Skip to main content
SpringerLink
Log in

Coxsackie virus infections in rheumatic fever

  • Original Articles
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The close relationship between Group A beta Hemolytic Streptococci (GABS) and rheumatic fever is a well established one. However, the concept of the streptococcus as the sole etiologic agent of the rheumatic heart disease (RHD) has been challenged over the past years. Since coxsackievirus group B (CVB) has long been proposed as a cause of acquired valvular disease simulating rheumatic fever, we attempted in this study to document infections with this group of viruses in patients with rheumatic fever. We obtained blood samples from 106 patients with old (quiescent) rheumatic fever/rheumatic heart disease [group I], 94 patients with acute rheumatic fever (ARF) [group II], and 74 normal matched controls. We tested for the presence of neutralizing antibodies to the 6 serotypes of CVB by a micro neutralization test. We have found that infection with CVB, especially types B2 and B4, was common in the studied population. Forty two percent of normal individuals had evidence of infection with any of the 6 serotypes of CVB. Patients of group I had significantly more frequent infections with CVB 2. Patients in group II had significantly more frequent infections with CVB 2 and CVB 6. There was no clear correlation between such infections and the clinical course of rheumatic fever. There was no difference in the incidence of CVB infections between patients with definite ARF, and patients with suspected ARF. We set a low order association between rheumatic fever and infection with CVB types B2 and B6. We emphasize the importance of pursuing the investigation of the role of CVB in relation to RHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rammelkamp CH, Denny FW, Wannamaker LW. Studies on the epidemiology of rheumatic fever. In: Thomas L, ed. Rheumatic Fever. Minneapolis: University of Minnesota Press, 1952.

    Google Scholar 

  2. Swift HF. The etiology of rheumatic fever. Ann Intern Med 1949; 31 (5): 715.

    PubMed  CAS  Google Scholar 

  3. Gordis L. The virtual disappearance of rheumatic fever in the U.S.: Lessons in the rise and fall of the disease. Circulation 1985; 72: 1155–1162.

    PubMed  CAS  Google Scholar 

  4. Anonymous. Aetiology of acquired cardiac valve lesions. Br Med J 1980; 280: 1064.

  5. Heymer B, Krause RM. Streptococcal infections and non suppurative complications. In: Samter A, ed. Immunological Diseases. Boston, Massachussets: Little Brown and Co Inc, 1979.

    Google Scholar 

  6. Markowitz M. Rheumatic fever in the eighties. Pediatr Clin North Am 1986; 33 (5): 1141–1149.

    PubMed  CAS  Google Scholar 

  7. Burch GE, Giles TD, Colcolough HL. Pathogenesis of “rheumatic” heart disease: Critique and theory. Am Heart J 1970; 80 (4) 556–561.

    Article  PubMed  CAS  Google Scholar 

  8. Ward C. Observations on the diagnosis of isolated rheumatic carditis. Am Heart J 1976; 91 (5): 545.

    Article  PubMed  CAS  Google Scholar 

  9. Ward C. A reappraisal of the clinical features in acute and chronic rheumatic heart disease: Etiological implications. Am Heart J 1979; 98 (3): 298–306.

    Article  PubMed  CAS  Google Scholar 

  10. Gordis L. Effectiveness of comprehensive-care programs in preventing rheumatic fever. N Engl J Med 1973; 289: 331–335.

    Article  PubMed  CAS  Google Scholar 

  11. Markowitz M. Eradication of rheumatic fever. An unfulfilled hope. Circulation 1970; 41: 1077.

    PubMed  CAS  Google Scholar 

  12. Sanyal SK, Berry AM, Duggal S et al. Sequelae of the initial attack of acute rheumatic fever in children from North India. A prospective 5-year follow-up study. Circulation 1982; 65 (2): 375–379.

    PubMed  CAS  Google Scholar 

  13. Krause RM. Prevention of streptococcal sequelae by penicillin prophylaxis: A reassessment. J Infect Dis 1975;, 131 (5): 592–601.

    PubMed  CAS  Google Scholar 

  14. Koontz CH, Ray CG. The role of coxsackievirus B infections in sporadic myopericarditis. Am Heart J 1971; 82 (6): 750–758.

    Article  PubMed  CAS  Google Scholar 

  15. Burch GE, Giles TD. The role of viruses in the production of heart disease. Am J Cardiol 1972; 29: 231–240.

    Article  PubMed  CAS  Google Scholar 

  16. Sainani GS. Adult heart disease due to Coxsackie virus B infection. Medicine 1968; 47 (2): 133–147.

    PubMed  CAS  Google Scholar 

  17. Babb JM. Myocarditis and croup caused by coxsackie virus group B5. Arch Dis Child 1961; 36: 551.

    Article  PubMed  CAS  Google Scholar 

  18. Burch GE et al. Coxsackie B viral myocarditis and valvulitis identified inroutine autopsy specimens by immunofluorescent techniques. Am Heart J 1967; 74 (1) 13–23.

    Article  PubMed  CAS  Google Scholar 

  19. Lau RCH. Coxsackie B virus infections in New Zealand patients with cardiac and non-cardiac diseases. J Med Virol 1983; 11: 131–137.

    Article  PubMed  CAS  Google Scholar 

  20. Pongpanich B, Suthas NA Ayuthya P, Jayavasu J, Sangkavibha N. Coxsackie group B virus and acquired valvular heart disease in children. J Med Assoc Thai 1976; 59: 452–456.

    PubMed  CAS  Google Scholar 

  21. Committee to revise the Jones Criteria of the council on rheumatic fever and congenital heart disease of the American Heart Association. Jones Criteria (Revised) for guidance, in the diagnosis of rheumatic fever. Circulation 1965; 32: 664.

    Google Scholar 

  22. Hierholzer JC, Bingham PG. Vero microcultures for adenovirus neutralization tests. J Clin Microbiol 1978; 7 (6): 499.

    PubMed  CAS  Google Scholar 

  23. Hierholzer JC et al. Quantitation of enterovirus-70 antibody by microneutralization test and comparison with standard neutralization, hemagglutination inhibition, and complement fixation tests with different virus strains J Clin Microbiol 1984; 19: 826–830.

    PubMed  CAS  Google Scholar 

  24. Lennette EH. Diagnostic Procedures for Viral, Rickettsial, and Chlamydial Infections. 5th edn. Washington D.C.: American Public Health Association, Inc., 1979. 34–35.

    Google Scholar 

  25. Rosner B. Fundamentals of Biostatistics. 2nd edn. Boston, Massachusetts: Duxbury Press, 1986.

    Google Scholar 

  26. Ostle B. Statistics in Research. Basic Concepts and Techniques for Research Wokers. 2nd edn. Towa, USA: The Iowa State University Press, 1963: 56–57.

    Google Scholar 

  27. Sleight P, Jones JV. Scientific Foundations of Cardiology. London: William Heinemann Medical Books Ltd, 1983.

    Google Scholar 

  28. Grist NR, Bell EJ. A six-year study of Coxsackie virus B infections in heart disease. J Hyg (Camb) 1974; 73: 165–172.

    CAS  Google Scholar 

  29. Wattre P, Leroy O, Dewilde A, Thery C. Les infections a Coxsackie virus “B” en cardiologie. A propos de soixantesix observations. Path Biol 1987; 35 (4): 347–352.

    CAS  Google Scholar 

  30. Nicholls AC, Thomas M. Coxsackievirus infection in acute myocardial infarction. Lancet 1977; 1: 883–884.

    Article  PubMed  CAS  Google Scholar 

  31. Griffithis PD, Hannington G, Booth JC. Coxsackievirus B infections and myocardial infarction. Lancet 1980; 1: 1387–1389

    Article  Google Scholar 

  32. Chandy KG, John TJ, Mukundan P, Cherian G. Coxsackie B antibodies in “rheumatic” valvular heart disease (Letter). Lancet 1979; 1: 381.

    Article  PubMed  CAS  Google Scholar 

  33. Limson BM et al. Occurrence of infection with cosxackie B virus in rheumatic and non-rheumatic Filipino children. J Infect Dis 1979; 140 (3): 415.

    PubMed  CAS  Google Scholar 

  34. Hamparian VV, Ottolenghi AC, Hughes JH. Enteroviruses in sludge: Multiyear experience with four wastewater treatment plants. Applied & Environmental Microbiol 1985; 50 (2): 280–286.

    CAS  Google Scholar 

  35. Melnick JL. Enteroviruses. In: Fields BN, ed. Virology. New York: Raven Press, 1985.

    Google Scholar 

  36. Smith WG. Adult heart disease due to cosxackievirus group B. Br Heart J 1966; 28: 204–219.

    Article  PubMed  CAS  Google Scholar 

  37. Smith WG. Coxsackievirus B myopericarditis in adults. Am Heart J 1970; 80 (1): 34–46.

    Article  PubMed  CAS  Google Scholar 

  38. Bell EJ, McCartney RA. A study of coxsackie virus B infections, 1972–1983. J Hyg (Camb) 1984; 93: 197–203.

    CAS  Google Scholar 

  39. Schmidt NJ, Magoffin RL, Lennette EH. Association of group B Coxsackie viruses with cases of pericarditis, myocarditis, or pleurodynia by demonstration of immunoglobulin M antibody. Infect Immunol 1973; 8: 341–348.

    CAS  Google Scholar 

  40. Lerner AM, Wilson FM, Reyes MP. Enteroviruses and the heart (with special emphasis on the probable role of coxsackie virus, group B, types 1–5). II. Observations in humans. Mod Conc Cardiovasc Dis 1975; 44 (3): 11–15.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Microbiology, Ohio State University, Columbus, Ohio, USA

    J. J. Hughes

  2. Department of Pediatrics, University of Alexandria, El Shatby Hospital for Children, El Shatby, Alexandria, Egypt

    S. R. Zaher & A. S. Kassem

Authors
  1. S. R. Zaher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. S. Kassem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. J. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zaher, S.R., Kassem, A.S. & Hughes, J.J. Coxsackie virus infections in rheumatic fever. Indian J Pediatr 60, 289–298 (1993). https://doi.org/10.1007/BF02822194

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02822194

Key words

Search

Navigation