Rheumatic fever and post-streptoccocal arthritis in a third tier hospital
Abstract
Introduction: Rheumatic Fever (RF) and Post-Streptococcal Arthritis (PSRA), are characterized by autoantibodies secondary to Group A β-hemolytic streptococcus (GAS). In our country, the disease acquired by the RF generate substantial costs for the State and family, becoming a public health problem. Objective: To evaluate the clinical and epidemiological characteristics and outcome ofpatients with RF and PSRA at the Pediatrics Department of the Hospital de Clinicas. Methods: A retrospective, observational, transverse study of patients diagnosed with RF and PSRA, during the period between January 2009 and June 2014. Results: 22 cases of RF and 4 PSRA were found. Diagnostic Age: 4-16 years. The most affected heart valve is the mitral, with 8/22 patients. Major criteria: 13/22 migratory arthritis, carditis 4/22, 3/22 Korea. Minor criteria: 10/22 arthralgia, fever 8/22, elevated ESR 14/22, CRP positive 11/22, 6/22 altered EKG. In 24/26 patients no throat culture was performed.ASO + 15/26 cases. Treatment: all received benzathine penicillin G, salicylates 9/26, 5/26 corticosteroids, 2/26 haloperidol. 23% of children with RF presented heart failure; 10/26 patients discontinued treatment. Conclusions: RF remains a major cause of acquired heart disease, perhaps by inadequate management of streptococcal infections and delayed diagnosis. Particularly striking is the lack of pursuit of infection (culture), the highest percentage of treatment abandonment, and inadequate diagnosis (PSRA vs RF).
Downloads
References
(1) Borges F, Barboza MLA, Borge RB, et al. Clinical and Demographic Characteristics of 99 Episodes of Rheumatic Fever in Acre, the Brazilian Amazon. Arq. Bras. Cardiol. 2005;84(2).
(2) Pereira BAF, da Silva NA, Andrade LEC, et al. Jones Criteria and Underdiagnosis of Rheumatic Fever. Indian J Pediatr. 2007;74(2):117-121.
(3) Kumar V, Carreño M. Rheumatic Fever. Curr Treat Options Cardio vasc Med. 1999;1:253–58.
(4) WHO. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation, Geneva, 29 October–1 November 2001. G eneva: World Health Organization. 2004.
(5) Jones TD. The diagnosis of acute rheumatic fever. JAMA. 1944;126:481–4.
(6) Rutstein DD. Report of the committee on standards and criteria for programs of care of the council of rheumatic fever and congenital heart disease of American Heart Association: Jones criteria (modified) for guidance in the diagnosis of rheumatic fever. Circulation. 1956;13: 617–20.
(7) Stollerman GH, Markowitz M, Taranta A, Wannamaker LW, Whittemore R. Committee report: Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation. 1965;32:664–68.
(8) Committee on rheumatic fever and bacterial endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation. 1984;69:03A–208A.
(9) G uidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association.
JAMA. 1992;268(15):2069–73.
(10) Dajani AS, Ayoub EM, Bierman FZ, et al. Guidelines for the diagnosis of rheumatic fever: Jones Criteria, updated 1992. JAMA. 1992;87:302–307.
(11) Carvalho S, et al. Rheumatic fever presentation and outcome: a case-series report, Rev Bras Reumatol. 2012;52(2):236-246.
(12) Bernal M, Dominguez MT. Fiebre Reumatica. Correa LF. Guias para manejo de Urgencias tomo 3. Federación Panamericana De Asociaciones De Facultades [Escuelas] De Medicina FEPAFEM, Colombia, 2009, páginas 64-70.
(13) Atatoa-Carr P, Lennon D, Wilson N, on behalf of the New Zealand Rheumatic Fever Guidelines Writing Group. Rheumatic fever diagnosis, management, and secondary prevention: a New Zealand guideline. NZMJ. 2008;121(1271):59-69.
(14) Carapetis JR, Brown A, Wilson NJ, Edwards KN, on behalf of the Rheumatic Fever Guidelines Writing Group. An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline. MJA. 2007;186: 581–586.
(15) Loiselle CR, Singer HS. Genetics of childhood disorders: XXXI. Autoimmune disorders, part 4: is Sydenham chorea an autoimmune disorder? J Am Acad Child Adolesc Psychiatry. 2001;40:1234–1236.
(16) Ministério da Saúde. Coordenação de Doenças Crônico-Degenerativas. Incidencia na febre reumática no Brasil. MS: 2003; Brasília/DF. 17. Ferrieri P. Jones Criteria Working group. Proceedings of the Jones Criteria Workshop. Circulation. 2002;106:2521-3.
(18) Markowitz M. Evolution of the Jones Criteria for the diagnosis of acute rheumatic fever. In: Narula J, Virmani R, Reddy KS, Tandon R, eds. Rheumatic fever. Washington: American Registry of Pathology. 1999: 299–306.
(19) Shiffman RN. Guideline maintenance and revision: 50 years of the Jones criteria for diagnosis of rheumatic fever. Arch Pediatr Adolesc Med. 1995;149:727–32.
(20) Olgunturk R, Canter B, Tunaoglu FS, Kula S. Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria. Int J Cardiol. 2006;112(1):91–8.
(21) Carceller A, Tapiero B, Rubin E, Miró J. Acute rheumatic fever: 27 year experience from Montreal’s pediatric tertiary care centers. Ann Pediatr (Barc). 2007;67(1):5–10.
(22) Dale RC. Immune-mediated extrapyramidal movement disorders, including Sydenham chorea. Handb Clin Neurol. 2013;112:1235-41.
(23) Cardoso F. Sydenham‘s Chorea. Curr Treat Options Neurol. 2008;10(3):230-5.
(24) Ramanan PV, Premkumar S, Ramnath B. Youngest patient with Sydenham‘s chorea: a case report. J Indian Med Assoc. 2009;107(4):246, 253.
(25) Swedo SE, Leonard HL, Schapiro MB, et al. Sydenham’s chorea: physical and psychological symptoms of St Vitus dance. Pediatrics. 1993;91:706–713.
(26) Stollerman GH. Rheumatic fever. Lancet. 1997;349:935–942.
(27) Swedo SE. Sydenham’s chorea. A model for childhood autoimmune neuropsychiatric disorders. JAMA. 1994;272:1788–1791.
(28) Nausieda PA, Grossman BJ, Koller WC, et al. Sydenham chorea: na update. Neurology. 1980;30:331–334.
(29) Aron AM, Freeman JM, Carter S. The natural history of Sydenham’s chorea. Review of the literature and long-term evaluation with emphasis on cardiac sequelae. Am J Med. 1965;38:83–95.
(30) Hilário MO, Terreri MT. Rheumatic fever and post-streptococcal arthritis. Best Pract Res Clin Rheumatol. 2002;16(3):481–94.
(31) Ayoub EM. Streptococcal antibody tests in rheumatic fever. Clin Immunol Newsletter. 1982;3:107-111.
(32) Ayoub EM, Wannamaker LW. Evaluation of the streptococcal deoxyribonuclease B and diphosphopyridine nucleotidase antibody tests in acute rheumatic fever and acute glomerulonephritis. Pediatrics. 1962;29:527-38.
(33) Ayoub EM, Wannamaker LW. Streptococcal antibody titers in Sydenham`s chorea. Pediatrics. 1966;38:946-56.
(34) Barash J, Mashiach E, Navon-Elkan P, et al. For the Pediatric Rheumatology Study Group of Israel. Differentation of Post-Streptococcal Reactive Arthritis from Acute Rheumatic Fever. J Pediatr. 2008;153:696-9.
(35) Esposito S, Bianchini S, Baggi E, Fattizzo M, Rigante D. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. Eur J Clin Microbiol Infect Dis. 2014;33(12):2105-9.
(36) Marconi D, et al. PANDAS: a possible model for adult OCD pathogenesis. Riv Psichiatr. 2009;44(5):285-98.
(37) Martino D, et al. The PANDAS subgroup of tic disorders and childhood-onset obsessive-compulsive disorder. J Psychosom Res. 2009;67(6):547-57.
(38) Pichichero ME. The PANDAS syndrome. Adv Exp Med Biol. 2009;634:205-16.
(39) Shulman ST. Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update. Curr Opin Pediatr. 2009;21(1):127-30.
(40) van Toorn R, Weyers HH, Schoeman JF. Distinguishing PANDAS from Sydenham’s chorea: case report and review of the literatura. E ur J Paediatr Neurol. 2004; 8:211–16.
(41) Romero C, et al. Fiebre reumática, Consenso nacional 2005. Rev costarric. cardiol. 2005;7(1):59-62.
(42) Nordet P, Lopez R, Sarmiento L. 42. Prevention and control of rheumatic fever and rheumatic heart disease: the Cuban experience (1986-1996-2002): cardiovascular topic. Cardiovasc J Afr. 2008; 19(3):135-140.
(43) Guilherme L, Ramasawmy R, Kalil J. Rheumatic fever and rheumatic heart disease: genetics and pathogenesis. Scand J Immunol. 2007;66:199-207.
(44) Carceller-Blanchard A. Fiebre reumática aguda. An Pediatr (Barc). 2007;67:1-4.
(45) Carceller A, Tapiero B, Rubin E, Miró J. Fiebre reumática aguda: 27 años de experiencia en los hospitales de Montreal. An Pediatr (Barc). 2007;67:5-10.
(46) Guía de atención de la fiebre reumática. Ministerio de Salud –Dirección General de Promoción y Prevención. República de Colombia. 1999.
(47) M.A. Gerber, R.S. Baltimore, C.B. Eaton, et al., Prevention of rheumatic fever and 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, the Interdisciplinary Council on Functional Genomics and Transitional Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research, Circulation 119 (2009) 1541–1551.
(48) G lenny AM, Oliver R, Roberts GJ, Hooper L, Worthington HV. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry. Cochrane Database Syst Rev.2013;10:CD003813.
(49) Sabui TK, Pant P. Sodium valproate in the treatment of Sydenham‘s chorea. Indian J Pediatr. 2010;77(6):703.
(50) Van Immerzeel TD, van Gilst RM, Hartwing NG. Beneficial use of immunoglobulins in the treatment of Sydenham chorea. Eur J Pediatr. 2010;169(9):1151-4.
(51) Walker K, Brink A, Lawrenson J, Mathiassen W, Wilmshurst JM. T reatment of sydenham chorea with intravenous immunoglobulin. J Child Neurol. 2012;27(2):147-55.
Copyright (c) 2015 Paraguayan Journal of Rheumatology
This work is licensed under a Creative Commons Attribution 4.0 International License.
