A total of 39 titles related to rheumatic fever or rheumatic heart disease in Malaysia were found with online literature search dating back to their inceptions and through 2014. Additional publications from conference journals were included. Nine papers were selected based on clinical relevance and future research implications. There were no population-based studies on the incidence or prevalence of ARF or RHD. In the 1980s, the incidence of admission due to ARF ranged from 2 to 21.1 per 100 000 paediatric admission per year. The burden of disease was significant in the adult population; 74.5% of patients with RHD were female, of which 77.1% were in the reproductive age group of 15-45 years old. Rheumatic mitral valve disease constituted almost half (46.7%) of all mitral valve repairs, ranging from 44.8 – 55.8 patients per year from 1997 – 2003. From 2010-2012, mitral valve interventions increased to 184 per year, of which 85.7% were mitral valve repair. In children with ARF, 25.4% - 41.7% had past history of rheumatic fever or RHD. In patients with rheumatic mitral valve disease undergoing surgical or medical interventions, only 6% reported history of ARF, none had history of GABHS pharyngitis or antibiotic prophylaxis. Only 44.7% of patients with RHD on follow-up were on intramuscular benzathine penicillin prophylaxis. Overall, there is scarcity of publications on ARF and RHD in Malaysia. Priority areas for research include determination of the incidence and prevalence of ARF and RHD, identification of high-risk populations, evaluation on the implementation and adherence of secondary preventive measures, identification of subclinical RHD especially amongst the high-risk population, and a surveillance system to monitor and evaluate preventive measures, disease progression and outcomes.
Rheumatic Fever ; Rheumatic Heart Disease

No abstract available.
Child* ; Humans ; Rheumatic Fever* ; Rheumatic Heart Disease*

No abstract available.
Rheumatic Fever*

BACKGROUND: Rheumatic fever (RF) and Rheumatic heart disease (RHD) patients Rheumatic Heart Disease (RHD) patients necessitate secondary prophylaxis with benzathine penicillin G (BPG) injection every 3 weeks to prevent recurrences and complications. Patients with rheumatic fever on regular benzathine penicillin G injection usually experience moderate to severe pain resulting to poor compliance to treatment. 

OBJECTIVES: This study aims to compare the effect of BPG diluted in lidocaine hydrochloride 1%  versus diluted water in reducing injection pain in patients with RF and RHD.

METHODS: This is a randomized double-blind crossover study conducted at the PCMC OPD. Thirty-three patients diagnosed with RF and RHD were divided into 2 groups; the first group received BPG diluted in sterile water followed by BPG diluted in lidocaine hydrochloride  1% after 21 days, the second group received the same medication in reverse order. Pain scale was measured using Universal pain assessment tool immediately after injection. Paired T test was used to compare the pain score results of the two groups.

RESULTS: Pain score was significantly less in patients who received BPG diluted in lidocaine hydrochloride 1%; from an average pain score of 4.88 to 0.63 (p<0.0001), among those who received BPG diluted in sterile water. No adverse effects were seen in all patients.

CONCLUSION: This study concluded that BPG diluted in lidocaine hydrochloride 1% significantly and safely reduced post-injection pain. In all patients diagnosed with RF and RHD, BPG injection should be diluted in lidocaine hydrochloride 1% to decrease injection pain and improve patient's compliance.

No abstract available.
Child* ; Humans ; Rheumatic Fever*

Acute rheumatic fever (ARF) is associated with systemic inflammation and arterial stiffness during the acute stage. It has not been reported if arterial stiffness remains after recovery. The aim of this study was to determine the arterial stiffness during acute stage and 6 months after recovery from ARF. Arterial stiffness was assessed by carotid femoral pulse wave velocity (PWV) in 23 ARF patients during the acute stage of ARF and 6 months later. Simultaneously, erythrocyte sedimentation rate (ESR) and other anthropometric measurements were taken during both stages. There was a significant reduction in PWV; 6.5 (6.0, 7.45) m/s to 5.9 (5.38, 6.48) m/s, p=0.003 6 months after the acute stage of ARF. Similarly, ESR was also significantly reduced from 92.0 (37.5, 110.50) mm/hr to 7.0 (5.0, 16.0) mm/hr, p=0.001. In conclusion, arterial stiffness improved 6 months after the acute stage with routine aspirin treatment; this correlates well with the reduction in systemic inflammation.
Rheumatic Fever ; Vascular Stiffness

Thirty-five year-old Amadeus Mozart died in Vienna after an acute illness that lasted only 15 days but no consensus has been reached on the cause of his death. From many letters written by his farther it is almost certain that he experienced at least three episodes of acute rheumatic fever attack in his childhood, and a relapse of rheumatic fever was suggested to have killed Mozart, although death from acute rheumatic fever is very rare in adults. His last illness was characterized by high fever, massive edema, vomiting and skin rash. His last illness can be explained by infectious endocarditis and heart failure. During his last hours, he was given phlebotomy, possibly for the third time in two weeks, and soon after he became unconscious and died. As such, phlebotomy performed on a man dehydrated by high fever and vomiting may have caused systemic shock. In summary, Mozart probably died from chronic rheumatic heart disease complicated by infective endocarditis and heart failure, and repeated phlebotomy-induced hypovolemic shock.
Adult ; Bloodletting ; Consensus ; Edema ; Endocarditis ; Exanthema ; Fever ; Heart Failure ; Humans ; Phlebotomy ; Recurrence ; Rheumatic Fever ; Rheumatic Heart Disease ; Shock ; Unconscious (Psychology) ; Vomiting

No abstract available.
Humans ; Pericardial Effusion* ; Rheumatic Fever*

Studying on 93 children from 6 to 15 years old who had Rheumatic fever, were injected to prevent rheumatic fever at 2nd level in Thanh Nhan Hospital from 1999 to 2003. The result showed that: in polyarthritic and chorea type, symptoms gradually decreased and disappeared, but common valvular lesions of severe carditis almost still existed. The recurrent rate was very low. The complications of disease were few and might, include: pain and hardening at injected site accounted for 12.9% of total patients and 2.56% of the times of injection. There were 5.38% of patients with mild allergy, accounted for 0.27% of the injection times. It must be on the alert against some dangerous complications as: embolism, anaphylactic shock, mortality… after injection benzathin penicillin
Rheumatic Fever ; Preventive Medicine ; Child

Chronic rheumatic heart disease is the most important consequence of rheumatic fever and characterized principally by deforming fibrotic valvular disease(particularly mitral stenosis), which can produce permanent dysfunction and severe, sometimes fatal, cardiac dysfunction decades later. So the operation should be carried out in symptomatic patients with moderate to severe mitral or aortic stenosis or regurgitation. Postoperative mortality rate is low. But some postoperative complications including thromboembolism and prosthetic valve endocarditis are associated with high mortality. We report a autopsy case diagnosed as cerebral infarction due to thromboembolic complication of rheumatic heart disease patient with mechanical mitral and aortic prostheses. To our knowledge, this is the initial autopsy presentation of cerebral infarction due to thromboembolic complication of mechanical prosthetic valve in the patient with rheumatic heart disease in Korea.
Aortic Valve Stenosis ; Autopsy ; Cerebral Infarction* ; Endocarditis ; Heart Valve Prosthesis ; Humans ; Korea ; Mortality ; Postoperative Complications ; Prostheses and Implants* ; Rheumatic Fever ; Rheumatic Heart Disease* ; Thromboembolism