Skip to main content
SpringerLink
Log in

Mitral regurgitation may be related with previous streptococcal infection

  • Cardiology
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

We measured anti M protein antibody (AMPA) titres in children with idiopathic mitral regurgitation (MR), streptococcal infection, rheumatic fever (RF), post-streptococcal acute glomerulonephritis (AGN) and normal healthy children. We investigated the association of MR with streptococcal infection and whether high AMPA titres can be used as persisting evidence of previous streptococcal infection. AMPA titres were measured with an enzyme-linked immunosorbent assay. We found significantly higher antibody titres in patients with MR and in streptococcal infection, RF, and AGN than in healthy controls. In the MR group (n=15), 54% patients had AMPA titres above the 90th percentile value that was found in normal controls. An elevated AMPA titre persisted for a long period even when the anti-streptolysin O titres had declined to normal in RF patients. Our data suggest that the high AMPA titres in MR should be further investigated to clarify the probable association with previous streptococcal infection.

Conclusion

High AMPA titre is a risk factor for developing complications after streptococcal infection. Our serological evidence suggests that in some patients. MR may be related to previous streptococcal infection.

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

Abbreviations

AGN :

poststreptococcal acute glomerulonephritis

AMPA :

anti M protein antibody

ASK :

antistreptokinase

ASO :

anti-streptolysin O

MR :

idiopathic mitral regurgitation

RF :

rheumatic fever

References

  1. Ayub EM (1982) Streptococcal antibody titers in rheumatic fever: general pattern of antibody response to Group A streptococcal extracellular antigens. Clin Immunol Newslett 3:107–110

    Google Scholar 

  2. Dale JB, Beachey EH (1986) Sequence of myosin-crossreactive epitopes of streptococcal M protein. J Exp Med 164:1785–1790

    PubMed  Google Scholar 

  3. Debra B, Kevin FJ, Fischetti VA (1989) Evidence of two distinct classes of streptococcal M protein and their relationship to rheumatic fever. J Exp Med 169:269–283

    PubMed  Google Scholar 

  4. Emery H, Wagner-Weiner L, Magiavy D (1987) Resurgence of childhood post-streptococcal rheumatic syndromes. Arthritis Rheum 30: 80S

  5. Feigenbaum H (1986) Echocardiography, 4th edn. Lea and Febiger, Philadelphia, USA, pp 262–268

    Google Scholar 

  6. Fenderson PG, Fischetti VA, Cunnigham MW (1989) Tropomyosin shares immunologic epitopes with group A streptococcal M proteins. J Immunol 142:2475–2481

    PubMed  Google Scholar 

  7. Gibbas DL, Broussard DA (1986) Post streptococcal reactive arthritis (PRSA)-rheumatic fever or not. Arthritis Rheum 29:92S

    Google Scholar 

  8. Goldsmith DP, Long SS (1982) Post streptococcal diseases of childhood a changing syndrome. Arthritis Rheum 25:18S

    Google Scholar 

  9. Goroncy-Bermes P, Dale JB, Beachey EH, et al (1987) Monoclonal antibody to human renal glomeruli crossreacts with streptococcal M protein. Infect Immun 55:2416–2419

    PubMed  Google Scholar 

  10. Guidelines for the diagnosis of rheumatic fever, Jones criteria (1992) JAMA 268:2069–2073

    Google Scholar 

  11. Guilherme L, Weidebach W, Kiss MH, et al (1991) Association of human leukocyte class II antigens with rheumatic fever or rheumatic heart diseases in a Brazilian population. Circulation 83:1995–1998

    PubMed  Google Scholar 

  12. Jones KF, Fischetti VA (1988) The importance of the location of antibody binding on the M6 protein for opsonization and phagocytosis of group A M6 streptococci. J Exp Med 167: 1114–1123

    PubMed  Google Scholar 

  13. Jones KF, Manjula BN, Jhonston KH, Hollingshead SK, Scott JR, Manjula BN (1985) Location of variable and conserved epitopes among the multiple serotype of streptococcal M protein. J Exp Med 161:623–628

    PubMed  Google Scholar 

  14. Lancefield RC (1959) Persistence of type specific antibodies in man following infection with group A streptococci. J Exp Med 110:271–292

    PubMed  Google Scholar 

  15. Pattariyo ME, Winchester RJ, Veerno A, et al (1979) Association of B-cell alloantigen with susceptibility to rheumatic fever. Nature 278:173–174

    PubMed  Google Scholar 

  16. Sargent SJ, Beachey EH, Cobett CE, et al (1987) Sequence of epitopes of streptococcal M protein shared with cardiac sarcolemmal membranes. J Immunol 139:1285–1290

    PubMed  Google Scholar 

  17. Schaffer FM, Agarwal R, Helm J, et al (1994) Post streptococcal reactive arthritis and silent carditis. Pediatrics 93:837–839

    PubMed  Google Scholar 

  18. Scott JR, Fischetti VA (1983) Expression of streptococcal M protein in Escherichia coli. Science 221:758–760

    PubMed  Google Scholar 

  19. Scott JR, Hollingshead SK, Fischetti VA (1986) Homologous regions within M protein genes in group A streptococci of different serotypes. Infect Immun 52:609–612

    PubMed  Google Scholar 

  20. Veasy LG, Tani LY, Hill HR (1994) Persistence of acute rheumatic fever in the intermountain area of the United states. J Pediatr 124:9–16

    PubMed  Google Scholar 

  21. Voller A, Bidwell D (1986) Enzymelinked immunosorbent assay. In: Rose NR, Friedman H, Fahley JL (eds) Manual of clinical laboratory immunology. American Society for Microbiology, Washington, pp 99–109

    Google Scholar 

  22. Zabriskie JB (1986) Rheumatic fever: a model for the pathological consequence of microbial-host mimicry. Clin Exp Rheumatol 4:65–73

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, 890, Kagoshima, Japan

    M. Rezwanul Wahid, M. Yoshinaga, Y. Nomura, S. Oku & S. Takei

  2. Department of Clinical Laboratory, Faculty of Medicine, Kagoshima University, Japan

    S. Narahara

Authors
  1. M. Rezwanul Wahid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Yoshinaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Nomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Oku
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Takei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Narahara
    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

Wahid, M.R., Yoshinaga, M., Nomura, Y. et al. Mitral regurgitation may be related with previous streptococcal infection. Eur J Pediatr 155, 168–172 (1996). https://doi.org/10.1007/BF01953931

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01953931

Key words

Search

Navigation