The post-infectious autoimmune sequelae of GAS infection, acute
rheumatic fever (ARF) and acute post-streptococcal glomerulonephritis
(APSGN), are the major global causes of GAS- related morbidity and
mortality, and pose challenging questions about pathogenesis and control.
An elevated expression of alloantigen D8/17 on B-lymphocytes has
been proposed as a susceptibility markers in rheumatic fever and rheumatic
heart disease.
Post- streptococcal reactive arthritis is a sterile arthritis associated with
antecedent streptococcal infection in patients not fullfilling the jones criteria
for acute rheumatic fever.
RF is autoimmune in nature and most likely results in part from the
production of auto-reactive antibodies‟‟. They agree with the concept of
antigenic mimicry and/or an abnormal immune response to group A
streptococcal extracellular or somatic antigens.
This study aimed to study the the frequency of D8/17 on B-lymphocyte
as a susceptibility marker in patients with RHD and post-streptococcal
arthritis.
Summary and Conclusion
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The study included Thirty patients (20 patients with rheumatic heart
disease and 10 patients with post-streptococcal reactive arthritis) as well as
10 age and sex matched healthy volunteers serving as controls constituted
the subjects of this study. Age of patients with RHD ranged from 19 to 69
years while age of patients with PSRA ranged from 12 to 30 years.The
patients were recruited from those attending the outpatients clinic and
hospital inpatients of Benha University Hospital.
All patients were subjected to thorough history taking, clinical
examination with stress on the following:
1-Major criteria of rheumatic fever.
2-Minor criteria of rheumatic fever.
3-Chronic valve lesions of RHD.
4- Criteria of Post-streptococcal reactive arthritis as mentioned before.
The following investigations were done to patients and control subjects:
Echocardiogram.
Test for D8/17 and CD19 with flow cytometry assay by using
monoclonal antibodies .
Titre of ASO and Anti-Dnase were done to PSRA patients.
This study showed the following results:
There was a non significant difference in age between control and RHD
subjects while there was a significant difference between control and PSRA
subjects and between RHD and PSRA subjects.
There was a significant difference in age between PSRA subjects and
rheumatic arthritis patients.
Summary and Conclusion
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There was a significant difference between females and males with RHD.
However there was a non significant difference between females and males
of control or PSRA subjects.
There was a non significant difference between females and males regarding
CD19 assay in PSRA subjects.
There was a non significant difference between females and males regarding
D8/17 assay in PSRA subjects.
There was a non significant difference between females and males regarding
CD19&D8/17 in PSRA subjects.
There was a non significant correlation between CD19 and age in PSRA
group while there was a significant positive correlation between CD19 and
ASO titre, Anti-Dnase, D8/17and CD19&D8/17 together.
There was a non significant correlation between D8/17 and age in PSRA
group while there was a significant positive correlation between D8/17and
ASO titre and with Anti-Dnase.
There was a non significant correlation between CD19& D8/17 and
age.Whereas, there was a significant positive correlation between
CD19&D8/17,ASO titre,Anti-Dnase and D8/17 in PSRA subjects. .
65% of RHD patients suffered from rheumatic arthritis.
The prevalence of valvular lesion among RHD patients was mitral stenosis,
mitral regurge, aortic stenosis and aortic requrge, in descending order.
Regarding CD19, there was a non significant difference in pure aortic cases
compared to control and pure mitral cases ,While there was a significant
difference between control and pure mitral cases.
Regarding D8/17, there was a non significant difference in pure aortic cases
compared to control and pure mitral cases ,While there was a significant
difference between control and pure mitral cases.
Summary and Conclusion
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There was a non significant difference in cases with pure mitral or pure
aortic compared to control regarding CD19&D8/17.
There was a non significant difference of CD19 assay in RHD group that
presented with or without rheumatic arthritis.
There was a non significant difference of D8/17 assay in RHD group that
presented with or without rheumatic arthritis.
There was a non significant difference of CD19&D8/17 assay in RHD group
that presented with or without rheumatic arthritis.
Statistical analysis of CD19 assay among control, PSRA and RHD groups,
showed that there was a significant difference between control and RHD
group, there was also a significant difference between control and PSRA
group, However there was a non significant difference between PSRA and
RHD group.
There was a significant difference in D8/17 antigen in total lymphocytes
between control and RHD group, there was also a significant difference
between control and PSRA group ,However there was a non significant
difference between PSRA and RHD group.
There was a significant difference in D8/17 antigen in B-lymphocytes
between control and RHD group, there was also a significant difference
between control and PSRA group, However there was a non significant
difference between PSRA and RHD group.
There was a non significant difference between PSRA and rheumatic
arthritis regarding the percent of expression of CD19-positive cells, D8/17
antigen in total lymphocytes. However, there was a significant difference
between PSRA and rheumatic arthritis regarding the percent of expression
of D8/17 antigen on B-lymphocytes. |
