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Coxsackie virus infections in rheumatic fever
S R Zaher1, A S Kassem, J J Hughes
1Department of Pediatrics, University of Alexandria, Egypt.
Insights
This study investigated coxsackievirus group B (CVB) infections in rheumatic fever patients. Results show a low-order association between CVB types B2 and B6 and rheumatic fever, suggesting a potential role for these viruses in rheumatic heart disease.
Area of Science:
- Cardiology
- Virology
- Rheumatology
Background:
- Rheumatic heart disease (RHD) is closely linked to Group A beta-hemolytic streptococci (GABS).
- The role of GABS as the sole cause of RHD has been questioned.
- Coxsackievirus group B (CVB) has been implicated in acquired valvular disease mimicking rheumatic fever.
Purpose of the Study:
- To investigate the presence of CVB infections in patients with rheumatic fever.
- To determine if specific CVB serotypes are associated with rheumatic fever or rheumatic heart disease.
Main Methods:
- Blood samples were collected from 106 patients with quiescent rheumatic fever/RHD, 94 with acute rheumatic fever (ARF), and 74 healthy controls.
- Micro-neutralization tests were used to detect neutralizing antibodies against 6 CVB serotypes.
- Infections were analyzed in relation to disease status and clinical course.
Main Results:
- CVB infections, particularly types B2 and B4, were common in the study population (42% of controls).
- Patients with quiescent RHD showed significantly more frequent CVB 2 infections.
- Patients with ARF had significantly more frequent infections with CVB 2 and CVB 6.
- No clear correlation was found between CVB infections and the clinical course of rheumatic fever or ARF severity.
Conclusions:
- A low-order association exists between rheumatic fever and CVB types B2 and B6.
- Further research is warranted to explore the role of CVB in the pathogenesis of rheumatic heart disease.
Abstract:
The close relationship between Group A beta Hemolytic Streptococci (GABS) and rheumatic fever is a well established one. However, the concept of the streptococcus as the sole etiologic agent of the rheumatic heart disease (RHD) has been challenged over the past years. Since coxsackievirus group B (CVB) has long been proposed as a cause of acquired valvular disease simulating rheumatic fever, we attempted in this study to document infections with this group of viruses in patients with rheumatic fever. We obtained blood samples from 106 patients with old (quiescent) rheumatic fever/rheumatic heart disease [group I], 94 patients with acute rheumatic fever (ARF) [group II], and 74 normal matched controls. We tested for the presence of neutralizing antibodies to the 6 serotypes of CVB by a micro neutralization test. We have found that infection with CVB, especially types B2 and B4, was common in the studied population. Forty-two percent of normal individuals had evidence of infection with any of the 6 serotypes of CVB. Patients of group I had significantly more frequent infections with CVB 2. Patients in group II had significantly more frequent infections with CVB 2 and CVB 6. There was no clear correlation between such infections and the clinical course of rheumatic fever. There was no difference in the incidence of CVB infections between patients with definite ARF, and patients with suspected ARF. We set a low order association between rheumatic fever and infection with CVB types B2 and B6. We emphasize the importance of pursuing the investigation of the role of CVB in relation to RHD.