Enfermos com histórico de Febre Reumática e suas implicações em odontologia: uma revisão de literatura / Sick with history of rheumatic fever and its implications in dentistry: a literature review

Objetivo: analisar informações presentes na literatura sobre a citada patologia com enfoque odontológico, baseando-se em evidências atuais, a fim de estruturar uma conduta clínica, métodos preventivos e terapêuticos. Revisão de literatura: executou-se busca na literatura em dezembro de 2020, por meio dos descritores pré-estabelecidos, nos bancos de dados LILACS e PubMed/MEDLINE, além de complementações utilizando o Google Scholar. Foram encontrados 563 artigos, refinados em 10, juntamente ao uso de 3 livros. Considerações finais: a partir dos achados, constatou-se que a realização de uma anamnese criteriosa durante a primeira consulta faz-se imprescindível, por auxiliar na compreensão dos aspectos fisiopatológicos do paciente, os quais irão determinar o emprego ou não de fármacos, principalmente antes de procedimentos invasivos. Em contrapartida, verificou-se a negligência desse assunto no âmbito odontológico, pelo fato de existirem poucos estudos relacionados ao manejo clínico de pacientes com Febre Reumática (FR), sendo necessárias maiores pesquisas, com o fito de construir-se uma conduta clínica adequada, reduzindo-se os riscos e a incidência de tal enfermidade.(AU)

Objective: to analyze information in the literature about mentioned pathology with a dental focus, based on current evidence in order to structure a clinical conduct, preventive and therapeutic methods. Literature Review: literature searches were performed in December 2020, using pre-established descriptors, in the databases LILACS and PubMed/MEDLINE, in addition to complementations using Google Scholar. About 563 articles were found, refined in 10, along with the use of 3 books. Final Considerations: From the findings, it was found that the performance of a careful anamnesis during the first consultation is essential, as it helps to understand the patient's pathophysiological aspects, which will determine the use of drugs, mainly, before invasive procedures. On the other hand, this matter was neglected in the Dental field, due to the fact that there are few studies related to the clinical management of patients with Rheumatic Fever (RF), and further research is necessary, with the aim of building an adequate clinical conduct, reducing the risks and the incidence of such a disease.(AU)

Association between rheumatic fever and takayasu's arteritis - case report / Associação entre febre reumática e arterite de Takayasu - Relato de caso

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.

RESUMO A arterite de Takayasu (AT) e a febre reumática (FR) são doenças que podem ter início commanifestação cardíaca, o que dificulta o diagnóstico. Há relatos de associação de FR com AT que se inicia com comprometimento cardíaco na faixa etária pediátrica. O objetivo deste estudo é relatar a possibilidade da associação de FR e AT em paciente com alteração cardíaca. Descrevemos o caso de uma adolescente diagnosticada inicialmente como FR que apresentou na evolução alterações que permitiram o diagnóstico de AT. A AT e a FR são duas causas importantes de envolvimento valvular que podem apresentar manifestações sistêmicas.

Dificuldades no diagnóstico diferencial entre arterite de Takayasu e febre reumática: relato de caso / Difficulties in the differential diagnosis between Takayasu arteritis and rheumatic fever: case report

Resumo Apresentamos o caso de uma paciente portadora de insuficiência cardíaca com prótese valvar aórtica biológica e alterações vasculares compatíveis com arterite de Takayasu (AT) que chegou ao serviço em uso de corticoides e em profilaxia para febre reumática (FR). Não foi possível afastar a associação entre ambas as enfermidades.

Abstract In this article, we present the case of a patient with heart failure with biological aortic valve prosthesis and multiple vascular changes consistent with Takayasu arteritis (TA) who was seen in our department receiving corticosteroids and secondary prevention of rheumatic fever (RF); it was not possible to exclude the association between both diseases.

Aspectos atuais da doença reumática / Current aspects of the rheumatic fever

O autor faz revisão sobre a Doença Reumática, frente à sua permanência nas regiões mais pobres do país. Da análise da tríade produtora da enfermidade, discute aspectos ligados aos aspectos imunitários envolvidos, a possibilidade de cepa estreptocócica de grande virulência na gênese de formas graves e, sobretudo, aspectos ligados à pobreza e ausência de saneamento nos locais em que vivem os enfermos. Sob o ângulo clínico, mostra a contradição entre "aspectos atuais da doença", quando eles apenas reproduzem a apresentação que existia nos países centrais nos séculos 18 e 19. Enfatiza a relevância do uso do Ecodopplercardiograma no estudo de populações, o que depõe por prevalência bem maior que estudos realizados apenas com o estetoscópio. Salienta a supremacia da prevenção da doença e a necessidade que seja ela incluída entre as doenças negligenciadas, na base de políticas de combate a essas enfermidades.

The author's review of the Rheumatic Fever, outside hispersistence in the poorest regions of the our country. Analysis of the epidemiological triad of the disease, the aspects immunological are argued, also the possibility of large strain streptococcus virulence in the genesis of serious issues and especially the relevance of the poverty and lack of sanitation inplaces where the sick live. Under the clinical angle shows the contradiction between "current aspects of the disease" when they merely reproduce the presentation that existed in the central countries in the 18th and 19th centuries. Emphasizes the importance of using Doppler echocardiogram in study populations, which argues for much greater prevalence than studies only with the stethoscope. Underlines the primacy of disease prevention and the need to be included it among the neglected diseases, on the basis of policies to combat these diseases.

Prevalence of Rheumatic Fever and Rheumatic Heart Disease Among School Children.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns in the developing countries like India. A total number of 10330 school children were examined clinically for evidence of acute rheumatic fever and rheumatic heart disease . Those suffering with the disease were subjected to electrocardiographic, rontgenographic and echocardiographic examination. Prevalence of acute rheumatic fever and rheumatic heart disease was found to be 0.87 per 1000.

Apresentação e desfecho da febre reumática em uma série de casos / Rheumatic fever presentation and outcome: a case-series report

OBJETIVO: Examinar as características clínicas de apresentação e desfecho em uma série de casos de febre reumática em um hospital de referência nos últimos 20 anos. PACIENTES E MÉTODOS: Pacientes com menos de 18 anos e diagnóstico de febre reumática, entre 1986 e 2007, foram avaliados retrospectivamente a partir da última consulta, para análise descritiva e de sobrevida, estimando-se a probabilidade de cardite e de recorrência. RESULTADOS: Dos 178 casos identificados, 134 foram incluídos. Desses, durante a fase aguda, 66,4 por cento apresentaram poliartrite, 56,8 por cento cardite, 28,6 por cento coreia, 1,5 por cento nódulos subcutâneos e 1,5 por cento eritema marginado; cardite foi associada com poliartrite em 40 por cento. Cardite e coreia predominaram no gênero feminino. Antiestreptolisina-O elevada ocorreu em 58,3 por cento dos pacientes, e história familiar de febre reumática em 14,5 por cento. O tempo de seguimento foi em média 6,8 anos (variando de 1,1 a 16,9 anos). Houve recorrência em 15 por cento dos pacientes, hospitalização durante a fase aguda em 27,6 por cento, e descontinuidade de seguimento em 47,4 por cento, após 5,1 anos em média. As probabilidades de cardite e de recorrência foram 17,5 por cento e 13,2 por cento, respectivamente, após cinco anos do surto inicial. CONCLUSÃO: Observou-se maior risco de evolução com cardite e de recorrências de febre reumática nos primeiros cinco anos. A descontinuidade de seguimento foi frequente, indicando serem necessárias medidas para melhorar a adesão à profilaxia e ao seguimento.

OBJECTIVE: To assess the clinical characteristics and outcome of a rheumatic fever case-series from a referral hospital over the last 20 years. PATIENTS AND METHODS: Patients under the age of 18 years, diagnosed with rheumatic fever between 1986 and 2007 were retrospectively assessed to estimate the carditis and relapse rates, by use of descriptive and survival analysis. RESULTS: Of 178 cases identified, 134 were included. During the acute phase, 66.4 percent had polyarthritis, 56.8 percent had carditis, 28.6 percent had chorea, 1.5 percent had subcutaneous nodules, and 1.5 percent had erythema marginatum. The association of carditis and arthritis occurred in 40 percent. Carditis and chorea were more frequent among female gender. High antistreptolysin-O titres were found in 58.3 percent, and family history of rheumatic fever, in 14.5 percent. Mean follow-up was 6.8 years (1.1 to 16.9). Relapse was observed in 15 percent, hospital admissions in 27.6 percent, and follow-up discontinuation in 47.4 percent after a mean of 5.1 years. Carditis and relapse probabilities were 17.5 percent and 13.2 percent, respectively, five years after the initial attack. CONCLUSION: The risk of carditis and relapse of rheumatic fever was higher within the first five years. Follow-up discontinuation was frequent, pointing to the need of measures to improve adherence to prophylaxis and follow-up.

Prevalência de transtornos psiquiátricos em portadores de prótese valvar mecânica com e sem febre reumática / Prevalence of psychiatric disorders in patients with mechanical valve prostheses with and without rheumatic fever

OBJETIVO: Valvulopatias cardíacas, causadas por febre reumática e outras etiologias, podem levar ao implante de prótese valvar mecânica e anticoagulação oral obrigatória. Comorbidade psiquiátrica pode reduzir a adesão à anticoagulação. Esse estudo teve como objetivo avaliar a prevalência de transtornos psiquiátricos em pacientes com prótese valvar mecânica. MÉTODOS: Foram avaliados 193 portadores de prótese valvar mecânica, sendo 135 com cardiopatia reumática, tendo sido utilizada a Mini International Neuropsychiatric Interview, versão 5.0.0, para investigação quanto à presença de transtornos psiquiátricos. RESULTADOS: Foram encontrados os seguintes transtornos psiquiátricos nos pacientes avaliados: transtornos de ansiedade generalizada (16,6 por cento), agorafobia (11,9 por cento), fobia social (10,4 por cento), depressão (9,8 por cento), distimia (4,1 por cento atual e 1 por cento no passado), transtorno obsessivo-compulsivo (3,6 por cento), pânico - vida inteira (1,6 por cento), dependência ou abuso de substâncias (2 por cento), dependência ou abuso de álcool (1 por cento), episódio hipomaníaco (0,5 por cento atual e 0,5 por cento no passado), bulimia (0,5 por cento). O risco de suicídio detectado foi de 13,4 por cento. Ao ser comparada a prevalência dos transtornos no grupo com e sem cardiopatia reumática, não foi encontrada diferença estatisticamente significativa. CONCLUSÃO: Foi encontrada elevada comorbidade de transtornos psiquiátricos, principalmente transtornos ansiosos e depressão, sendo também elevado o risco de suicídio nessa população.

OBJECTIVE: Valvular heart diseases, caused by rheumatic fever and another causes, can lead to implant of mechanical valve prosthesis and mandatory oral anticoagulation. Psychiatric comorbidity may reduce adherence to treatment. This study aimed at assessing the prevalence of psychiatric disorders in patients with mechanical heart valve prostheses. METHODS: This study assessed 193 patients with mechanical heart valve prostheses, 135 of whom diagnosed with rheumatic heart disease. The Mini International Neuropsychiatric Interview, version 5.0.0, was used to assess the presence of psychiatric disorders. RESULTS: The following psychiatric disorders were found in the patients with mechanical heart valve prostheses assessed: generalized anxiety disorder (16.6 percent); agoraphobia (11.9 percent); social phobia (10.4 percent); depression (9.8 percent); dysthymia (4.1 percent current and 1 percent past); obsessive-compulsive disorder (3.6 percent); panic - lifetime (1.6 percent); substance dependence or abuse (2 percent); alcohol dependence or abuse (1 percent); hypomanic episode (0.5 percent current; 0.5 percent past); and bulimia (0.5 percent). A 13.4 percent suicide risk was detected. When comparing the prevalence of psychiatric disorders in the groups with and without rheumatic heart disease, no statistically significant difference was found. CONCLUSION: High comorbidity of psychiatric disorders, mainly depression and anxiety disorders, was observed in that population, in addition to a high suicide risk.

Translation, cultural adaptation and reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil

OBJECTIVE: To translate, to perform a cultural adaptation of and to test the reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil. METHODS: First, the Cochin Hand Functional Scale questionnaire was translated into Portuguese and was then back-translated into French. These translations were reviewed by a committee to establish a Brazilian version of the questionnaire to be tested. The validity and reproducibility of the Cochin Hand Functional Scale questionnaire was evaluated. Patients of both sexes, who were aged 18 to 60 years and presented with rheumatoid arthritis affecting their hands, were interviewed. The patients were initially interviewed by two observers and were later interviewed by a single rater. First, the Visual Analogue Scale for hand pain, the Arm, Shoulder and Hand Disability questionnaire and the Health Assessment Questionnaire were administered. The third administration of the Cochin Hand Functional Scale was performed fifteen days after the first administration. Ninety patients were assessed in the present study. RESULTS: Two questions were modified as a result of the assessment of cultural equivalence. The Cronbach's alpha value for this assessment was 0.93. The intraclass intraobserver and interobserver correlation coefficients were 0.76 and 0.96, respectively. The Spearman's coefficient indicated that there was a low level of correlation between the Cochin Hand Functional Scale and the Visual Analogue Scale for pain (0.46) and that there was a moderate level of correlation of the Cochin Scale with the Health Assessment Questionnaire (0.66) and with the Disability of the Arm, Shoulder and Hand questionnaire (0.63). The average administration time for the Cochin Scale was three minutes. CONCLUSION: The Brazilian version of the Cochin Hand Functional Scale was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

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: New Ideas in Diagnosis and Management

Rheumatic heart disease remains a major cause of disability and death in developing countries. careful re-analysis of mid- 20th century data as well as the juxtaposition of well-funded research units and populations at risk have generated information that resulted in radical departures from standard approaches to the prevention; clinical recognition and treatment of acute rheumatic fever. As a result; rheumatic heart disease may be eliminated in the future

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

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 por cento). 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) administered to the parents of 133 patients with rheumatic fever aged between 5 and 18 years. The scores of the several dimensions of the questionnaire were calculated and compared within the categories of clinical and sociodemographic variables using a nonparametric test. RESULTS: Patients' age ranged from 5 to 18 years old, with a mean age of 12 years and standard deviation of 2.8 years. The most common manifestation of the disease was articular symptoms associated with cardiac problems, present in 74 cases (56.1 percent). Most patients belonged to low-income families. Subjects had higher scores on the following concepts of the questionnaire: physical functioning, role/social-physical; role/social-emotional/behavioral; bodily pain; and family activities. The items with the lowest scores were: family cohesion; general health; global behavior; and parental impact-emotional. Girls had higher scores on: self-esteem; role/social-emotional/behavioral; and general health. Patients belonging to middle-income families had higher scores on: mental health; physical functioning; role/social-physical; and family activities. Children from the lowest social class had higher scores on bodily pain and psychosocial aspects. CONCLUSIONS: The quality of life of patients with rheumatic fever is similar to that of patients with other chronic diseases, showing intermediate scores on the several concepts included both in the physical and the psychosocial domains. Social class was the variable most frequently associated with the CHQ concepts.

Epidemiology of Valvular Heart Diseases in Africa

Rheumatic heart disease (RHD) resulting from rheumatic fever (RF) is the main form of valve disease in Africa. Other forms of valve diseases such as myxomatous mitral valve disease; age-related valve disease; -valvular aneurysms or valve disease related to endomyocardial fi brosis are less common than RHD. In developed countries; RF and RHD are rare and no longer pose a public health problem; but the combination of poverty; lack of awareness; lack of infrastructure and resources; and social instability contribute to the persistence of RF and RHD in Africa. The presence of other major infectious diseases also shifts attention away om RF and RHD. Contemporary population-based epidemiologic data utilising echocardiography to detect valve disease suggests the prevalence of valve diseases in Africa is likely much higher than previously thought; meaning the estimated mortality; morbidity and socio-economic burden they cause could also be much higher than currently appreciated. Increased efforts are needed to defi ne the scope of the problem of valve diseases in Africa to draw attention to these illnesses and step up public health efforts to control and eradicate them as has already been achieved in other parts of the world. This article highlights the public health problem of valve diseases in Africa; the efforts underway to combat them and the attendant challenges

Interpretación clínica de anticuerpos anti-estreptococo en fiebre reumática / Streptococcal antibody test clinical interpretation in rheumatic fever

La Fiebre Reumática es una complicación no supurativa de la infección por Streptocococus pyogenes. Es una enfermedad prevalente con una tasa importante de morbilidad y mortalidad en países en desarrollo. El diagnóstico de Fiebre Reumática tanto en el episodio agudo como en la recurrencia se apoya en criterios clínicos sumado a la evidencia serológica de infección previa por estreptococo beta hemolítico del grupo A. Los anticuerpos anti-estreptococo disponibles comercialmente son los anticuerpos anti-estreptolisina O (ASTO) y los anticuerpos anti- DNAasa B (anti-DNAasa B). Estos deben ser analizados teniendo en cuenta la edad del paciente, el tipo de infección, las comorbilidades asociadas, los títulos de anticuerpos, el tratamiento antibiótico previo y el momento en el cual se toman las muestras para la medición de estos. En este artículo se realiza una revisión de la literatura disponible con el objetivo de determinar la utilidad e interpretación de las pruebas de anti-estreptolisina O y anti-DNAsa B.