Rheumatic heart disease: 15 years of clinical and immunological follow-up

Rheumatic fever (RF) is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD), the major sequel of RF, occurs in 30%-45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximat...

Full description

Saved in:
Bibliographic Details
Published in:Vascular health and risk management 2007, Vol.3 (6), p.1007-1017
Main Authors: Sampaio, Roney O, Fae, Kellen C, Demarchi, Lea M F, Pomerantzeff, Pablo M A, Aiello, Vera D, Spina, Guilherme S, Tanaka, Ana C, Oshiro, Sandra E, Grinberg, Max, Kalil, Jorge, Guilherme, Luiza
Format: Article
Language:English
Subjects:
Adolescent
Antigens, Bacterial - immunology
Bacterial Outer Membrane Proteins - immunology
Biopsy
Cardiovascular disease
Carrier Proteins - immunology
CD4-Positive T-Lymphocytes - cytology
CD8-Positive T-Lymphocytes - cytology
CD8-Positive T-Lymphocytes - immunology
Child
Clone Cells - immunology
Female
Follow-Up Studies
Heart
Heart Valve Diseases - pathology
Heart Valve Diseases - surgery
Humans
Immunohistochemistry
Immunology
Male
Myocardium - pathology
Original Research
Quality of Life
Rheumatic Heart Disease - immunology
Rheumatic Heart Disease - pathology
Streptococcus
Streptococcus infections
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Rheumatic fever (RF) is a sequel of group A streptococcal throat infection and occurs in untreated susceptible children. Rheumatic heart disease (RHD), the major sequel of RF, occurs in 30%-45% of RF patients. RF is still considered endemic in some regions of Brazil and is responsible for approximately 90% of early childhood valvular surgery in the country. In this study, we present a 15-year clinical follow-up of 25 children who underwent surgical valvular repair. Histopathological and immunological features of heart tissue lesions of RHD patients were also evaluated. The patients presented severe forms of RHD with congestive symptoms at a very young age. Many of them had surgery at the acute phase of RF. Histological analysis showed the presence of dense valvular inflammatory infiltrates and Aschoff nodules in the myocardium of 21% of acute RHD patients. Infiltrating T-cells were mainly CD4+ in heart tissue biopsies of patients with rheumatic activity. In addition, CD4+ and CD8+ infiltrating T-cell clones recognized streptococcal M peptides and cardiac tissue proteins. These findings may open the possibilities of new ways of immunotherapy. In addition, we demonstrated that the surgical procedure during acute phase of the disease improved the quality of life of young RHD patients.
ISSN:1176-6344
1178-2048