Resurgence of Acute Rheumatic Fever in the Intermountain Area of the United States

Abstract

We describe an outbreak of acute rheumatic fever that occurred in the intermountain area centered in Salt Lake City, Utah. Seventy-four children meeting the modified Jones criteria for the diagnosis of acute rheumatic fever were evaluated by the staff at Primary Children's Medical Center, Salt Lake City, from January 1985 through June 1986. This represents an eightfold increase over the average annual incidence at this hospital during the past decade. Carditis, a dominant feature of the outbreak, was confirmed by auscultation in 53 of the patients (72 percent). An additional 14 patients were found to have mitral regurgitation by Doppler ultrasound examination, raising the total incidence of carditis to 91 percent. The children were predominantly from white (96 percent) middle-class families with above-average incomes and with ready access to medical care. There was no apparent increase in the incidence of streptococcal disease or other explanation for the marked increase in acute rheumatic fever. However, mucoid M type 18 and M type 3 group A streptococcal strains were isolated from several siblings of the patients and from schoolchildren (chosen at random) in the area. We conclude that acute rheumatic fever remains an important health problem in the United States.

Comparison of the efficacy of carbamazepine, haloperidol and valproic acid in the treatment of children with Sydenham´s chorea: clinical follow-up of 18 patients

“…This drug was administered during 6 and 10 months, respectively. DISCUSSION SC is a movement disorder that affects patients aged 5 to 15 years, with a peak incidence at 8 years, and a 2:1 female predominance 15 . The neurological manifestations are usually preceded by emotional instability, low scholar achievement and motor clumsiness.…”

“…These motor alterations appear when the patient is at rest, and may cease during sleep. A genetic predisposition to develop CS has been suggested [14][15][16] .…”

Bacterial determinants of persistent throat colonization and the associated immune response in a primate model of human group A streptococcal pharyngeal infection

“…Rarely, throat infection is followed by the post-infectious syndrome of acute rheumatic fever. Although the incidence of rheumatic fever has declined in the developed world, outbreaks continue to occur (Veasy et al, 1987(Veasy et al, , 1994Wald et al, 1987) and the disease remains endemic in much of the developing world where it is a leading cause of acquired heart disease (McLaren et al, 1994).…”

Intravenous Immunoglobulin in Acute Rheumatic Fever

“…16,17,21 Preliminary stratification had resulted in an equal proportion of patients with nil, mild, or severe carditis in the treated and placebo groups, but some imbalance occurred because of withdrawals. There was no difference in the relative proportion of patients exhibiting mild, moderate, or severe carditis over time assessed at 2, 4, or 6 weeks and at the 6-month and 1-year follow-up visits (Table 3).…”