Serum neopterin level in childerin with acute rheumatic fever

ABSTRACT

Acute rheumatic fever [ARF] is a systemic inflammatory disease thought that immune activation may play an important role in the pathogenesis of the disease. The objective of. this study was to investigate serum concentration of marker of immune activation [Neopterin], in acute rheumatic fever patients. The study included 30, patients, 16 of them with acute rheumatic fever diagnosed according to updated J Jone's criteria and 14 childern of matched age, sex, socioeco-nomic st and er and didn't suffer sore-throat or other infection as control group. All studied childern subjected for detailed history analysis, clinical examination, ECG and echocardiography. Blood sambles were examined for CBC.CRP, Asot, and Neopterin level before and after treatment before discharge from the hospital.Analysis of the two groups data was performed using Student Test. Neopterin marker were analysed in both groups and the associated correlation between them and the laboratory data were evaluated. All the patients had elevated sedimentation rate [mean +/- SD 76.3 +/- 27.2 mm/h.]. Increased ASOT [mean +/- SD 345.8 +/- 137.6 Todd's]. Colour Echo- Doppler detected single mitral valve disease in 5 patients, mitral valve prolapse in one patient, mitral and aortic valve affection in 8 patients. Affection of mitral, aortic and tricuspid valves were detected in two patients Neoptrein was assessed in both patient and control group, the mean value was 11.5 +/- 8.8 nmol/1 during acute rheumatic fever and decreased to 7.5 +/- 2.3, nmol/1 during follow up before hospital -discharge. While it was 5.3 +1.8 nmol/1 in control group. Neopterin differ significantly than control group either during acute stage [P<.0001] or before hospital discharge [P <.05]. In conclusion serum neopterin is increased in acute rheumatic fever reflecting activation of the cellular immune system. Higher serum neopterin concentration are associated with development of combined aortic and mitral insufficiency. Neopterin may allow assessment of severity of cardiac involvement and may present markers by which immunosuppression can be judged.