First attack of rheumatic fever in an adult: the case for greater awareness

Article Abstract:

Rheumatic fever is a childhood disease that was previously common, but has become rare in developed countries. Initial attacks occurring in adults have always been rare, as most adult attacks are recurrences of childhood episodes of the disease. Recent US outbreaks suggest that rheumatic fever is becoming more common; in the 1970s the incidence was between 0.23 and 1.88 cases per 100,000 population per year. During the 1985 and 1986 Utah outbreak, the incidence was 18 cases per 100,000 population. In sharp contrast, the estimated incidence in India ranges between 200 and 1,200 cases per 100,000 population per year. A case is reported of a 40-year-old woman who had a widespread rash, fever, and arthritis involving several joints (polyarthritis). The rash was not confined to light-exposed areas. The arthritis involved both knees and the joints of middle finger of both hands. Her symptoms suggested a mild inflammation of the throat, but it was not red and her tonsils were not enlarged. The patient had a similar, but milder illness the previous year. She had not been exposed to drugs or toxins. Antibiotics, antihistamines, and antipyretics (fever-reducing) drugs had little effect. Laboratory tests were positive for acute phase reaction (related to acute inflammation or infection), but negative for rheumatoid disease, liver and kidney dysfunctions, and a host of infections. Antibodies against streptococcal bacteria were elevated, indicating a recent streptococcal infection. Fever, polyarthritis, and acute phase reaction also supported the diagnosis of rheumatic fever. These factors fulfill the Jones criteria for this diagnosis. The patient's symptoms lasted about 10 weeks and were treated effectively with the non-steroidal anti-inflammatory drug naproxen. No outbreak of rheumatic fever had occurred in the community. The patient remained well during two years of prophylactic penicillin therapy. The study suggests that, although rare in adults, rheumatic fever should be considered as a possible diagnosis in adults with fever of unknown origin. The role of streptococcal bacteria in the development of autoantibodies and arthritis requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Demographic aspects

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Multisystem disease in post-streptococcal arthritis

Article Abstract:

The incidence of acute rheumatic fever until recently was declining in developed countries. A set of signs, the revised Jones criteria, are usually used to diagnose the disease, which follows infection by group A streptococcal bacteria. This set of criteria tend to emphasize the most specific features of the disease and to restrict comprehension of its potential variability and generalized nature. A case is described of a 58-year-old man who developed manifestations of rheumatic fever in a number of bodily systems along with post-streptococcal arthritis. The patient developed a rash and a painless penile ulcer after starting medication for joint pain. He was admitted to the hospital with pneumonitis (lung inflammation), which caused severe left chest wall pain and shortness of breath. He had palpable purpuric lesions (hemorrhages under the skin causing discoloration), a fever and rapid pulse. Blood cells in the urine were indicative of kidney inflammation, and changes in heart and liver function were noted. Because of the ulcer, he was presumed to have a venereal disease, but laboratory tests for this and other infections were negative, as was the patient's medical history. However, levels of antibodies to streptococcus were high, suggestive of infection, and he was then treated with penicillin plus aspirin. Arthritis, rash, fever, and penile ulcer then resolved. The patient continued to improve and was well one year later. (Consumer Summary produced by Reliance Medical Information, Inc.)

Streptococcal infections, Complications and side effects

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Rheumatic fever: autoantibodies against a variety of cardiac, nuclear, and streptococcal antigens

Article Abstract:

Evidence of a unique set of cross-reactive antigens involved in different types of rheumatic fever is unclear. Cross-reactive antigens are substances capable of stimulating the same immune response due to their structural similarity and are helpful in developing diagnostic tests. Researchers tested blood samples from seven groups of people for antibodies to bacterial, heart, and nuclear antigens. The groups consisted of 20 people each with acute rheumatic fever, ischemic heart disease or acute glomerulonephritis, children with chronic rheumatic heart disease, and adults with chronic rheumatic heart disease. Two groups of 20 healthy adults and children made up the control groups. Blood levels of antibodies to these antigens were higher in the rheumatic fever groups as compared to the controls but were not unique to these groups.

Research, Physiological aspects, Cross reactions (Immunology)

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