First‐episode versus recurrent acute rheumatic fever: Is it different?

Rayamajhi, Ajit; Sharma, Deewakar; Shakya, Urmila

doi:10.1111/j.1442-200x.2008.02743.x

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…In Australia the implementation of a RF register was associated with a decrease in recurrence rates from 28% (in 1998) to 16% (in 1999) [14]. In contrast to our results, increase in age has been identified as a predictor of RF recurrence in a cross-sectional study in Nepal [2]. …”

Section: Discussioncontrasting

confidence: 87%

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Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

et al. 2010

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BackgroundMore than 15 million people worldwide have rheumatic fever (RF) and rheumatic heart disease due to RF. Secondary prophylaxis is a critical cost-effective intervention for preventing morbidity and mortality related to RF. Ensuring adequate adherence to secondary prophylaxis for RF is a challenging task. This study aimed to describe the rates of recurrent episodes of RF, quantify adherence to secondary prophylaxis, and examine the effects of medication adherence to the rates of RF in a cohort of Brazilian children and adolescents with RF.MethodsThis retrospective study took place in the Pediatric Rheumatology outpatient clinic at a tertiary care hospital (Instituto de Puericultura e Pediatria Martagão Gesteira) in Rio de Janeiro, Brazil, and included patients with a diagnosis of RF from 1985 to 2005.Results536 patients with RF comprised the study sample. Recurrent episodes of RF occurred in 88 of 536 patients (16.5%). Patients with a recurrent episode of RF were younger (p < 0.0001), more frequently males (p = 0.003), and less adherent (p < 0.0001) to secondary prophylaxis than patients without RF recurrence. Non-adherence to medication at any time during follow-up was detected in 35% of patients. Rates of non-adherence were higher in the group of patients that were lost to follow-up (42%) than in the group of patients still in follow-up (32%) (p = 0.027). Appointment frequency was inadequate in 10% of patients. Higher rates of inadequate appointment frequency were observed among patients who were eventually lost to follow-up (14.5%) than in patients who were successfully followed-up (8%) (p = 0.022). 180 patients (33.5%) were lost to follow up at some point in time.ConclusionsWe recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary prophylaxis is the main cause of RF recurrence. Detection of irregularity in secondary prophylaxis or in appointments should be an alert about the possibility of loss of follow-up and closer observation should be instituted.

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Section: Discussioncontrasting

confidence: 87%

“…In developing countries, rheumatic fever (RF) is the predominant cause of acquired childhood cardiopathy [1,2]. More than 15 million people worldwide have RF and rheumatic heart disease (RHD) due to RF, with nearly a quarter million deaths occurring annually due to this condition [3-6].…”

Section: Introductionmentioning

confidence: 99%

Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

et al. 2010

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“…1Employment status for the attendants was considered for children and students.2For patients < 13 years, education level of primary caretaker was considered.3Fisher’s exact test was used. OR = odds ratio, CI = confidence interval.…”

Section: Resultsmentioning

confidence: 99%

“…In developing countries, rheumatic fever (RF) is the predominant cause of acquired childhood cardiomyopathy 1,2. The prevalence of RHD is estimated to be higher in developing than in developed countries, ranging from 24/1 000 to 0.3/1 000, respectively 3-5.…”

Section: Introductionmentioning

confidence: 99%

Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital : cardiovascular topics

Musoke¹,

Mondo²,

Okello³

et al. 2013

CVJA

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IntroductionRheumatic heart disease (RHD) frequently occurs following recurrent episodes of acute rheumatic fever (ARF). Benzathine penicillin (benzapen) is the most effective method for secondary prophylaxis against ARF whose efficacy largely depends on adherence to treatment. Various factors determine adherence to therapy but there are no data regarding current use of benzapen in patients with RHD attending Mulago Hospital. The study aims were (1) to determine the levels of adherence with benzapen prophylaxis among rheumatic heart disease patients in Mulago Hospital, and (2) establish the patient factors associated with adherence and, (3) establish the reasons for missing monthly benzathine penicillin injections.MethodsThis was a longitudinal observational study carried out in Mulago Hospital cardiac clinics over a period of 10 months; 95 consecutive patients who satisfied the inclusion criteria were recruited over a period of four months and followed up for six months. Data on demographic characteristics and disease status were collected by means of a standardised questionnaire and a card to document the injections of benzapen received.ResultsMost participants were female 75 (78.9%). The age range was five to 55 years, with a mean of 28.1 years (SD 12.2) and median of 28 years. The highest education level was primary school for most patients (44, 46.3%) with eight (8.4%) of the patients being illiterate. Most were either NYHA stage II (39, 41.1%) or III (32, 33.7%). Benzathine penicillin adherence: 44 (54%) adhered to the monthly benzapen prophylaxis, with adherence rates ≥ 80%; 38 (46%) patients were classified as non-adherent to the monthly benzapen, with rates less than 80%. The mean adherence level was 70.12% (SD 29.25) and the median level was 83.30%, with a range of 0–100%; 27 (33%) patients had extremely poor adherence levels of ≤ 60%. Factors associated with adherence: higher education status, residing near health facility favoured high adherence, while painful injection was a major reason among poor performers.ConclusionThe level of non-adherence was significantly high (46%). Residence in a town/city and having at least a secondary level of education was associated with better adherence, while the painful nature of the benzapen injections and lack of transport money to travel to the health centre were the main reasons for non-adherence among RHD patients in Mulago.

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“…Recurrent pharyngeal GAS infection can trigger a severely exaggerated immune response in these patients, and studies have shown that recurrent RF is associated with a higher incidence of carditis and mortality, highlighting the need for preventative medicine in this population. 65,66 The duration of prophylactic antibiotic administration is dependent on several factors, including patient age, risk of re-exposure to GAS, number of prior episodes, length of time since prior infection, and most importantly, the presence of valvular heart disease. In general, prophylaxis is continued until the age of 21 years if there is no prior cardiac involvement; however, in the setting of valvular disease, treatment is continued until the age of 40 years, and in some instances, is recommended to be continued lifelong.…”

Section: Treatment and Prevention Of Rfmentioning

confidence: 99%

The immunology of mitral valve stenosis

Artola¹,

Mihos²,

Santana³

2011

IJICMR

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Although the prevalence of rheumatic heart disease (RHD) has rapidly subsided over the last several decades in the United States, it still remains a serious cardiovascular disorder across the world, particularly in developing nations. Chronic autoimmune inflammation of the cardiac valves can result in mitral stenosis, increasing the risk of morbidity, mortality, and long-term sequelae in these patients. Researchers have begun to unravel the mysteries behind the development of RHD in the setting of chronic autoimmune inflammatory reactions and the roles genetic predisposition, antibody-and T-cell-mediated molecular mimicry, and cytokine proinflammatory responses play. In this article, the immunologic pathogenesis of RHD and its effects on the mitral valve are reviewed.

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First‐episode versus recurrent acute rheumatic fever: Is it different?

Abstract: Subclinical carditis occurred only in the first-episode patients, which requires further evaluation for clinical significance. Because all deaths occurred in recurrent RF group (P = 0.02), secondary prophylaxis and management of sore throat need re-emphasis.

Cited by 7 publications

References 25 publications

Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital : cardiovascular topics

The immunology of mitral valve stenosis

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