Cytokines as a predictor of progression to valvular disease in children with rheumatic fever

Abstract

The immunologic basis of rheumatic fever is well established. However the role of penicillin in the control of the rheumatic process and the prevention of development of rheumatic heart disease is poorly understood.Objectivethe objective of this study was to monitor the changes in serum levels of Tumour Necrosis Factor (TNF-alpha) and interleukin-8 (IL-8) in children presenting with various stages of rheumatic fever over a time.Subjects and methodsStudy included 42 children aged 6–15 years with RHD followed up over one year by Doppler-echocardiography and laboratory tests to monitor IL-8 and TNF-alpha by ELISA technique.ResultsTwenty five children presented with acute arthritis with or without carditis (59.5%), all had statistically significantly high levels of IL-8 and TNF-alpha throughout the follow-up period. Of these 9 (36%) developed rheumatic reactivity and 6 (24%) developed valvular heart disease. Eight children (19%) presented with rheumatic chorea, all had significantly high levels of IL-8 and TNF-alpha throughout the follow-up period, of whom 4 (50%) developed valvular disease. Nine children (21.4%) presented with varying degrees of established chronic rheumatic heart disease, all of whom had no rise in the serum levels of IL-8 and TNF-alpha.ConclusionsThese findings indicate that the clinical and epidemiological pattern of rheumatic fever is changing. Immunemodulatory responses could assist us in tracking these changing patterns of disease and assessing current protocols of management