Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-22T13:37:43.387Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnostic aspects, carditis and other acute manifestations of streptococcal infection

Published online by Cambridge University Press:  19 August 2008

Cleonice de Carvalho Coelho Mota ,
Zilda Maria Alves Meira ,
Rosangela Nicoli Graciano  and
Marly Conceição Silva
Cleonice de Carvalho Coelho Mota*
Affiliation:
Hospital das Cilnicas, Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte
Zilda Maria Alves Meira
Affiliation:
Hospital das Cilnicas, Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte
Rosangela Nicoli Graciano
Affiliation:
Hospital das Cilnicas, Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte
Marly Conceição Silva
Affiliation:
Hospital das Cilnicas, Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte
*
Dr. Cleonice de Carvalho Coelho Mota, Rua Cabrália, 30/501, 30240 Belo Horizonte, Brazil. Tel. (031)2252836.
Get access Rights & Permissions [Opens in a new window]

Abstract

We have conducted, in two stages, a descriptive and comparative analysis of the diagnostic and evolutionary clinical aspects of rheumatic fever. The descriptive analysis was based on a sample of 226 patients seen between 1976–1986. The forms and frequency of the manifestations of rheumatic fever were studied, as well as the difficulties encountered in diagnosing mild cases and the risk of making a hasty diagnosis due to the high prevalence of the disease. Subsequent to the establishment of an outpatient clinic for referral of patients with rheumatic fever, as part of a study and control program for the disease, 98 patients were seen in the period 1988–1991. In order to compare the profile of the manifestations in the acute phase with evolutionary aspects over the course of the disease, a subgroup of 61 children, treated in the period 1983–986 was selected to obtain equivalence in size of sample and time of follow-up (p = 0.08). The comparative analysis revealed that no modifications have occurred over the period of study in the profile of the manifestations during the acute phase, and no statistically significant differences have occurred in age at first attack, severity ofcarditis, or in the type ofvalvar and articular involvement. Evolutionary data after rigid control of primary and secondary prevention, however, showed a marked reduction in the incidence of recurrence (p = 0.036), the frequency of hospital admission (p = 0.001) and deaths (p = 0.024). The main factors modifying the evolution of the disease were analyzed. The action of the health team had a fundamental importance in the control of recurrence. This fact is especially important for developing countries, where a reduction of the prevalence of the disease can only be achieved through major structural socioeconomic changes in the community.

Keywords

Rheumatic feverrheumatic heart diseasestreptococcal infection
Type
World Forum for Pediatric Cardiology Symposium on Rheumatic Fever
Information
Cardiology in the Young , Volume 2 , Issue 3 , July 1992 , pp. 222 - 228
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Zbriskie, JB. Rheumatic fever: the interplay between host, genetics, and microbe. Circulation 1985; 71: 1077–1086.CrossRefGoogle Scholar
2. Decourt, LV. Doença reum´tica. Sarvier, São Paulo, 1972.Google Scholar
3. Snitcowisky, R. [Personal communication]Google Scholar
4. Jones, TD. The diagnosis of rheumatic fever. J Am Med Assoc 1944; 126: 481–485.CrossRefGoogle Scholar
5. Shulman, ST, Kaplan, EL, Bisno, AL, Millard, HD, Amren, DP, Houser, H, Sanders, WE, Durack, DT, Watanakunakorn, C. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 69: 204A–208A.Google Scholar
6. Markowitz, M, Kuttner, AG. Rheumatic Fever: Diagnosis, Management and Prevention. W.B. Saunders, Philadelphia, 1965.Google Scholar
7. Organizacion Panamericana de Ia Salud. Prevencion y control de la flebre reumatica en la comunidad: manual de normas operativas para un programa de extension de la coberrura en los diferentes niveles de atencion. Washington, 1980, p 399.Google Scholar
8. Spagnuolo, M, Pasternak, B, Taranta, A. Risk ofrheumaric fever recurrence after streprococcal infections: prospective study of clinical and social factors. N Engl J Med 1971; 285: 641–647.CrossRefGoogle Scholar
9. Mota, CCC, Oliveira, SL. Doença Reumática. In: Tonelli, E (ed). Doenças Infecciosas na Infáncia. Medsi, Rio de Janeiro, 1987, pp 239–248.Google Scholar
10. Mota, CCC, Oliveira, RG, Meira, ZMA. Doença reumática. In: Leão, E, Corréa, EJ, Viana, MB, Mota, JAC. (eds). Pediatria Ambulatorial. Coopmed, Belo Horizonte, 1989, pp 373–378.Google Scholar
11. Bisno, AL, Shulman, ST, Dajani, AS. The rise and fall (and rise?) of rheumatic fever. J Am Med Assoc 1988; 259: 728–729.CrossRefGoogle ScholarPubMed
12. Kaplan, EL, Markowitz, M. The fall and rise of rheumatic fever in the United States: a commentary. Int J Cardiol 1988; 21: 3–10.CrossRefGoogle ScholarPubMed