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ARTICLE |

Immunologic Aspects of Cardiovascular Disease FREE

Jordan N. Fink, MD; Anthony Fauci, MD
JAMA. 1982;248(20):2716-2721. doi:10.1001/jama.1982.03330200140026
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ACUTE RHEUMATIC FEVER 

Clinical Findings  RHEUMATIC fever is an acute febrile illness characterized by inflammation of the heart, joints, and subcutaneous tissues. Characteristic diagnostic features have been grouped into so-called major and minor criteria. Among the major clinical manifestations of the disease are polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and chorea. Minor manifestations include fever, arthralgia, a history of previous rheumatic fever or rheumatic heart disease and the presence of certain laboratory findings. Among these laboratory findings are an elevated erythrocyte sedimentation rate, prolongation of the PR interval on the ECG, leukocytosis, and the presence of acute phase reactants in the blood (such as C reactive protein). The criteria require, in addition, evidence of a preceding streptococcal infection detected by antibody studies, results of throat culture, or history of scarlet fever.Features of cardiac involvement consist of heart murmurs, cardiomegaly, congestive heart failure, pericardial friction rubs, or signs of effusion.

REFERENCES

Bauer H, Walters TJ, Talano JV:  Antimyocardial antibodies in patients with coronary heart disease . Am Heart J 1972;;83:612-619.
Beachey EH, Stollerman GH:  Mediation of cytotoxic effects of streptococcal M Protein by non-type specific antibody in normal human sera . J Clin Invest 1973;;52:2563-2570.
Bisno AL, Ofek I:  Serologic diagnosis of streptococcal infection: Comparison of a rapid hemagglutination technique with conventional antibody test . Am J Dis Child 1974;;127:676-681.
Dressler W:  The post-myocardial infarction syndrome: A report of forty-four cases . Arch Intern Med 1959;;103:28-42.
Engle MA, McCabe JC, Ebert PA, et al:  The post-pericardiotomy syndrome and antiheart antibodies . Circulation 1974;;49:401-406.
Goldstein I, Halpern B, Robert L:  Immunological relationship between streptococcus A polysaccharide and structural glycoproteins of heart valve . Nature 1967;;213:44-47.
Kaplan MH, Meyerserian M:  An immunological cross-reaction between group A streptococcal cells and human heart tissue . Lancet 1962;; 1:706-710.
Kaplan MH, Svec KH:  Immunologic relation of streptococcal and tissue antigens: III. Presence in human sera of streptococcal antibody cross-reactive with heart tissue—association with streptococcal infection, rheumatic fever, and glomerulonephritis . J Exp Med 1964;;119:651-665.
Livelli FD, Johnson RA, McEnany MT, et al:  Unexplained in-hospital fever following cardiac surgery: Natural history, relationship to postpericardiotomy syndrome, and a prospective study of therapy with indomethacin versus placebo . Circulation 1978;;57:968-975.
Stollerman GH:  Global changes in group A streptococcal diseases and strategies for their prevention , in Stollerman GH (ed): Advances in Internal Medicine . Chicago, Yearbook Medical Publishers Inc, 1982;, pp 373-405.
Stollerman GH: Rheumatic Fever and Streptococcal Infection . New York, Grune & Stratton Inc, 1975;.
Stollerman GH:  Streptococcal immunology: Protection vs. injury . Ann Intern Med 1978;; 88:422-423.
Stollerman GH, Lewis AJ, Schultz I, et al:  Relationship of immune response to group A streptococci to the cause of acute, chronic and recurrent rheumatic fever . Am J Med 1956;; 20:163-169.
Stollerman GH, Moskowitz M, Taranta A, et al: Jones criteria (revised) for guidance in the diagnosis of rheumatic fever . Dallas, American Heart Association, 1967;.
Van de Rijn I, Zabriski J, McCarty M:  Group A streptococcal antigens cross-reactive with myocardium: Purification of heart-reactive antibody and isolation and characterization of the streptococcal antigen . J Exp Med 1977;;146:579-599.
Fauci AS, Haynes BF, Katz P:  The spectrum of vasculitis: Clinical, pathologic, immunologic and therapeutic considerations . Ann Intern Med 1978;;89:660-676.
Fauci AS, Katz P, Haynes BF, et al:  Cyclophosphamide therapy of severe systemic necrotizing vasculitis . N Engl J Med 1979;;301:235-238.
Fauci AS, Wolff SM:  Wegener's granulomatosis: Studies in eighteen patients and a review of the literature . Medicine 1973;;52:535-561.
Levo Y, Gorevic PD, Kassab HH, et al:  Association between hepatitis B virus and essential mixed cryoglobulinemia . N Engl J Med 1977;; 296:1501-1504.
Zeek PM:  Periarteritis nodosa and other forms of necrotizing angiitis . N Engl J Med 1953;; 18:764-772.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Bauer H, Walters TJ, Talano JV:  Antimyocardial antibodies in patients with coronary heart disease . Am Heart J 1972;;83:612-619.
Beachey EH, Stollerman GH:  Mediation of cytotoxic effects of streptococcal M Protein by non-type specific antibody in normal human sera . J Clin Invest 1973;;52:2563-2570.
Bisno AL, Ofek I:  Serologic diagnosis of streptococcal infection: Comparison of a rapid hemagglutination technique with conventional antibody test . Am J Dis Child 1974;;127:676-681.
Dressler W:  The post-myocardial infarction syndrome: A report of forty-four cases . Arch Intern Med 1959;;103:28-42.
Engle MA, McCabe JC, Ebert PA, et al:  The post-pericardiotomy syndrome and antiheart antibodies . Circulation 1974;;49:401-406.
Goldstein I, Halpern B, Robert L:  Immunological relationship between streptococcus A polysaccharide and structural glycoproteins of heart valve . Nature 1967;;213:44-47.
Kaplan MH, Meyerserian M:  An immunological cross-reaction between group A streptococcal cells and human heart tissue . Lancet 1962;; 1:706-710.
Kaplan MH, Svec KH:  Immunologic relation of streptococcal and tissue antigens: III. Presence in human sera of streptococcal antibody cross-reactive with heart tissue—association with streptococcal infection, rheumatic fever, and glomerulonephritis . J Exp Med 1964;;119:651-665.
Livelli FD, Johnson RA, McEnany MT, et al:  Unexplained in-hospital fever following cardiac surgery: Natural history, relationship to postpericardiotomy syndrome, and a prospective study of therapy with indomethacin versus placebo . Circulation 1978;;57:968-975.
Stollerman GH:  Global changes in group A streptococcal diseases and strategies for their prevention , in Stollerman GH (ed): Advances in Internal Medicine . Chicago, Yearbook Medical Publishers Inc, 1982;, pp 373-405.
Stollerman GH: Rheumatic Fever and Streptococcal Infection . New York, Grune & Stratton Inc, 1975;.
Stollerman GH:  Streptococcal immunology: Protection vs. injury . Ann Intern Med 1978;; 88:422-423.
Stollerman GH, Lewis AJ, Schultz I, et al:  Relationship of immune response to group A streptococci to the cause of acute, chronic and recurrent rheumatic fever . Am J Med 1956;; 20:163-169.
Stollerman GH, Moskowitz M, Taranta A, et al: Jones criteria (revised) for guidance in the diagnosis of rheumatic fever . Dallas, American Heart Association, 1967;.
Van de Rijn I, Zabriski J, McCarty M:  Group A streptococcal antigens cross-reactive with myocardium: Purification of heart-reactive antibody and isolation and characterization of the streptococcal antigen . J Exp Med 1977;;146:579-599.
Fauci AS, Haynes BF, Katz P:  The spectrum of vasculitis: Clinical, pathologic, immunologic and therapeutic considerations . Ann Intern Med 1978;;89:660-676.
Fauci AS, Katz P, Haynes BF, et al:  Cyclophosphamide therapy of severe systemic necrotizing vasculitis . N Engl J Med 1979;;301:235-238.
Fauci AS, Wolff SM:  Wegener's granulomatosis: Studies in eighteen patients and a review of the literature . Medicine 1973;;52:535-561.
Levo Y, Gorevic PD, Kassab HH, et al:  Association between hepatitis B virus and essential mixed cryoglobulinemia . N Engl J Med 1977;; 296:1501-1504.
Zeek PM:  Periarteritis nodosa and other forms of necrotizing angiitis . N Engl J Med 1953;; 18:764-772.
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