RESUMEN
Secondary prophylaxis of rheumatic heart diseases is efficient in reducing disease recurrence, heart damage, and cardiac impairment. We aimed to monitor the clinical evolution of a large Brazilian cohort of rheumatic patients under prolonged secondary prophylaxis. From 1986 to 2018, a cohort of 593 patients with rheumatic fever was followed every 6 months by the Reference Center for the Control and Prevention of Rheumatic Fever and Rheumatic Cardiopathy (CPCFR), Paraná, Brazil. In this cohort, 243 (41%) patients did not present cardiac damage (group I), while 350 (59%) were diagnosed with rheumatic heart disease (RHD) (group II) using the latest case definition. Among group II, 233 and 15 patients had impairment of the mitral and aortic valves, respectively, while 102 patients had impairment of both valves. Lesions on the mitral and aortic valves presented a regression in 69.9 and 48.7% of the patients, respectively. Active patient recruitment in the reference center and early detection of oropharyngeal GAS were important factors for optimal adherence to the prophylactic treatment. Patients with disease progression were associated with noncompliance to secondary prophylaxis. No patients undergoing regular prophylaxis presented progression of the rheumatic cardiac disease. Eighteen valvular surgeries were performed, and four (0.7%) patients died. This study confirmed that tailored and active efforts invested in rheumatic heart disease secondary prevention allowed for significant clinical improvement.
RESUMEN
OBJECTIVE: Our objective was to develop an easy, safe, pragmatic, clinical scoring system that would allow decreases in unnecessary treatment with antimicrobial agents in low-resource settings. METHODS: Children with pharyngitis were enrolled prospectively from 2 public hospitals and 1 medical unit in Brasilia, Brazil, over 17 months. Attending clinicians completed a questionnaire and a previously published scoring system for pharyngitis before performing throat swabs and group A streptococcus (GAS) rapid antigen-detection tests. Data from this study were added to those collected in 2004, to assess the performance of each item of the scoring system. The performance of the new clinical decision rule was determined with a receiver operating characteristic curve. The final outcome of the model was assessed on the basis of sensitivity, specificity, and positive likelihood ratio for non-GAS infections with the clinical approach, compared with throat culture or rapid antigen-detection test results. RESULTS: A total of 576 children were included, among whom 400 had non-GAS pharyngitis. The use of our new clinical decision rule would allow for 35% to 55% antibiotic reduction, with 88% specificity. CONCLUSIONS: This clinical decision rule could reduce unnecessary antibiotic treatment significantly in low-resource settings.
Asunto(s)
Faringitis/diagnóstico , Faringitis/microbiología , Adolescente , Brasil , Niño , Preescolar , Técnicas de Apoyo para la Decisión , Femenino , Recursos en Salud , Humanos , Lactante , Masculino , Estudios ProspectivosRESUMEN
Group A Streptococci (GAS) are classified into 180 emm-types based on the sequence of the amino-terminal hyper-variable region of the M surface protein. The genetic relatedness of the whole surface-exposed part of M was investigated in well-characterized Belgian and Brazilian GAS isolates which belong to different epidemiological and clinical landscapes. Despite a small number of different emm-types and an apparent low diversity in the Belgian isolates (as revealed by the emm-typing method), our data showed that the overall genetic diversity of the M proteins was higher than expected. On the contrary, the M proteins from the Brazilian isolates were genetically highly related. Since M is a multi-functional protein, an analysis of the whole surface-exposed sequence that takes into account the different functional domains may provide tools for typing as well as for analyzing the molecular mechanisms of M virulence or defining vaccine strategies.