syndrome of acute rheumatic fever: up-dated

Globally RF and RHD remain the significant cause of cardiovascular diseases to day. There is a documented decrease in the incidence of ARF and in the prevalence of RHD in developed countries during the past five decades. No such a significant decrease in the prevalence of RHD in developing countries was recorded even at the beginning of the 21[st] century. RF/RHD is preventable diseases thus optimal methods of prevention and management are required. ARF is a unique non-suppurative sequel to group A streptococcal infections. Studies conducted during the last four decades clearly documented that the control of the preceding infections and their sequelae is both cost-effective and inexpensive [1]. RF and RHD are non-suppurative complications of group A streptococcal pharyngitis due to a delayed immune response[2] in a susceptible individual. It was estimated that about 15 million individuals suffered from RF/RHD worldwide[3]. The mortality rate for RHD varied from 0.5 Per 100.000 populations in Denmark to 8.2 Per 100.000 populations in China[4]. Data from developing countries suggest that mortality due to RF and RHD remains a problem and that children and young adults still die from acute RF[5].The prevalence of RF/RHD worldwide varies from 5 per 10.000 in developed countries[6] to 110/10.000 in school children in developing countries[7]. The incidence and prevalence of RF/RHD show marked variation from one country to another due to various factors related to the streptococcus, the host, the environment or any combination of them[8][9]

Rheumatic fever runs in families: an old golden statement with recent echocardiographic proof

Since more that one-hundred years ago, Cheadle [1889] was the first to direct the attention that [Rheumatic fever runs in families]. This study was done to confirm this statement by Echo-Doppler for 62 families classified as: 28 families with index cases of R.H.Dand 34 families with only history of documented ARF. All family members of the two groups were investigated clinically, and by laboratory investigations to assess their rheumatic state i:e active or quiescent 4D and colour-flow echodoppler studies were performed for all the family members of the two rheumatic groups. An age matched control of 25 family members were also echo studied. The positive data obtained are the first study in the literature where 28.6% of the hearts of the fathers and mothers of the index cases with RHD are also affected, and the hearts of the first and second siblings are affected in 32.1% and 10.7% respectively. On the other hand, for the second group of families where the index cases had no cardiac pathology but only history of ARF, the percentage of valve affection of the fathers, mothers, and first sibling were 5.9%, 23.5% and 14.5% respectively. ARF: Acute Rheumatic Fever. RHD: Rheumatic Heart Disease. TNF: Tumor Necrozing Factor. 1FN: Interferon-gamma. IL: Interlukin. M.R: Mitral Regurgitation. A.R.: Aortic Regurgitation. M.V.P: Mitral valve Prolapse. M.S: Mitral Stenosis, GAS:Group A streptococci. C.B.C: Complete Blood Count. E.S.R: Erythrocyte Sedimentation Rate. C.R.P: C. Reactive Protein. A.S.O.T.: Antistreptolysin. O titer