neuronopathies, multiple mononeuropathies and chronic inflammatory demyelinating polyradiculoneuropathy, with an emphasis on clinical features and therapeutic options. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Ultrasound of enthesopathy in rheumatic diseases.

    Science.gov (United States)

    Falsetti, Paolo; Acciai, Caterina; Lenzi, Lucia; Frediani, Bruno

    2009-01-01

    Enthesopathy is the pathologic change of the insertion of tendons, ligaments and joint capsules on the bone. It is a cardinal feature of spondyloarthropathies (SpA), but it can occur in other rheumatic disease. Recent studies using magnetic resonance imaging (MRI) and ultrasonography (US) have demonstrated that enthesopathy can often be asymptomatic, in both the axial and peripheral skeleton. Therefore, a systematic US study of peripheral entheses could be useful in the diagnostic process of patients with rheumatic diseases, in particular SpA. Recently, power Doppler US (PDUS) has been proved to be useful for differentiating mechanical/degenerative and inflammatory enthesopathy and for monitoring the efficacy of therapy. This article reviews the main histopathologic aspects of enthesopathy and describes the normal US features of enthesis and the basic US features of enthesopathy, in its various stages. The usefulness of US and PDUS in the diagnosis and assessment of enthesopathy is discussed on the basis of the literature and our experience.

  16. Fibrositis: Misnomer for a Common Rheumatic Disorder

    OpenAIRE

    Bennett, Robert M

    1981-01-01

    Fibrositis is a misnomer for a very common form of nonarticular rheumatism. The name implies an inflammatory process in fibroconnective tissue which has never been verified. The symptoms of fibrositis are ill-defined musculoskeletal pain made worse by stress, cold, noise and unaccustomed exercise; there is usually a significant element of depression, nonrestorative sleep, chronic fatigue and early morning stiffness. Results of physical examination are strikingly normal, apart from painful ten...

  17. The management of rheumatic diseases in pregnancy

    OpenAIRE

    Mitchell, K; Kaul, M; Clowse, MEB

    2010-01-01

    Pregnancy can create a challenge for physicians caring for women with rheumatic diseases. For many women with rheumatoid arthritis (RA), pregnancy can provide a reprieve from long-term joint pain and inflammation, but others will not experience remission and will continue to need medication. Systemic lupus erythematosus (SLE) may remain quiet in some women, but in others may become more aggressive during pregnancy, putting both mother and foetus at risk. Women with limited scleroderma can do ...

  18. Adipokines, Metabolic Syndrome and Rheumatic Diseases

    OpenAIRE

    Vanessa Abella; Morena Scotece; Javier Conde; Verónica López; Verónica Lazzaro; Jesús Pino; Gómez-Reino, Juan J; Oreste Gualillo

    2014-01-01

    The metabolic syndrome (MetS) is a cluster of cardiometabolic disorders that result from the increasing prevalence of obesity. The major components of MetS include insulin resistance, central obesity, dyslipidemia, and hypertension. MetS identifies the central obesity with increased risk for cardiovascular diseases (CVDs) and type-2 diabetes mellitus (T2DM). Patients with rheumatic diseases, such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis...

  19. Role of diet in rheumatic disease.

    Science.gov (United States)

    Li, Sophia; Micheletti, Robert

    2011-02-01

    Millions of people suffer from rheumatic diseases such as gout, fibromyalgia, osteoarthritis, and rheumatoid arthritis. These can be incapacitating and detrimental to quality of life. Diet, nutrition, and weight loss have shown promise in alleviating some of this disease burden. These lifestyle changes may give patients a feeling of control and ownership over their disease as well as a nonpharmacologic means of treatment. This article reviews the available research on the effects of diet and nutrition on rheumatoid disease.

  20. Adipokines, metabolic syndrome and rheumatic diseases.

    Science.gov (United States)

    Abella, Vanessa; Scotece, Morena; Conde, Javier; López, Verónica; Lazzaro, Verónica; Pino, Jesús; Gómez-Reino, Juan J; Gualillo, Oreste

    2014-01-01

    The metabolic syndrome (MetS) is a cluster of cardiometabolic disorders that result from the increasing prevalence of obesity. The major components of MetS include insulin resistance, central obesity, dyslipidemia, and hypertension. MetS identifies the central obesity with increased risk for cardiovascular diseases (CVDs) and type-2 diabetes mellitus (T2DM). Patients with rheumatic diseases, such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis, have increased prevalence of CVDs. Moreover, CVD risk is increased when obesity is present in these patients. However, traditional cardiovascular risk factors do not completely explain the enhanced cardiovascular risk in this population. Thus, MetS and the altered secretion patterns of proinflammatory adipokines present in obesity could be the link between CVDs and rheumatic diseases. Furthermore, adipokines have been linked to the pathogenesis of MetS and its comorbidities through their effects on vascular function and inflammation. In the present paper, we review recent evidence of the role played by adipokines in the modulation of MetS in the general population, and in patients with rheumatic diseases.

  1. Adipokines, Metabolic Syndrome and Rheumatic Diseases

    Directory of Open Access Journals (Sweden)

    Vanessa Abella

    2014-01-01

    Full Text Available The metabolic syndrome (MetS is a cluster of cardiometabolic disorders that result from the increasing prevalence of obesity. The major components of MetS include insulin resistance, central obesity, dyslipidemia, and hypertension. MetS identifies the central obesity with increased risk for cardiovascular diseases (CVDs and type-2 diabetes mellitus (T2DM. Patients with rheumatic diseases, such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis, have increased prevalence of CVDs. Moreover, CVD risk is increased when obesity is present in these patients. However, traditional cardiovascular risk factors do not completely explain the enhanced cardiovascular risk in this population. Thus, MetS and the altered secretion patterns of proinflammatory adipokines present in obesity could be the link between CVDs and rheumatic diseases. Furthermore, adipokines have been linked to the pathogenesis of MetS and its comorbidities through their effects on vascular function and inflammation. In the present paper, we review recent evidence of the role played by adipokines in the modulation of MetS in the general population, and in patients with rheumatic diseases.

  2. Soft-tissue rheumatism: diagnosis and treatment.

    Science.gov (United States)

    Reveille, J D

    1997-01-27

    Soft tissue rheumatism is one of the most common and most misunderstood categories of disorders facing the primary care physician. Among the more common types are subacromial bursitis, epicondylitis, trochanteric bursitis, anserine bursitis, and fibromyalgia. The keys to the diagnosis of soft-tissue rheumatism are the history and, more importantly, the physical examination. Extensive laboratory testing and radiographs are not as helpful in evaluating patients with these complaints. Treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs) and nonnarcotic analgesics. Especially in patients with localized disorders, intralesional injections of corticosteroids are particularly effective and safe and should be part of the armamentarium of the primary care practitioner. Fibromyalgia is a particularly challenging form of nonarticular rheumatism. The clinical presentation is rather characteristic, with the patient typically being a woman 30-60 years of age who presents with diffuse somatic pain. Patients often give a history of sleep disturbance, may be depressed, and show characteristic tender areas, or trigger points. Laboratory findings are normal. Management includes reassurance, correction of the underlying sleep disturbance with low doses of a tricyclic antidepressant, treatment with muscle relaxants and nonnarcotic analgesics or NSAIDs, and an exercise program with a strong aerobic component.

  3. [Ocular manifestations of rheumatic diseases. Cooperation between internist/ophthalmologist].

    Science.gov (United States)

    Tyndall, A; Steiger, U

    1993-05-01

    A red or painful eye may be the clue to a systemic condition, many of which are of a rheumatological or immunological nature. Conjunctivitis may occur in Sjögren's Syndrome, Reiter's Syndrome (and other sero negative spondyloarthropathies) and with infections such as chlamydia and viruses. 70% of cases of episcleritis are idiopathic, the other 30% being associated with rheumatoid arthritis or other connective tissue diseases or herpes zoster infection. Scleritis may be seen with connective tissue diseases or auto immune conditions (rheumatoid arthritis, Wegener granulomatosis, polyarteritis nodosa, relapsing polychondritis, SLE), infections (herpes, tuberculosis, syphilis, aspergillosis) or metabolic (gout, porphyria, cystinosis). Retinal vasculitis is seen in SLE, Behçet's Disease, sarcoidosis, polyarteritis nodosa, Whipple's disease and Crohn's disease among others. However, uveitis presents perhaps the greatest diagnostic challenge and interface between ophthalmology and rheumatology. Some syndromes are purely ophthalmological (eg: Fuch's heterochromic cyclitis) but others may lead to the diagnosis of a rheumatic disorder (eg: recurrent unilateral acute anterior uveitis and ankylosing spondylitis). Systemic syndromes most likely to be associated with uveitis are Reiter's disease, ankylosing spondylitis, sarcoidosis, juvenile arthritis, interstitial nephritis, inflammatory bowel disease, syphilis. The patterns are different, eg: acute painful unilateral anterior uveitis with ankylosing spondylitis and chronic asymptomatic bilateral uveitis in juvenile arthritis (ANA positive, pauci-articular) or bilateral symptomatic uveitis in sarcoidosis. An illustrative case will be presented and an algorithm for the evaluation of uveitis discussed.

  4. Lassa fever or lassa hemorrhagic fever risk to humans from rodent-borne zoonoses.

    Science.gov (United States)

    El-Bahnasawy, Mamdouh M; Megahed, Laila Abdel-Mawla; Abdalla Saleh, Hala Ahmed; Morsy, Tosson A

    2015-04-01

    Viral hemorrhagic fevers (VHFs) typically manifest as rapidly progressing acute febrile syndromes with profound hemorrhagic manifestations and very high fatality rates. Lassa fever, an acute hemorrhagic fever characterized by fever, muscle aches, sore throat, nausea, vomiting, diarrhea and chest and abdominal pain. Rodents are important reservoirs of rodent-borne zoonosis worldwide. Transmission rodents to humans occur by aerosol spread, either from the genus Mastomys rodents' excreta (multimammate rat) or through the close contact with infected patients (nosocomial infection). Other rodents of the genera Rattus, Mus, Lemniscomys, and Praomys are incriminated rodents hosts. Now one may ask do the rodents' ectoparasites play a role in Lassa virus zoonotic transmission. This paper summarized the update knowledge on LHV; hopping it might be useful to the clinicians, nursing staff, laboratories' personals as well as those concerned zoonoses from rodents and rodent control.

  5. Treatment of Colchicine-Resistant Familial Mediterranean Fever With Anakinra

    OpenAIRE

    Javadi Parvaneh; Shiari

    2015-01-01

    Introduction Familial Mediterranean Fever (FMF) is an auto-inflammatory disease presenting with periodic fever and various clinical manifestations. Almost 10% of the patients with FMF do not respond to colchicine therapy. Case Presentation Herein was reported a colchicine non-responsive patient with accurate diagnosis and early treatment of FMF. She had presented with recurrent and persistent acute abdominal pain attacks and sever...

  6. Hemorrhagic fever with renal syndrome and coexisting hantavirus pulmonary syndrome

    Directory of Open Access Journals (Sweden)

    Young Min Hong

    2012-06-01

    Full Text Available Hemorrhagic fever with renal syndrome (HFRS is an acute viral disease with fever, hemorrhage and renal failure caused by hantavirus infection. Hantavirus induces HFRS or hantavirus pulmonary syndrome (HPS. HPS progression to a life-threatening pulmonary disease is found primarily in the USA and very rarely in South Korea. Here, we report a case of HFRS and coexisting HPS.

  7. Pulmonary hypertension in autoimmune rheumatic diseases

    Directory of Open Access Journals (Sweden)

    L. Massironi

    2011-09-01

    Full Text Available Objective. Pulmonary hypertension is a severe and rapidly progressive disease, particularly frequent in patients with rheumatic diseases. The aims of this study were the following: to determine the prevalence of pulmonary hypertension in Italian patients with autoimmune rheumatic diseases, and to evaluate if the presence of a rheumatic disease in general, or of a specific autoimmune rheumatic disease, is a risk factor for the development of pulmonary hypertension. Patients and Methods. One hundred and thirteen Italian patients with connective tissue diseases (105 females, 8 males, aged 19 to 83 yrs, entered the study. Fifty-one had systemic sclerosis (SSc: 49 were females, 2 males, aged 34 to 83 yrs; 41 had limited cutaneous SSc, 8 diffuse cutaneous SSc, and 2 SSc sine scleroderma. Thirty-three patients had systemic lupus erythematosus (SLE: all but one were females, their age ranged from 19 to 82 yrs. Twenty-five had rheumatoid arthritis (RA: 21 females, 4 males, aged 26 to 45 yrs. Three females and one male, 51-77 yrs, had mixed connective tissue disease (MCTD. Systolic pulmonary arterial pressure (SPAP was assessed by Doppler echocardiography. Results. Twenty three patients had pulmonary hypertension, which was more frequent in MCTD than in SLE (75% vs 6.1%, p=0.0002 or in AR (20%, p=0.0313. Pulmonary hypertension was more frequent in SSc than in SLE (25.5% vs 6.1%, p=0.0028 and in limited than in diffuse SSc(21.6% vs 3.9%. SPAP was significanly related to age (R=0.35, P=0.0275, with patients with pulmonary hypertension older than patients with normal SPAP (66±13 vs 52±16 yrs, p=0.0003. Conclusions. These data show a significant association between pulmonary hypertension and autoimmune rheumatic diseases. Therefore pulmonary hypertension assessment seems mandatory, at least in MCTD and SSc. However, more studies are needed to clarify the relationship between age and pulmonary hypertension and to verify whether the low prevalence of

  8. Vacinação contra febre amarela em pacientes com diagnósticos de doenças reumáticas, em uso de imunossupressores Vaccination against yellow fever among patients on immunosuppressors with diagnoses of rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Licia Maria Henrique da Mota

    2009-02-01

    Full Text Available A febre amarela é endêmica em alguns países. A vacina, único modo eficaz de proteção, é contra-indicada em pacientes imunocomprometidos. Nosso objetivo é relatar uma série de casos de pacientes reumatológicos, usuários de imunossupressores, vacinados contra a doença. Foi feito um estudo retrospectivo, por meio de questionário aplicado em pacientes reumatológicos medicados com imunossupressores, vacinados 60 dias antes da investigação. Foram avaliados 70 pacientes, com idade média de 46 anos, 90% mulheres, portadores de artrite reumatóide (54, lupus eritematoso sistêmico (11, espondiloartropatias (5 e esclerose sistêmica (2. Os esquemas terapêuticos incluíam metotrexato (42, corticoesteróides (22, sulfassalazina (26, leflunomida (18, ciclofosfamida (3 e imunobiológicos (9. Dezesseis (22,5% pacientes relataram efeitos adversos menores. Dentre os 8 pacientes, em uso de imunobiológicos, apenas um apresentou efeito adverso, leve. Entre pacientes em uso de imunussopressores, reações adversas não foram mais freqüentes do que em imunocompetentes. Este é o primeiro estudo sobre o tema.Yellow fever is endemic in some countries. The anti-yellow fever vaccine is the only effective means of protection but is contraindicated for immunocompromised patients. The aim of this paper was to report on a case series of rheumatological patients who were using immunosuppressors and were vaccinated against this disease. This was a retrospective study by means of a questionnaire applied to these patients, who were vaccinated 60 days before the investigation. Seventy patients of mean age 46 years were evaluated. Most of them were female (90%. There were cases of rheumatoid arthritis (54, systemic lupus erythematosus (11, spondyloarthropathy (5 and systemic sclerosis (2. The therapeutic schemes included methotrexate (42, corticosteroids (22, sulfasalazine (26, leflunomide (18, cyclophosphamide (3 and immunobiological agents (9. Sixteen

  9. Subacute fulminant hepatic failure with intermittent fever

    Institute of Scientific and Technical Information of China (English)

    Cong-Xin Chen; Bo Liu; Yong Hu; Joyce E. Johnson; Yi-Wei Tang

    2009-01-01

    BACKGROUND:Viral hepatitis B accounts for over 80%of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever is rare. METHODS:A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia, coagulopathy, hepatic encephalopathy, serum anti-HBs-positive without hepatitis B vaccination, and typical intrahepatic pathological features of chronic hepatitis B. Plasma exchange was administered twice and she awoke with hyperbilirubinemia and discontinuous fever. RESULTS:Urethritis was conifrmed and medication-induced fever and/or spontaneous bacterial peritonitis (Gram-negative bacillus infection) was suspected. The patient was treated with antibiotics, steroids and a Chinese herbal medicine, matrine, for three months and she recovered. CONCLUSION:The survival rate of patients with hepatic failure might be improved with comprehensive supporting measures and appropriate, timely management of com-plications.

  10. Tick-borne relapsing fever in children.

    Science.gov (United States)

    Le, C T

    1980-12-01

    Three cases of tick-borne fever diagnosed during the summer of 1979 are reported and the ecoepidemiology, clinical manifestations, and treatment of this infection are reviewed. Although challenging, the diagnosis can be made easily if specific historical clues are sought and the patient's blood smear is carefully examined. The diagnosis of this condition early in its course can save clinicians and patients the anxiety and cost of the work-up of a "fever of unknown origin." Since vacationing in the national parks and forests has become increasingly popular among many American families, tick-borne relapsing fever should be considered in any patient with an acute or recurrent fever of unknown origin who exhibits nonspecific symptoms of an undifferentiated "viral illness," and who gives a history of sleeping overnight in log cabins in the coniferous forests of the Western mountains of the United States.

  11. Neurogenic fever after traumatic brain injury: an epidemiological study

    OpenAIRE

    Thompson, H; Pinto-Martin, J; Bullock, M.

    2003-01-01

    Objectives: To determine the incidence of neurogenic fever (NF) in a population of patients in the acute phase following severe traumatic brain injury (TBI); to identify factors associated with the development of NF following severe TBI in adults.

  12. Familial Mediterranean fever

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000363.htm Familial Mediterranean fever To use the sharing features on this page, please enable JavaScript. Familial Mediterranean fever (FMF) is a rare disorder passed down through ...

  13. Fever due to levamisole

    Directory of Open Access Journals (Sweden)

    Gupta R

    2003-05-01

    Full Text Available Fever is rarely caused by levamisole. We report a 26-year-old woman who repeatedly developed fever 4-12 hrs after taking levamisole. The association was confirmed by repeated provocation tests.

  14. Rocky Mountain spotted fever

    Science.gov (United States)

    ... Mountain spotted fever is caused by the bacteria Rickettsia rickettsii (R. Rickettsii) , which is carried by ticks. ... Saunders; 2014:chap 212. Walker DH, Blaton LS. Rickettsia rickettsii and other spotted fever group rickettsiae (Rocky ...

  15. Familial Mediterranean fever: current perspectives

    Science.gov (United States)

    Sönmez, Hafize Emine; Batu, Ezgi Deniz; Özen, Seza

    2016-01-01

    Familial Mediterranean fever (FMF) is the most frequent monogenic autoinflammatory disease, and it is characterized by recurrent attacks of fever and polyserositis. The disease is associated with mutations in the MEFV gene encoding pyrin, which causes exaggerated inflammatory response through uncontrolled production of interleukin 1. The major long-term complication of FMF is amyloidosis. Colchicine remains the principle therapy, and the aim of treatment is to prevent acute attacks and the consequences of chronic inflammation. With the evolution in the concepts about the etiopathogenesis and genetics of the disease, we have understood that FMF is more complicated than an ordinary autosomal recessive monogenic disorder. Recently, recommendation sets have been generated for interpretation of genetic testing and genetic diagnosis of FMF. Here, we have reviewed the current perspectives in FMF in light of recent recommendations. PMID:27051312

  16. Pathogenesis of arenavirus hemorrhagic fevers.

    Science.gov (United States)

    Moraz, Marie-Laurence; Kunz, Stefan

    2011-01-01

    Viral hemorrhagic fevers (VHFs) caused by arenaviruses belong to the most devastating emerging human diseases and represent serious public health problems. Arenavirus VHFs in humans are acute diseases characterized by fever and, in severe cases, different degrees of hemorrhages associated with a shock syndrome in the terminal stage. Over the past years, much has been learned about the pathogenesis of arenaviruses at the cellular level, in particular their ability to subvert the host cell's innate antiviral defenses. Clinical studies and novel animal models have provided important new information about the interaction of hemorrhagic arenaviruses with the host's adaptive immune system, in particular virus-induced immunosuppression, and have provided the first hints towards an understanding of the terminal hemorrhagic shock syndrome. The scope of this article is to review our current knowledge on arenavirus VHF pathogenesis with an emphasis on recent developments.

  17. Unusual Presentation of Dengue Fever

    Science.gov (United States)

    Aslam, Moaz; Aleem, Numra A.; Zahid, Mohammad F.; Rahman, Arshalooz J.

    2016-01-01

    Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes. PMID:26909198

  18. Q fever in Greenland

    DEFF Research Database (Denmark)

    Koch, Anders; Svendsen, Claus Bo; Christensen, Jens Jorgen

    2010-01-01

    We report a patient with Q fever endocarditis in a settlement in eastern Greenland (Isortoq, Ammassalik area). Likely animal sources include sled dogs and seals. Q fever may be underdiagnosed in Arctic areas but may also represent an emerging infection.......We report a patient with Q fever endocarditis in a settlement in eastern Greenland (Isortoq, Ammassalik area). Likely animal sources include sled dogs and seals. Q fever may be underdiagnosed in Arctic areas but may also represent an emerging infection....

  19. Q fever in Greenland

    DEFF Research Database (Denmark)

    Koch, Anders; Svendsen, Claus Bo; Christensen, Jens Jorgen

    2010-01-01

    We report a patient with Q fever endocarditis in a settlement in eastern Greenland (Isortoq, Ammassalik area). Likely animal sources include sled dogs and seals. Q fever may be underdiagnosed in Arctic areas but may also represent an emerging infection.......We report a patient with Q fever endocarditis in a settlement in eastern Greenland (Isortoq, Ammassalik area). Likely animal sources include sled dogs and seals. Q fever may be underdiagnosed in Arctic areas but may also represent an emerging infection....

  20. Severe myalgia in familial Mediterranean fever: clinical and ultrastructural aspects.

    OpenAIRE

    Schapira, D; Ludatscher, R; Nahir, M.; M. Lorber; Scharf, Y.

    1988-01-01

    Severe myalgia is an uncommon feature of familial Mediterranean fever (FMF). A patient is presented in whom acute myalgia and high fever were the sole clinical findings during an FMF attack. The ultrastructural picture of the muscle tissue during the acute stage was characterised by a large deposition of collagen fibrils. The myalgia subsided during colchicine treatment. The clinical and ultrastructural features of myalgia in FMF are discussed in the light of the relevant literature.