Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 ...Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 to December 2016 (5 years) in the Department of Pediatrics. We had included patients aged from 5 to15 years old, admitted for ARF. Results: Twenty-nine black African children, 15 boys (51.7%) were included. The incidence was 5.8 cases/year. The mean age was 10.4 ± 2.7 years. The mean age of parents was 34.5 ± 6.9 years (range: 24-48) for mother and 41.2 ± 6.9 years (range: 28 - 56) for father. Parents were low-income 10 (34.5%), the delay of consultation was 17.7 ± 19.5 days. The medical history was: frequent pharyngitis 22 (76%), previous ARF 17 (58.6%), previous hospitalization 11 (38%). Signs were: polyarthralgia (n = 28, 96.6%), fever (n = 24, 82.8%), asthenia (n = 18, 62%), migratory polyarthritis (n = 12, 41.4%). Organic heart murmur has been reported in 13 cases (44.8%), and heart failure in 7 cases. The anomalies of blood analysis were inflammatory syndrome (100%), elevation of streptococcal enzymes (n = 27, 93%), and anemia (n = 16, 55.2%). In cardiac ultrasound, anomalies were: thickened valve (n = 13, 44.8%), mitral regurgitation (n = 13, 44.8%), dilatation of left ventricle (n = 9, 31%), aortic regurgitation (n = 5, 17.2%). The nosology of pathology was acute RHD (n = 15, 51.7%), ARF only (n = 14, 48.3%). Associated factors of acute RHD were: female sex (OR 1.52, 95%CI 0.35 - 6.6), low-income (OR 1.33, 95%CI 0.24 - 7.4), previous hospitalization (OR 2.7, 95%CI 0.58 - 13) and migratory polyarthritis (OR 1.12, 95%CI 0.25 - 4.9). Conclusion: The ARF remains prevalent in our countries. Its complications lead to sequelae that are difficult to treat, because of the lack of cardiac surgery centers in many sub-Saharan African countries including Congo. Prevention and effective treatment of angina should be applied by practitioners.展开更多
Introduction: Acute rheumatic fever (ARF) and its complications including rheumatic heart disease (RHD) remain one of the leading causes of cardiovascular disease worldwide. In our setting with no cardiac surgery, dat...Introduction: Acute rheumatic fever (ARF) and its complications including rheumatic heart disease (RHD) remain one of the leading causes of cardiovascular disease worldwide. In our setting with no cardiac surgery, data on RHD are therefore important to point out the need for such structure. In this study, we therefore describe rheumatic disease in terms of prevalence, patients’ characteristics and management of patients. Methods: We performed a retrospective study from May to September 2012, involving children aged 3 to 15 years old and seen at the Mother and Child University Hospital Luxembourg (MC UHL). Included were all children diagnosed with RHD. The diagnosis of rheumatic fever (RF) was defined using the revised Jones criteria from 1992 and RHD defined according to the WHO/NIH joint criteria. Data of interview, clinical examination, complementary and those on evolution were recorded. Results: We found an hospital prevalence of 6.2%. Mean age was 15.33 years ± 6.005 (3 to 36), females representing 54.2% and students 70%. Mitral regurgitation (MR), Mitral Stenosis (MS) and concomitant MR + MS were most found RHD with resp. 43.3%, 15% and 13.3%. Complications occurred in 74.1% before surgery. An operative indication was set in 90% of all cases whereas only 36% underwent surgery. After surgery immediate complications were dominated by anemia (11.6%) and late ones by heart failure in 18.5% of cases. Conclusion: Despite advances in medical diagnostic approach and therapeutical progress which partly explained the relatively high prevalence, the evolution of rheumatic heart disease in our context is unfavorable due to the lack of a surgical management structure. While waiting for a cardiology institute, the focus should be on information and awareness in primary prevention.展开更多
Endocarditis is an inflammation of the endocardium and its structures (valves), most often of infectious origin, described by William Osler in 1885. In the 21st century, infective endocarditis remains a reality in our...Endocarditis is an inflammation of the endocardium and its structures (valves), most often of infectious origin, described by William Osler in 1885. In the 21st century, infective endocarditis remains a reality in our countries. We report a complicated case of infective endocarditis (IE). This is a 53-year-old woman, obese and passive smoker who died on the 5th day of her hospitalization following an infective endocarditis (IE) with bacterial strains resistant to the usual antibiotics: daughter of acute lithiasic cholecystitis, mother of major mitral valve perforation, brain abscess, ischemic stroke and atrial fibrillation. All were responsible for septic shock and fatal coma. Surgical management of the infective endocarditis in the first hours of her admission could have improved her prognosis. To conclude, in addition to its interests and its clinical particularities, our present observation has highlighted major public health problems specific to our sub-Saharan African countries, namely: The problem of the double health burden, the problem of delays in seeking care, the problem of resistance to antibiotics and the problem of the insufficiency of reference health technical platforms.展开更多
Background:The neuropsychiatric disorders due to post-streptococcal autoimmune complications such as Sydenham's chorea(SC)are associated with acute rheumatic fever and rheumatic heart disease(ARF/RHD).An animal mo...Background:The neuropsychiatric disorders due to post-streptococcal autoimmune complications such as Sydenham's chorea(SC)are associated with acute rheumatic fever and rheumatic heart disease(ARF/RHD).An animal model that exhibits char-acteristics of both cardiac and neurobehavioral defects in ARF/RHD would be an important adjunct for future studies.Since age,gender,strain differences,and geno-types impact on the development of autoimmunity,we investigated the behavior of male and female Wistar and Lewis rat strains in two age cohorts(6 weeks and 12 weeks)under normal husbandry conditions and following exposure to group A streptococcus(GAS).Methods:Standard behavioral assessments were performed to determine the impair-ments in fine motor control(food manipulation test),gait and balance(beam walk-ing test),and obsessive-compulsive behavior(grooming and marble burying tests).Furthermore,electrocardiography,histology,and behavioral assessments were per-formed on male and female Lewis rats injected with GAS antigens.Results:For control Lewis rats there were no significant age and gender dependent differences in marble burying,food manipulation,beam walking and grooming be-haviors.In contrast significant age-dependent differences were observed in Wistar rats in all the behavioral tests except for food manipulation.Therefore,Lewis rats were selected for further experiments to determine the effect of GAS.After ex-posure to GAS,Lewis rats demonstrated neurobehavioral abnormalities and cardiac pathology akin to SC and ARF/RHD,respectively.Conclusion:We have characterised a new model that provides longitudinal stability of age-dependent behavior,to simultaneously investigate both neurobehavioral and cardiac abnormalities associated with post-streptococcal complications.展开更多
文摘Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 to December 2016 (5 years) in the Department of Pediatrics. We had included patients aged from 5 to15 years old, admitted for ARF. Results: Twenty-nine black African children, 15 boys (51.7%) were included. The incidence was 5.8 cases/year. The mean age was 10.4 ± 2.7 years. The mean age of parents was 34.5 ± 6.9 years (range: 24-48) for mother and 41.2 ± 6.9 years (range: 28 - 56) for father. Parents were low-income 10 (34.5%), the delay of consultation was 17.7 ± 19.5 days. The medical history was: frequent pharyngitis 22 (76%), previous ARF 17 (58.6%), previous hospitalization 11 (38%). Signs were: polyarthralgia (n = 28, 96.6%), fever (n = 24, 82.8%), asthenia (n = 18, 62%), migratory polyarthritis (n = 12, 41.4%). Organic heart murmur has been reported in 13 cases (44.8%), and heart failure in 7 cases. The anomalies of blood analysis were inflammatory syndrome (100%), elevation of streptococcal enzymes (n = 27, 93%), and anemia (n = 16, 55.2%). In cardiac ultrasound, anomalies were: thickened valve (n = 13, 44.8%), mitral regurgitation (n = 13, 44.8%), dilatation of left ventricle (n = 9, 31%), aortic regurgitation (n = 5, 17.2%). The nosology of pathology was acute RHD (n = 15, 51.7%), ARF only (n = 14, 48.3%). Associated factors of acute RHD were: female sex (OR 1.52, 95%CI 0.35 - 6.6), low-income (OR 1.33, 95%CI 0.24 - 7.4), previous hospitalization (OR 2.7, 95%CI 0.58 - 13) and migratory polyarthritis (OR 1.12, 95%CI 0.25 - 4.9). Conclusion: The ARF remains prevalent in our countries. Its complications lead to sequelae that are difficult to treat, because of the lack of cardiac surgery centers in many sub-Saharan African countries including Congo. Prevention and effective treatment of angina should be applied by practitioners.
文摘Introduction: Acute rheumatic fever (ARF) and its complications including rheumatic heart disease (RHD) remain one of the leading causes of cardiovascular disease worldwide. In our setting with no cardiac surgery, data on RHD are therefore important to point out the need for such structure. In this study, we therefore describe rheumatic disease in terms of prevalence, patients’ characteristics and management of patients. Methods: We performed a retrospective study from May to September 2012, involving children aged 3 to 15 years old and seen at the Mother and Child University Hospital Luxembourg (MC UHL). Included were all children diagnosed with RHD. The diagnosis of rheumatic fever (RF) was defined using the revised Jones criteria from 1992 and RHD defined according to the WHO/NIH joint criteria. Data of interview, clinical examination, complementary and those on evolution were recorded. Results: We found an hospital prevalence of 6.2%. Mean age was 15.33 years ± 6.005 (3 to 36), females representing 54.2% and students 70%. Mitral regurgitation (MR), Mitral Stenosis (MS) and concomitant MR + MS were most found RHD with resp. 43.3%, 15% and 13.3%. Complications occurred in 74.1% before surgery. An operative indication was set in 90% of all cases whereas only 36% underwent surgery. After surgery immediate complications were dominated by anemia (11.6%) and late ones by heart failure in 18.5% of cases. Conclusion: Despite advances in medical diagnostic approach and therapeutical progress which partly explained the relatively high prevalence, the evolution of rheumatic heart disease in our context is unfavorable due to the lack of a surgical management structure. While waiting for a cardiology institute, the focus should be on information and awareness in primary prevention.
文摘Endocarditis is an inflammation of the endocardium and its structures (valves), most often of infectious origin, described by William Osler in 1885. In the 21st century, infective endocarditis remains a reality in our countries. We report a complicated case of infective endocarditis (IE). This is a 53-year-old woman, obese and passive smoker who died on the 5th day of her hospitalization following an infective endocarditis (IE) with bacterial strains resistant to the usual antibiotics: daughter of acute lithiasic cholecystitis, mother of major mitral valve perforation, brain abscess, ischemic stroke and atrial fibrillation. All were responsible for septic shock and fatal coma. Surgical management of the infective endocarditis in the first hours of her admission could have improved her prognosis. To conclude, in addition to its interests and its clinical particularities, our present observation has highlighted major public health problems specific to our sub-Saharan African countries, namely: The problem of the double health burden, the problem of delays in seeking care, the problem of resistance to antibiotics and the problem of the insufficiency of reference health technical platforms.
基金RAM Rafeek is recipient of International Postgraduate Research Award(IPRA)from University of New England.CM Lobbe and E.Wilkinson are recipients of student scholarship from the Royal College of Pathologists of Australasia(RCPA).
文摘Background:The neuropsychiatric disorders due to post-streptococcal autoimmune complications such as Sydenham's chorea(SC)are associated with acute rheumatic fever and rheumatic heart disease(ARF/RHD).An animal model that exhibits char-acteristics of both cardiac and neurobehavioral defects in ARF/RHD would be an important adjunct for future studies.Since age,gender,strain differences,and geno-types impact on the development of autoimmunity,we investigated the behavior of male and female Wistar and Lewis rat strains in two age cohorts(6 weeks and 12 weeks)under normal husbandry conditions and following exposure to group A streptococcus(GAS).Methods:Standard behavioral assessments were performed to determine the impair-ments in fine motor control(food manipulation test),gait and balance(beam walk-ing test),and obsessive-compulsive behavior(grooming and marble burying tests).Furthermore,electrocardiography,histology,and behavioral assessments were per-formed on male and female Lewis rats injected with GAS antigens.Results:For control Lewis rats there were no significant age and gender dependent differences in marble burying,food manipulation,beam walking and grooming be-haviors.In contrast significant age-dependent differences were observed in Wistar rats in all the behavioral tests except for food manipulation.Therefore,Lewis rats were selected for further experiments to determine the effect of GAS.After ex-posure to GAS,Lewis rats demonstrated neurobehavioral abnormalities and cardiac pathology akin to SC and ARF/RHD,respectively.Conclusion:We have characterised a new model that provides longitudinal stability of age-dependent behavior,to simultaneously investigate both neurobehavioral and cardiac abnormalities associated with post-streptococcal complications.
