The etiology and pathogenesis of rheumatic fever

  • The role of genetic factors
  • The General scheme of pathogenesis
  • Immune system disorders rheumatism
  • The role of a strep infection. The relationship between the development of rheumatic fever with streptococcal infection supported at present the actual data. Became the classical proof of the role of streptococcal etiology based on the fact that the development of rheumatic fever precedes angina during rheumatism found in the high titles and long-various protiwastmaticescoe antibodies, and most importantly, rheumatism can be reliably prevented proper treatment of angina, and acute - year-round by baselineprotection.
    The undisputed evidence of the importance of streptococcal infection is that often affects children 7 to 15 years old, which are more frequent disease streptococcal infection. Numerous observations have shown that currently rheumatism often develops in the so-called closed groups (schools, military units) in the first months of their formation, when the rise of streptococcal diseases, especially Angin (I.e. Century Gembicki and others, 1968; E. N. Maksakova and others, 1970, 1973). It is established that single injection bicillin-5 in this period reliably prevents the development of rheumatic fever (N. I. Nesterov, 1975).
    The necessary condition for the occurrence of rheumatism - the severity of streptococcal infections and the length of carriage of Streptococcus in the shed that there is usually inadequate treatment of angina bactericidal preparations. The most difficult proceed epidemic angina, so, apparently, and the frequency of rheumatism after them higher (3%), while after sporadic angina, generally flowing softer, rheumatic fever develops in 3 times less.
    A. S. Labinsk (1975), studying And-strep carrier, showed that it was especially high in the first 2 weeks of illness in 100% of patients in primary and 90% - upon return rheumatism. Exemption And-strep carriage occurred more rapidly in primary rheumatism, than with the return, in which only 6 months the performance of the carriage approached indices of streptococcal infection in patients in the inactive phase and only the result of many years of baselineprotection reached (that is, P. Ponomarev, 1971) the level specified in practically healthy persons (10-20%).
    Long-carriage And-Streptococcus rheumatism adversely to the disease; in addition, as shown by A. S. Labinsk (1975), the media Streptococcus can infect patients with rheumatism, located in the same chambers. Patients with latent current streptococcal infection pose a great danger to others as the source of infection than patients with clinically evident disease of the upper respiratory tract, as not receive etiotropic therapy, more active and have more contacts with roommates. At the same time confirmed the fact of hypersensitivity to Streptococcus patients (Stollerman, 1964), who suffered the first attack of rheumatism.
    Currently, more and more recognized by the pathogenic mechanisms of action of Streptococcus. A major role in this belongs to M-protein cell wall Streptococcus, which is one of the virulence factors, and hyaluronic acid capsules. M protein and hyaluronic acid suppress phagocytosis Streptococcus, and M protein, apparently, has a damaging effect on the heart, because it is found in the form of a fixed complex with antibodies in subendocardialnah layer attack. Antigens cytoplasmic membrane of Streptococcus also reacts with components of the heart. Of particular interest is the detection of cross-reactions between polysaccharide Streptococcus group a and epithelial cells of the thymus gland that can contribute to the development of violation of cellular immunity. The very fact very frequent detection of antibodies to the cytoplasm Streptococcus (tan SIC hawk, 1974) suggests the involvement of its components in the pathogenesis of rheumatic fever.
    Streptococcus And affects the body also diverse products of their vital activity. Among them well-known streptolysin-0-S, desoksiribonukleaza In, and hyaluronidase and streptokinase. All these enzymes have the properties of antigens and induce the formation of antibodies: SLA, ASC, VDR, anti-dnaase Century
    Streptolysin-O and-S, damaging lysosomal membranes of cells, promotes the release of acid hydrolases that cause an inflammatory response. Stradali-zine-0 also has a cardiotoxic effects, and streptolysin-S experiment with repeated vnutrisustavne caused arthritis. In turn hyaluronidase can contribute to the damage of the basic substance of the connective tissue, rich in hyaluronic acid, and streptokinase with fibrinolytic activity, has kininogen action.
    Thus, the components of the Streptococcus and the metabolic products have different effects on the body, thus promoting development characteristic of rheumatoid arthritis inflammatory process and violation of humoral protiwastmaticescoe of immunity in the form of excess of formation and long-term circulation of different antibodies. This reaction of the immune system is an essential element of the pathological process in rheumatoid arthritis.
    Violations protiwastmaticescoe immunity is also expressed in the increase of phagocytic activity of leukocytes and reducing complete phagocytosis Streptococcus (A. S. Labinsk and others, 1975), caused by reduced activity of acid proteases (A. S. Kainova, 1975), which may contribute ultimately to the experience of Streptococcus inside of cells.
    In all likelihood, has a value of family tendency, perhaps genetically determined, streptococcal infections, as shown L. I. Benevolensky et al. (1976) during examination of streptococcal infection in the families of patients with rheumatism and in control.
    Thus, streptococcal infection, and in the conditions of the changed course of rheumatism retains its value as a factor, which begins the disease, which further aggravates the disease. With him is not easy, but possible and necessary to fight, because the problem of "Streptococcus and rheumatism" is not only the problem of the sick, but also its environment.
    You must specify that in the conditions of etiotropic therapy with penicillin increases the possibility of induction of L-forms of Streptococcus. Moreover, there is a possibility that an adverse course options rheumatism associated with the persistence of L-forms of Streptococcus.
    In 1962 C. D. Timakov and G. I. Kagan has allocated L-forms hemolytic streptococci from the blood of patients with rheumatism. In recent years, numerous works proved the possibility of antibody productions in response to the introduction of L-forms-hemolytic streptococci: In the works of N. Century Chumachenko, A. S. Labinsk and others (1974) shows that more than half of patients with rheumatism, especially with adverse (prolonged and continuous recurrent) variants of flow, defined antibodies to L-forms of Streptococcus. The fact of detection of antibodies to L-forms of Streptococcus allows to assume their role in the pathogenesis of rheumatic disease, in particular its chronic, progressive variants of flow.