We describe an outbreak of acute rheumatic fever that occurred in the intermountain area centered in Salt Lake City, Utah. Seventy-four children meeting the modified Jones criteria for the diagnosis of acute rheumatic fever were evaluated by the staff at Primary Children's Medical Center, Salt Lake City, from January 1985 through June 1986. This represents an eightfold increase over the average annual incidence at this hospital during the past decade. Carditis, a dominant feature of the outbreak, was confirmed by auscultation in 53 of the patients (72 percent). An additional 14 patients were found to have mitral regurgitation by Doppler ultrasound examination, raising the total incidence of carditis to 91 percent. The children were predominantly from white (96 percent) middle-class families with above-average incomes and with ready access to medical care. There was no apparent increase in the incidence of streptococcal disease or other explanation for the marked increase in acute rheumatic fever. However, mucoid M type 18 and M type 3 group A streptococcal strains were isolated from several siblings of the patients and from schoolchildren (chosen at random) in the area. We conclude that acute rheumatic fever remains an important health problem in the United States.
This article has been cited by other articles:
Martins, T. B., Hoffman, J. L., Augustine, N. H., Phansalkar, A. R., Fischetti, V. A., Zabriskie, J. B., Cleary, P. P., Musser, J. M., Veasy, L. G., Hill, H. R.
(2008). Comprehensive analysis of antibody responses to streptococcal and tissue antigens in patients with acute rheumatic fever. Int Immunol
20: 445-452
[Abstract][Full Text]
Miyake, C. Y., Gauvreau, K., Tani, L. Y., Sundel, R. P., Newburger, J. W.
(2007). Characteristics of Children Discharged From Hospitals in the United States in 2000 With the Diagnosis of Acute Rheumatic Fever. Pediatrics
120: 503-508
[Abstract][Full Text]
Essop, M. R., Nkomo, V. T.
(2005). Rheumatic and Nonrheumatic Valvular Heart Disease: Epidemiology, Management, and Prevention in Africa. Circulation
112: 3584-3591
[Abstract][Full Text]
Musser, J. M., DeLeo, F. R.
(2005). Toward a Genome-Wide Systems Biology Analysis of Host-Pathogen Interactions in Group A Streptococcus. Am. J. Pathol.
167: 1461-1472
[Abstract][Full Text]
Mayon-White, R.
(2005). Re-emerging infections: Part 4: Respiratory infections. British Journal of Infection Control
6: 13-15
[Abstract]
Edmonson, M. B., Farwell, K. R.
(2005). Relationship Between the Clinical Likelihood of Group A Streptococcal Pharyngitis and the Sensitivity of a Rapid Antigen-Detection Test in a Pediatric Practice. Pediatrics
115: 280-285
[Abstract][Full Text]
Hillman, N. D., Tani, L. Y., Veasy, L. G., Lambert, L. L., Di Russo, G. B., Doty, D. B., McGough, E. C., Hawkins, J. A.
(2004). Current Status of Surgery for Rheumatic Carditis in Children. Ann. Thorac. Surg.
78: 1403-1408
[Abstract][Full Text]
Kaplan, E L
(2004). Rheumatic heart disease in rural Pakistan. Heart
90: 361-362
[Abstract][Full Text]
Yacoub, M. H., Cohn, L. H.
(2004). Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part I. Circulation
109: 942-950
[Full Text]
Veasy, L. G., Tani, L. Y., Daly, J. A., Korgenski, K., Miner, L., Bale, J., Kaplan, E. L., Musser, J. M., Hill, H. R.
(2004). Temporal Association of the Appearance of Mucoid Strains of Streptococcus Pyogenes With a Continuing High Incidence of Rheumatic Fever in Utah. Pediatrics
113: e168-172
[Abstract][Full Text]
Shaw, T R D, Sutaria, N, Prendergast, B
(2003). Clinical and haemodynamic profiles of young, middle aged, and elderly patients with mitral stenosis undergoing mitral balloon valvotomy. Heart
89: 1430-1436
[Abstract][Full Text]
Honig, P. J., Frieden, I. J., Kim, H. J., Yan, A. C.
(2003). Streptococcal Intertrigo: An Underrecognized Condition in Children. Pediatrics
112: 1427-1429
[Abstract][Full Text]
Tani, L. Y., Veasy, L. G., Minich, L. L., Shaddy, R. E.
(2003). Rheumatic Fever in Children Younger Than 5 Years: Is the Presentation Different?. Pediatrics
112: 1065-1068
[Abstract][Full Text]
Barrozo, C. P., Russell, K. L., Smith, T. C., Hawksworth, A. W., Ryan, M. A. K., Gray, G. C.
(2003). National Department of Defense Surveillance Data for Antibiotic Resistance and emm Gene Types of Clinical Group A Streptococcal Isolates from Eight Basic Training Military Sites. J. Clin. Microbiol.
41: 4808-4811
[Abstract][Full Text]
Smoot, L. M., McCormick, J. K., Smoot, J. C., Hoe, N. P., Strickland, I., Cole, R. L., Barbian, K. D., Earhart, C. A., Ohlendorf, D. H., Veasy, L. G., Hill, H. R., Leung, D. Y. M., Schlievert, P. M., Musser, J. M.
(2002). Characterization of Two Novel Pyrogenic Toxin Superantigens Made by an Acute Rheumatic Fever Clone of Streptococcus pyogenes Associated with Multiple Disease Outbreaks. Infect. Immun.
70: 7095-7104
[Abstract][Full Text]
Smoot, J. C., Korgenski, E. K., Daly, J. A., Veasy, L. G., Musser, J. M.
(2002). Molecular Analysis of Group A Streptococcus Type emm18 Isolates Temporally Associated with Acute Rheumatic Fever Outbreaks in Salt Lake City, Utah. J. Clin. Microbiol.
40: 1805-1810
[Abstract][Full Text]
Li, Y, Pan, Z, Ji, Y, Peng, T, Archard, L.C, Zhang, H
(2002). Enterovirus replication in valvular tissue from patients with chronic rheumatic heart disease. Eur Heart J
23: 567-573
[Abstract][Full Text]
Quinn, A., Kosanke, S., Fischetti, V. A., Factor, S. M., Cunningham, M. W.
(2001). Induction of Autoimmune Valvular Heart Disease by Recombinant Streptococcal M Protein. Infect. Immun.
69: 4072-4078
[Abstract][Full Text]
Ferretti, J. J., McShan, W. M., Ajdic, D., Savic, D. J., Savic, G., Lyon, K., Primeaux, C., Sezate, S., Suvorov, A. N., Kenton, S., Lai, H. S., Lin, S. P., Qian, Y., Jia, H. G., Najar, F. Z., Ren, Q., Zhu, H., Song, L., White, J., Yuan, X., Clifton, S. W., Roe, B. A., McLaughlin, R.
(2001). Complete genome sequence of an M1 strain of Streptococcus pyogenes. Proc. Natl. Acad. Sci. USA
98: 4658-4663
[Abstract][Full Text]
Figueroa, F E, Fernández, M S., Valdés, P, Wilson, C, Lanas, F, Carrión, F, Berríos, X, Valdés, F
(2001). Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease. Heart
85: 407-410
[Abstract][Full Text]
Voss, L. M., Wilson, N. J., Neutze, J. M., Whitlock, R. M. L., Ameratunga, R. V., Cairns, L. M., Lennon, D. R.
(2001). Intravenous Immunoglobulin in Acute Rheumatic Fever : A Randomized Controlled Trial. Circulation
103: 401-406
[Abstract][Full Text]
Lee, L. H., Ayoub, E., Pichichero, M. E.
(2000). Fewer Symptoms Occur in Same-Serotype Recurrent Streptococcal Tonsillopharyngitis. Arch Otolaryngol Head Neck Surg
126: 1359-1362
[Abstract][Full Text]
Cunningham, M. W.
(2000). Pathogenesis of Group A Streptococcal Infections. Clin. Microbiol. Rev.
13: 470-511
[Abstract][Full Text]
Soler-Soler, J., Galve, E.
(2000). VALVE DISEASE: Worldwide perspective of valve disease. Heart
83: 721-725
[Full Text]
Narula, J., Chandrasekhar, Y., Rahimtoola, S.
(1999). Diagnosis of Active Rheumatic Carditis : The Echoes of Change. Circulation
100: 1576-1581
[Full Text]
Carsenti-Etesse, H., Roger, P.-M., Dunais, B., Durgeat, S., Mancini, G., Bensoussan, M., Dellamonica, P.
(1999). Gradient plate method to induce Streptococcus pyogenes resistance. J Antimicrob Chemother
44: 439-443
[Abstract][Full Text]
Garvey, M. A., Giedd, J., Swedo, S. E.
(1998). Topical Review: PANDAS: The Search for Environmental Triggers of Pediatric Neuropsychiatric Disorders. Lessons from Rheumatic Fever. J Child Neurol
13: 413-423
[Abstract]
Marzullo, M. J., Shetty, A. K.
(1998). A 14-Year-Old Boy with Back Pain. CLIN PEDIATR
37: 437-439
Webb, K. H.
(1998). Does Culture Confirmation of High-sensitivity Rapid Streptococcal Tests Make Sense? A Medical Decision Analysis. Pediatrics
101
: e2-e2
[Abstract][Full Text]
Eltohami, E. A., Hajar, H. A., Folger, G. M., Eltohami, E. A.
(1997). Acute Rheumatic Fever in an Arabian Gulf Country Effect of Climate, Advantageous Socioeconomic Conditions, and Access to Medical Care. ANGIOLOGY
48: 481-489
[Abstract]
Vasan, R. S., Shrivastava, S., Vijayakumar, M., Narang, R., Lister, B. C., Narula, J.
(1996). Echocardiographic Evaluation of Patients With Acute Rheumatic Fever and Rheumatic Carditis. Circulation
94: 73-82
[Abstract][Full Text]
Crater, D. L., Dougherty, B. A., van de Rijn, I.
(1995). Molecular Characterization of hasC from an Operon Required for Hyaluronic Acid Synthesis in Group A Streptococci. J. Biol. Chem.
270: 28676-28680
[Abstract][Full Text]
Havranek, E. P., Dwinnell, B., Smith, K. S.
(1995). Multiorgan Failure After Cardiac Arrest in a 20-Year-Old Man. Circulation
92: 3139-3143
[Full Text]
Shvartzman, P.
(1994). Careful prescribing is beneficial. BMJ
309: 1011-1012
[Full Text]
Christie, C., Marx, M. L., Marchant, C. D., Reising, S. F.
(1994). The 1993 Epidemic of Pertussis in Cincinnati -- Resurgence of Disease in a Highly Immunized Population of Children. NEJM
331: 16-21
[Abstract][Full Text]
Wenger, N. K., Speroff, L., Packard, B.
(1993). Cardiovascular Health and Disease in Women. NEJM
329: 247-256
[Full Text]
Fischetti, V., Hodges, W., Hruby, D.
(1989). Protection against streptococcal pharyngeal colonization with a vaccinia: M protein recombinant. Science
244: 1487-1490
[Abstract]
Beach, P. S., Balfour, L. C., Lucia, H. L.
(1989). Group A Streptococcal Rapid Test: Antigen Detection After 18-24 Hours of Penicillin Therapy. CLIN PEDIATR
28: 6-10
[Abstract]
