Epidemiology of acute rheumatic fever in a multiethnic, multiracial urban community: the Miami-Dade County experience

Article Abstract:

Acute rheumatic fever (ARF) can occur during the recovery period following an infection with group A streptococcus bacteria. It is a serious illness because, in severe cases, it can damage the valves in the heart, leading to heart failure. The incidence of ARF in the United States has been declining since the early 1900s. However, in the 1980s several outbreaks of ARF were reported in military recruit camps and civilian populations. In many of the outbreaks, most of the victims were white children from middle-class suburban or rural families. This article describes the results of a study designed to report on the prevalence of ARF in the multiracial and multi-ethnic urban areas of Miami-Dade County, Florida. Between 1984 and 1988, 35 definite cases and 4 probable cases of ARF were identified. Fifty-four percent of the patients developed carditis (inflammation of the heart). Eighty-two percent of the patients with ARF were black. It is estimated that 12 of every 100,000 black children (aged 5 to 14 years) developed ARF each year during the study period, while only 1 of every 140,845 white and hispanic children developed ARF. It is concluded that in Miami-Dade County ARF is a disease that affects underprivileged, black inner-city children. While it is a disease that occurs in all parts of the world, previous studies have not reported a racial predilection for ARF. The high incidence of ARF among blacks in Miami may be related to socioeconomic factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Florida, Demographic aspects, Miami, Florida

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Human heart sarcolemmal sheath antibodies in children with non-suppurative sequelae of group A streptococcal infections: a follow up study

Article Abstract:

Antibodies that react with heart tissue are induced following infections with group A streptococcal bacteria, including infections with kidney complications and rheumatic fever. In some patients, levels of these antibodies decreased over a two- to three-year period; some were absorbed by the bacterial membrane, while in other patients antibodies were bound to the human heart sarcolemmal sheath (HHSS, a membrane that surrounds muscle fibers), but not to skeletal muscle or muscle in blood vessel walls. Changes in the levels of heart-reactive antibodies were evaluated in 15 children with acute rheumatic fever but no carditis (inflammation of the heart), 15 children with rheumatic fever and carditis that progressed to rheumatic heart disease with involvement of the heart valves, 13 children with poststreptococcal kidney disease, and 27 healthy control children. The first two groups received continued monthly penicillin therapy. At the onset of infection, levels of antibody titers were significantly higher in children who developed rheumatoid heart disease and in those who developed kidney disease. After three years or more, levels remained significantly elevated only in children with rheumatic heart disease. The association between continued high levels of antiHHSS antibodies and the presence of rheumatic heart disease deserves further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Streptococcal infections, Complications and side effects, Antibodies

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