Saturday, August 6, 2011

Rheumatic fever and Streptoccus pyogenes

 Infection with Streptococcus pyogenes can cause a wide variety of clinical complications and diseases including tonsillitis, scarlet fever, sepsis and toxic shock syndrome as well as the post-streptococcal autoimmune diseases, like rheumatic fever and rheumatic heart disease

 These sequels are common in overcrowded poor communities.

 Today, the mean annual incidence of rheumatic fever in affluent communities is less than 5 per 100 000 schoolchildren and it is still falling

 According to statistical analysis the incidence in Egypt is 10/100000 cases per year compared to 0.23-1.88/100000 in USA and in England

 Development of rheumatic fever depends upon several genetic and microbial factors.

 Among theories explaining rheumatic fever pathogenesis is the molecular mimicry between streptococcal and human proteins that is considered as the triggering factor leading to autoimmunity in rheumatic fever (RF) and rheumatic heart disease (RHD).

 Cross-reactive B-cell and T-cell epitopes have been located within the C-repeat region in M protein of Streptococcus pyogenes.

 Research has focused on the identification of conserved epitopes of the M protein that evoke protective mucosal immune responses and are not host tissue cross-reactive.

 Several human leucocytes antigens (HLA) for class I and II alleles are According to WHO for control program to be established in country the following steps should be taken

 Education of professional personnel, health agenesis and the public

 Registration of new cases of rheumatic fever, prophylaxis with antibiotics from the recurrence of the attack up to age of 18 years

 Proper isolation for GAS from suspected patients and its identification with proper treatment for the patients to prevent the RF attacks.

 Efforts should focus on collaboration with physicians working in liable population such as school children.

 associated with the disease.

 Application of mass screening methods to discover the established RHD such as phonocardiogram pattern.

 Surgical interventions are applied for patients with valvular rheumatic heart diseases

 Facilities must be given for those with heart lesions such as rehabilitation, vocational guidance and job placement after cardiac surgery.

 Research about individual genetic susceptibility among population

 Development of effective immunotherapy as vaccination

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