Acute Rheumatic Fever and Rheumatic Carditisin Izmir

Acute rheumatic fever is a non-suppurative complication of Streptococcus pyogenes which only licks the joints, however bites the heart valves, particularly the mitral, aortic or both, rarely the tricuspid valve, resulting in valvular endothelial ulceration, collagen degeneration, neovascularization, interstitial calcification and fibrosis associated with lymphocytic infiltration [1]. Currently in Turkey, it is believed that there are tens of thousands of heart valve diseased adult patients half of whom are class III or higher according to New York Heart Association (NYHA) classification [2]. It is stated that the other half is in mild or moderate heart failure condition, ie. Class I or II, possibly due to previous interventions [3]. Currently, the incidence of rheumatic fever (RF) and rheumatic heart disease (RHD) is really lowat certain parts of the globe compared to the incidence in Fiji, South Africa, New Zealand etc., and Turkey, with a high incidence following right after these countries [3]. Many countries have recognized the problem and tried to manage the disease so the diagnosis could be made earlier, using hand held echocardiography, as a screening test [4]. Some others have integrated using computer assisted auscultation in addition to two dimensional (2D) echocardiography, in an effort to improvethe diagnostic methods. The reason behind such efforts has been to initiate secondary prophylaxis without delay, hoping to minimize the upcoming valvular damage. Once the valve is damaged, valvular mechanics of the beating heart damages the valve even further. Hence, the valve will requirea suitable type of intervention, such as repair, balloon valvuloplasty and/ or prosthetic valve replacement. In Turkey, the most frequent etiology of heart valve disease(HVD) is still of rheumatic original [2]. The question is, is this disease preventable ? Many publications support the fact that RF and RHD are preventable. For many years, the prevalance of the disease has been shown to decline dramatically within decades in certain populations at a certain place when certain precautions are carried out. Recently, the decline in RF wasreported to be in association with the changes in M protein of Group A Streptococci, which is one of the main portions of the microorganism responsible for the mechanism of antigenic mimicry within the host [5]. Certain strategies should be proposed in order to increase the possibility of earlierdiagnosis and to keep track of the patient’s compliance to secondary prophylaxis, as well as to infective endocarditis prophylaxis. Due to variations of the disease incidence between regions, even within the same country, it is our belief that many doctors had to make their clinical judgements as a personal initiative. One of the main reasons for this has been the inadequacy of the criteria used within the last few decades [6]. However, the disease is not only a problem of how healthcare is provided to the patient; but also mainly ralated to low economic income , crowded living conditions, low socioeconomic status overall. The aim is to discuss the most current recommendations in the diagnosis of definite and/or probable RF with special emphasis on subclinical carditis and preventive measures.