Abstract
The reason why abnormal immune response exists in acute rheumatic fever is not exactly explained. The influence of co-pathogens like certain viruses were mentioned regarding the initiation of the immunological reaction in acute rheumatic fever patients by several authors since 1970. This study was designed to find the role or effect of some viral infections in the development of rheumatic fever. In this study, 47 cases with acute rheumatic fever (acute rheumatic arthritis, acute rheumatic carditis, and chorea), 20 cases with chronic rheumatic fever, 20 cases with streptococcal pharyngitis, and 20 healthy age- and gender-matched control cases were involved. Serological and molecular tests were made including hepatitis B virus, hepatitis C virus, rubella virus, herpes simplex virus (HSV group 1), and Epstein-Barr virus (EBV). HBsAg, rubella IgM and EBV IgM positivity were not seen in any of patients with rheumatic fever. Although antiHBs seropositivity was higher in the control group, it was not statistically significant (p > 0.05). There was no difference in rubella IgG, HSV IgM seropositivity, either (p > 0.05). EBV DNA was searched by the polymerase chain reaction technique; due to the latent nature of the virus, no significant difference was found between the control group and the other groups (p > 0.05). In this study, no positive correlation could be found to support the synergism theories regarding the streptoccocus infection and viral infections in the development of acute rheumatic fever. Only EBV DNA positivity was found in all acute rheumatic fever cases but not in the control group may lead to further studies with larger series of patients.
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References
Olgunturk R, Aydin GB, Tunaoglu FS, Akalin N (1999) Rheumatic heart disease prevelance among school children in Ankara, Turkey. Turk J Pediatr 41:201–206
Boonpucknavig S, Udomsangpetch R, Pongpanich B (1984) Immunological studies on acute rheumatic fever and rheumatic heart disease. J Clin Lab Immunol 13(3):133–136
Gibofsky A, Kerwar S (1998) Rheumatic Fever. The relationships between host, microbe and genetics. Rheum Dis Clin North Am 24(2):237–259
Khosrashahi HE, Kahramanyol O, Dogancı L (1992) HLA and rheumatic fever in Turkish children. Pediatr Cardiol 13(4):204–207
Olgunturk R, Aykol N, Laleli Y, Ayberk U (1988) Plasma lipid and lipoprotein levels in rheumatic fever. Turk J Pediatr 30(1):1–8
Ozkan M, Carin M, Sonmez G, Senocak M, Ozdemir M, Yakut C (1993) HLA antigen in Turkish race with rheumatic heart diseases. Circulation 87(6):1974–1978
Burch GE, Giles TD, Colcolough HL (1970) Pathogenesis of “rheumatic” heart disease: critique and theory. Am Heart J 80(4):556–561
Burch GE, Giles TD (1972) The role of viruses in the production of heart disease. Am J Cardiol 29(2):231–240
Pongpanich B, Boonpucknavig S, Wasi C, Tanphaichitr P, Boonpucknavig V (1983) Immunopathology of acute rheumatic fever and rheumatic heart disease. The demonstration of Coxackie group B viral antigen in the myocardium. Clin Rheumatol 2(3):217–222
Zaher SR, Kassem AS, Hughes JJ (1993) Coxsackie virus infections in rheumatic fever. Indian J Pediatr 60:289–298
Li Y, Pan Z, Ji Y, Zhang H, Archard LC (2005) Herpes simplex virus type 1 infection in rheumatic valvar disease. Heart 91:87–88
Ertugrul M, Berksoy E, Saraclar M (1973) Rheumatic fever and Australia antigen. Lancet 2:507
Rowe PC (1985) Possible association of measles virus infection with rheumatic fever. N Engl J Med 313(9):580–581
Wedum BG (1985) Possible association between rubella vaccination and the decline in rheumatic fever. N Engl J Med 312(15):991–992
Brengel-Pesce K, Morand M, Schmuck A et al (2002) Routine use of real-time quantitative PCR for laboratory diagnosis of Epstein-Barr virus infections. J Med Virol 66(3):360–369
Jakop GJ (1982) Viral bacterial interactions in pulmonary infection. Adv Vet Sci Comp Med 26:155
Mills EL (1984) Viral infections predisposing to bacterial infections. Annu Rev Med 35:469
Fainstein V, Musher DM, Cate TR (1980) Bacterial adherence to pharyngeal cells during viral infection. J Infect Dis 141:172
Abuhammour W, Hasan RA, Unuvar E (2004) Group A beta-hemolytic streptococcal bacteremia. Indian J Pediatr Oct 71(10):915–919
Suresh L, Chandrasaker S, Rao RS, Ravi V, Badrincath S (1989) Coxsakie virus and rheumatic fever. A correlative study. J Assoc Phys India 37(9):582–585
Mims CA (1985) Viral aetiology of diseases of obscure origin. Br Med Bull 41:63–69
Gutirrez KM (2003) Infectious and inflamatorry artritis. In: Long SS (ed) Principles and practice of pediatric ınfectious diseases, 2nd edn. Churchill Livingstone, Philadelphia, pp 475–481
Rose CD, Eppes SC (1997) Infection-related arthritis. Rheum Dis Clin North Am 23(3):677–690
el-Kholy M, Helmy M, Shaker M, Lotfi H, Gadalla M, Darwish M, Khattab AK (1990) Rheumatic fever and rubella immunity. J Egypt Public Health Assoc 65(5-6):609–616
el-Nanawy AA, el-Azzouni OF, Soliman AT, Amer AE, Demian RS, el-Sayed HM (1995) Prevalence of hepatitis-C antibody seropositivity in healthy Egyptian children and four high risk groups. J Trop Pediatr 41(6):341–343
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Olgunturk, R., Okur, I., Cirak, M.Y. et al. The role of viral agents in aetiopathogenesis of acute rheumatic fever. Clin Rheumatol 30, 15–20 (2011). https://doi.org/10.1007/s10067-010-1447-x
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DOI: https://doi.org/10.1007/s10067-010-1447-x