Talk:Rheumatic fever

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Carditis[edit]

Carditis is the inflammation of all three layers of the heart - pericardium, myocardium and endocardium, and it is a common finding in Rheumatic Fever.--82.24.195.140 11:53, 18 July 2006 (UTC)Schwing.

–--82.24.195.140 11:53, 18 July 2006 (UTC)I am working on revising this article to better fit with the template Wikipedia:WikiProject Clinical medicine#Template. Also, subacute bacterial endocarditis while technically a subset of carditis is not related to rheumatic fever except as a possible sequelae. --DocJohnny 23:06, 31 December 2005 (UTC)

Still needs editing to remove repetition. --DocJohnny 00:20, 1 January 2006 (UTC)

ASOT[edit]

Diagnostic approach is probably useful to add, e.g. echocardiography, acute and convalescent antistreptolysin titres. Do we still use digoxin for congestive heart failure? JFW | T@lk 06:20, 1 January 2006 (UTC)

Good point. I never use digoxin on new patients, but it is mentioned in all the rheumatic fever articles. --DocJohnny 06:50, 1 January 2006 (UTC)

Two questions, is it contagous once someone has long term rheumatic fever? Is it contagous when your pregnant?

critique[edit]

Nice work. I don't recognize anything wrong. Two questions arose in my own mind as I read it:

  • First paragraph on incidence seems confusing to me: statistical whipsaw. Each sentence seems to void the previous one. I would recommend a clearer statement of when rheumatic fever was at its height, what the approximate incidence was then, what the approximate incidence is now, whether there are major regional variations (Europe vs NA vs underdeveloped countries), whether antibiotic use in last 50 years was responsible for decreased incidence, and whether currently the incidence seems to be still diminishing or re-increasing.
  • Clarify carditis. How is carditis different from myocarditis? Does it simply mean "myocarditis and/or pericarditis" or something more distinct? I think myocarditis is by far the more familiar term if they are synonymous. alteripse 19:36, 1 January 2006 (UTC)
  • Myocarditis refers to myocytes, the myocardium proper. Carditis refers to a pancarditis, which would include endocarditis, myocarditis, and pericarditis, which are more specific regional and histological terms.

Thank you for your clear and concise guide. I think however, that evidence of recent streptococcus infection is required in addition to the major and minor criteria stated and so wonder if it should therefore be moved from the list of minor criteria? — Preceding unsigned comment added by Nweatherley (talkcontribs) 10:47, 7 June 2011 (UTC)

Jones Criteria[edit]

According to the 2004 Ferri's Clinical Advisor: Instant Diagnosis and Treatment, the Jones Criteria had been revised, so it states the following:

"Jones Criteria (revised) for Guidance in the Diagnosis of Rheumatic Fever" published by the American Heart Association. One major and two minor criteria if supported by evidence of an antecedent group A streptococcal infection.

- Major Criteria

 1. Increased titer of antistreptococcal antibodies such as ASO
 2. Positive throat culture
 3. Recent scarlet fever

- Minor Criteria

 1. Previous rheumatic fever or rheumatic heart disease
 2. Fever
 3. Arthralgia
 4. Increased acute-phase reactants
    a. ESR
    b. C-reactive protein
    c. Leukocytosis
 5. Prolonged P-R interval

Scarlet Fever vs. Rheumatic Fever[edit]

There appears to be a conflict between the entries for the two articles.

Under scarlet fever it says: "Antibiotic treatment is usually given. It has however never been shown to reduce the chance that rheumatic fever develops.

Under rheumatic fever it says: "The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%. The rate of development is far lower in individuals who have received antibiotic treatment."


Speleothing 21:16, 1 October 2007 (UTC)


Changes[edit]

Just undid a few bits in the pathophysiology bit which were highly dubious and unsourced. Hope that's ok. 19th October 2007 —Preceding unsigned comment added by 89.168.30.147 (talk) 23:47, 18 October 2007 (UTC)

Image[edit]

I added an image of S. pyrogenes to the infobox. Please let me know if anybody thinks it's a poor choice. Rex Manning (talk) 20:40, 6 February 2009 (UTC)

It's better than nothing, but it would be nice to see an actual photoJohnfravolda (talk) 03:52, 24 September 2009 (UTC)

Need images of swelling and detail image of heart[edit]

Can someone put an image of swelling of how sever it can be? Also it would be good if there is marking on the image of the heart with comparison with normal heart. —Preceding unsigned comment added by 61.8.134.131 (talk) 06:55, 10 August 2009 (UTC)


No Brainer[edit]

The introduction says the disease can involve the brain, but there is no mention of the brain in the body of the article. —Preceding unsigned comment added by 89.100.82.102 (talk) 10:37, 4 June 2010 (UTC)

Sydenham's Chorea IS the brain-involvement part of the disease, but the article doesn't make that point clear to the casual reader. Wordreader (talk) 23:00, 2 September 2011 (UTC)

Some observations...[edit]

Hello -

1. There are two #8s in the REFERENCE section.

2. Under MINOR CRITERIA, points 5 & 6 are the same thing - a 1st degree AV block is the heart block that is characterized by a prolonged PR interval.

Check out: http://en.wikipedia.org/wiki/First_degree_AV_block

3. Under the PREVENTION section, the American Heart Association's recommendations are a little more complex than that. You'll find them here: "Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis" http://circ.ahajournals.org/content/119/11/1541.full.pdf

The World Health Organization (WHO) has their own, slightly different, guidelines. You can find them here in this Emedicine/Medscape article: "Rheumatic Fever" http://emedicine.medscape.com/article/236582-overview. (It's a good overall article.) Some cardiologists, including my own Electrophysiologist, still prefer to have patients take a penicillin prophylaxis prior to invasive procedures like dental cleanings and surgeries. During surgery, he recommends prophylaxic adrenaline to prevent a hypervagal episode from making my heart rate and B/P plummet.

4. There's no mention at all of Rheumatic Heart Disease, artial fibrillation, stroke, hypervagaltonia, or other long-term sequelae. These conditions are major contributors to the mortality rate of RF. MORBIDITY/MORTALITY, DIFFERENTIAL DIAGNOSIS, etc, is information that you should consider including, but feel free to chose more accessible titles for the causual reader.

I still think that such a section on the sequelae is appropriate if only to mention that it these effects can occur and to provide a WP link citation to further information. If a researcher doesn't know these conditions can be consequences of rheumatic fever, how would they know to follow up on them?

Thanks, Wordreader (talk) 01:01, 3 September 2011 (UTC)

Rheumatic heart disease is still only glancingly mentioned in the article in a comprehensible manner. More simply stated information is required for the casual reader. Leave the jargon if you want, but add initial paragraphs to the section that readers can clearly understand - name the sequelae and why they count as serious consequences. Then, if readers are further interested, they can read the complex cellular information that exists here now. I am not an MD and, therefore, I am not qualified to insert such information myself. Can a qualified writer add it, please? Thank you for your help, Wordreader (talk) 02:28, 14 August 2014 (UTC)
This comprehensive article from emedicine/Medscape (and meant for actual medical professionals) is less complicated than the Rheumatic Heart Disease section in this article, though not as simplified as most readers would require, of course:
This article is from Circulation, a journal of the American Heart Association. It appears to be meant as patient information and is quite understandable:
Brief article from Johns Hopkins meant for the casual reader:
Thank you, Wordreader (talk) 04:17, 14 August 2014 (UTC)

Regarding Reyes Syndrome. . .[edit]

I thought I had a good handle on Reyes Syndrome before I started to look into it today, checking on the age at risk.

Risk age varies between the following websites. Use of aspirin in children varies, too.
NOTE: Any emphasis given below is my own addition.


  • National Reye's Syndrome Foundation [risk age varies within this document]

"What is the Role of Asprin?"
http://reyessyndrome.org/aspirin.html

paragraph 2 - . . .aspirin not be given to children under 19 years of age during episodes of fever-causing illnesses.
paragraph 5 - Teenagers and adults are especially at risk of developing Reye's Syndrome due to self-medication. Too often, teenagers are ingesting aspirin-type products without parental knowledge.


  • MedlinePlus [U.S. National Library of Medicine at the National Institutes of Health - it takes a more casual approach on risk age]

"Reye Syndrome" http://www.nlm.nih.gov/medlineplus/ency/article/001565.htm

Causes, incidence, and risk factors Reye syndrome is most often seen in children ages 4 - 12. Most cases that occur with chickenpox are in children ages 5 - 9. Cases that occur with the flu (influenzae type B) are usually in children ages 10 - 14.
Prevention
Never give a child [definition of a child?] aspirin unless told to do so by your doctor.


  • Aspirin Foundation [probably European, definitely industry, site - that doesn't mean the information is wrong, just that they have a financial stake; DO give for Kawasaki's Disease]

"Asprin and Reye Syndrome"
http://www.aspirin-foundation.com/suitability/backgrounder.html
In the UK, for example, it may not be given to children and adolescents under 16 years old except for a specific medical indication such as Kawasaki's disease, preventing clotting after cardiac surgery or reducing the risk of stroke. Some European countries also make an exception for the treatment of mild to moderate pain in children provided they do not have fever or a viral illness.


  • American Liver Foundation [gives two age variations in the documents]

"Reye Syndrome" http://www.liverfoundation.org/abouttheliver/info/reye/

Who is at risk for Reye syndrome?
Reye syndrome occurs most commonly in children between the ages of 4 and 12, although it can occur at any age.
What is the best way to prevent Reye syndrome?
Unless specifically instructed to do so by your child's doctor, do not give aspirin to anyone younger than 19.


  • Medscape Today [DON'T give for Kawasaki Disease]

"Use of Aspirin in Children with Cardiac Disease: Reye's Syndrome" http://www.medscape.com/viewarticle/555392_8

paragraph 1 - The routine use of aspirin as an OTC antipyretic and analgesic is no longer recommended in children because of the potential association with Reye's syndrome. paragraph 3 - On December 28, 1982, the FDA first proposed a requirement for OTC and prescription salicylate-containing products to carry a warning against use for the treatment of flu or chickenpox in children under 16 years of age. . .
paragraph 5 - In 2005, Wei and colleagues described a 10 month-old child receiving high-dose aspirin after the diagnosis of Kawasaki disease. . . [description of the symptoms]. . . A liver biopsy revealed findings consistent with Reye's syndrome. He recovered without sequelae.


  • Medscape Reference

"Reye Syndrome"
http://emedicine.medscape.com/article/803683-overview#showall

Age
The peak ages are 5-14 years, with a median of 6 years and a mean of 7 years.
Reye syndrome rarely occurs in newborns or in children older than 18 years.
In African Americans, 67% of patients are younger than 1 year compared with only 12% in white patients.


  • Centers for Disease Control and Prevention

"Caring for Someone Sick at Home: Medicine Safety and Children"
http://www.cdc.gov/h1n1flu/homecare/medsafetychildren.htm

Warning
Think your child age 18 or younger might have the flu?
Never give them aspirin or products with aspirin in them.
Check all medicine labels to make sure they do not contain aspirin, also called salicylate. Although it mostly affects people age 18 or younger, Reye’s Syndrome can strike anyone who takes aspirin products when they have the flu.


  • National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/disorders/reyes_syndrome/reyes_syndrome.htm
"NINDS Reye's Syndrome Information Page"

What is Reye's Syndrome? Reye's syndrome (RS) is primarily a children's disease, although it can occur at any age.


SUMMARY 1: Aspirin can be given to children sick with Kawasaki Disease except when it can't.
SUMMARY 2: The risk age for the development of Reye Syndrome is: a child; 5-9 years; adolescents; 4-12 years; 5-14 years; 10-14 years; teenagers; under 16 years; newborns-18 years and younger; under 19 years; adults; anyone at any age.
SUMMARY 3: There are 3 spelling variations that I've found: REYE Syndrome, REYES Syndrome, REYE'S Syndrome. Take your pick?

Thanks, Wordreader (talk) 00:42, 16 June 2012 (UTC)

Seeking additional and more recent review articles.[edit]

Centenary Review Article, Indian J Med Res 137, "Rheumatic fever & rheumatic heart disease: The last 50 years." R. Krishna Kumar & R. Tandon*, April 2013, pp 643-658.

Division of Pediatric Cardiology, Amrita Institute of Medical Sciences & Research Centre, Kochi & *Sitaram Bhartia Institute of Science & Research, New Delhi, India

https://www.scienceopen.com/document/vid/2dd0fe40-d0bc-414c-a61c-805f0c5627d5;jsessionid=nKXXh22UJs4SnBPdICUAe564.master:so-app1-prd <--Abstract

Abstract

"Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to be a major health hazard in most developing countries as well as sporadically in developed economies. Despite reservations about the utility, echocardiographic and Doppler (E&D) studies have identified a massive burden of RHD suggesting the inadequacy of the Jones’ criteria updated by the American Heart Association in 1992. Subclinical carditis has been recognized by E&D in patients with acute RF without clinical carditis as well as by follow up of RHD patients presenting as isolated chorea or those without clinical evidence of carditis. . . "

" . . . Paediatric and juvenile mitral stenosis (MS), upto the age of 12 and 20 yr respectively, severe enough to require operative treatement was documented. These negate the belief that patients of RHD become symptomatic ≥20 years after RF as well as the fact that congestive cardiac failure in childhood indicates active carditis and RF. . . " <--This is a confusing compound sentence. Cool Nerd (talk) 21:53, 17 January 2014 (UTC)

Diagnosis of RF

" . . . The updated criteria emphasize the value of indolent carditis and chorea to be accepted as evidence of RF . . . "

" . . . However, physicians have a right to make a diagnosis of RF on the basis of clinical judgment even if the updated criteria are not satisfied. This may be due to (i) absence of history suggestive of RF in almost 50 per cent patients of RHD, and (ii) identification of subclinical carditis by echocardiographic studies, indicating inadequacy of clinical diagnosis."

Identification of RF

" . . Follow up of patients with pure chorea without RHD or of patients who have had RF but no clinical evidence of carditis indicates that RHD can develop over a period of time. Bland[50] in a 20 year follow up of patients with isolated chorea found 23 per cent patients without clinical carditis to develop RHD predominantly mitral valve obstruction (MS). . "

" . . . In a subsequent evaluation of 125 children below of the age of 12 yr with isolated mitral stenosis, past history of rheumatic fever was available in 54 (51%)[54]. . . " <-- I don't get this. 54 is not 51% of 125. Perhaps just a lesson from my work on "system accidents" that it's extremely difficult to focus on both big picture and the details. Cool Nerd (talk) 21:53, 17 January 2014 (UTC)


I found this review article using MEDLINE (EBSCO) at a university library. I don't know if it's available through the Internet generally. Yes, we can use nonlinkable references, but that does make it less of a collaborative process. And, I want to look at this article a couple more times and do more than just read the abstract and skim a little of the rest. Cool Nerd (talk) 03:39, 14 January 2014 (UTC)
The full article can be read here at PMC. I found the full text by Googling the article name and clicking on the PubMed link. If I were citing this article I'd just type in <ref<>{{cite journal|pmc=3724245}}</ref> and then let the citation expander do the rest. I don't really know anything about this subject (or medicine in general), but I've ended up with a number of medical articles on my watchlist over the years, partly due to interest and partly due to luck. Graham87 15:48, 14 January 2014 (UTC)
Thank you very much.
A couple more notes. To me, it sure looks like Sydenham's chorea is significant in its own right and not merely a marker for possible heart damage. Maybe it's just that cardiologists did the initial research on rheumatic fever, and this to their credit. Now fortunately, it looks like Sydenham's is relatively rare. According to Harrison's Principles of Internal Medicine (2001), 10% or fewer of persons with rheumatic fever get Sydenham's chorea.
Yes, I'm reasonable good at looking stuff up. But please note, I am not a doctor by any stretch. Cool Nerd (talk) 21:54, 14 January 2014 (UTC)
As far as formatting the references, we might need to agree to disagree. I just don't see the upside to the fancy spancy style, I prefer the plain vanilla. Among other issues, we are throwing two dates at our readers. Yes, this does make it easier for editors, but we ought to be about the business of making it easier on the reader, and fully accept the fact that some readers just fly through something.
Down the line, I might well experiment with the citation expander, for I do like learning new things. But I'm probably going to stick with plain vanilla. Cool Nerd (talk) 01:52, 16 January 2014 (UTC)

"Rheumatic fever & rheumatic heart disease: The last 50 years," Indian Journal of Medical Research, R. Krishna Kumar & R. Tandon, April 2013, pages 643-658.

Sorry, I'd unleashed the citation expander on the article before getting these messages. The citation templates provide a standardized look-and-feel to references, and are also easier to read for machines (it's also comforting for me to know that the URL brings me to somewhere reputable, which the "PMC" part of the citation tells me. Feel free to revert my edit along with the one by the Citation Expander if you feel strongly enough to do so. Graham87 04:31, 16 January 2014 (UTC)
This is fine. We can hang with this style for a while. I really want to focus on things like the following from the abstract:
"Despite reservations about the utility, echocardiographic and Doppler (E&D) studies have identified a massive burden of RHD suggesting the inadequacy of the Jones’ criteria updated by the American Heart Association in 1992. Subclinical carditis has been recognized by E&D in patients with acute RF without clinical carditis as well as by follow up of RHD patients presenting as isolated chorea or those without clinical evidence of carditis."
We should include this in the section on the Jones' criteria, for starters. And maybe other places as well. Cool Nerd (talk) 22:48, 16 January 2014 (UTC)

American Heart Association antibiotic prophylaxis recommendations[edit]

The Prevention section only mentions prophylaxis for endocarditis, but the same reference also mentions other conditions that I have added:

Quote: You can help reduce the risk for this problem by keeping teeth clean and cavities filled. In the past, the American Heart Association recommended that people with rheumatic heart disease take a dose of antibiotics before certain dental or surgical procedures. However, our association does not suggest this type of preventive treatment any longer for people with rheumatic heart disease unless they have a history of endocarditis, an artificial heart valve, certain congenital heart defects, or have had a heart transplant and have heart valve problems.

The last point/s confuses me, though. Since there's no Harvard comma, does "a heart transplant and have heart valve problems" mean that you get prophylaxis if you've had "a heart transplant ACCOMPANIED BY valve problems" or "a heart transplant, and [as a separate issue] have heart valve problems"? Thank you, Wordreader (talk) 02:09, 14 August 2014 (UTC)

Review[edit]

... in Circulation doi:10.1161/CIRCULATIONAHA.114.009857 JFW | T@lk 21:49, 9 December 2014 (UTC)