Background/Objective: To clarify the state of different immunologic factors in patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) compared to healthy individuals.Patients and Methods: Patients with ARF (#21), patients with RHD six months after the onset of ARF (#19), and healthy children from the same age group with normal physical examination and no history of pharyngitis during the previous month as the control group (#20) were studied. All patients were evaluated and followed for the presence and the severity of carditis, heart failure, and valvular involvement with echocardiography. Antistreptolysin-O (ASO) titer, erythrocyte sedimentation rate (ESR), serum complements C3 and C4, immunoglobins IgA, IgM, and IgG, IgM Rheumatoid Factor (RF), IgM and IgG anti-cardiolipin antibody (ACLA), and IgM and IgG anti-M group A streptococcal protein (AMP) were compared.Results: There was a significant difference for IgG and IgM, ACLA between groups (p=0.005 and p=0.0001, respectively). These results were shown to reflect the difference between patients with ARF and the other two groups. There was a significant difference for IgG AMP between ARF. and RHD groups (p=0.05). There was a significant difference for IgM RF between ARF and RHD groups (p=0.05). There was a significant difference for serum IgG between groups (p=0.0005). This was shown to reflect a significant difference between patients with ARF and the two other groups. Serum IgG was significantly lower in patients with, than in patients without, aortic valve involvement (p=0.039). Similarly, Serum IgG was significantly lower in patients with pericardial effusion (p=0.013).Conclusion: There are significant differences for IgG and IgM ACLA and IgG AMP and serum IgG levels and IgM RF between ARF patients and the other two groups. Whether IgG has a "protective effect" in patients with ARF preventing them from developing pericardial effusion, aortic valve involvement, or other complications is a notable question that must be answered.

Objective: This study evaluated the correlation between human leukocyte antigens and rheumaticheart disease in Iranian population. Background; Rheumatic fever and chronic rheumatic valvular heart disease are one of the major public health.problems in this country,as well as in most of the developingcountries. Methods: The distribution of human leukocyte antigens was evaluated in 92 rheumatic valvular heart disease patients. Class I (A, 13and C) and class n (DR and DQ) antigenswere studied in 92 patients and comparedwith 200 normal subjects. Results: This study showed significantcorrelations between rheumatic heart disease and DQW2 antigen, (57.4% versus 19%, p<0.0001) as well as DRW53 (47.5% versus 8.5%, p<0.0001) and A24 (31.2% versus 13.3%,p<0.005). Conclusion: Human leukocyte antigens (DQW2, DRW53 and A24) are more ftequent in rheumatic valvular heart disease than normal population and could be.markers for more susceptibilityto rheumatic heart diseasein Iranianpopulation.

Rheumatic heart disease (RHD) is the leading cause of heart disease worldwide, accounting for 90% of all heart disorders in women of childbearing age, and also accounts for 10% to 15% of maternal mortality.

Background- Rheumatic heart disease (RHD), which is one of the most common causes of cardiovascular mortality and morbidity in the world, occurs following repeated episodes of rheumatic fever (RF) recurrences. This study evaluated the RF recurrences to verify the clinical features of the disease and to determine the related risk factors in recurrences.Methods- The medical charts of 38 cases of confirmed RF with recurrence who were admitted to our Pediatric Cardiology Unit from March 1995 to March 2001 were reviewed and evaluated. All demographic data and injection schedules were completely recorded.Results- Of the 38 patients with recurrent RF, 25 (65.8%) were girls and 13 (34.2%) were boys. Their age at the time of their first attack ranged from 4 to 13 years with a mean (±SD) of 8.14 (±2.8) years. Carditis was the most common major manifestation (86.8%). Pure chorea was seen in 4 (10.5%) of the patients (2 boys and 2 girls) and isolated arthritis occurred only in one (2.6%) case. Major clinical manifestations were not statistically different in both sexes (p=0.38). Of the 38 patients, 37 (97.4%) cases were not on penicillin prophylaxis at the time of recurrence. In 15 (39.5%) of the patients, medical staff were responsible for the discontinuation of prevention and in 22 (57.9%) patients, secondary prophylaxis was stopped because of their own or their families’ refusal.Conclusions- The present study supports the need to concentrate on optimizing adherence to secondary prophylactic regimens in the years immediately following an episode of ARF and to assure medical staff and patients of the long-term benefits of benzathine penicillin administration to prevent recurrent RF