Archana B Demonstrator, Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116 India, India
Muhammed Aseel Zahir Hussain IV Year MBBS Student, 2 Demonstrator, Department of Pathology, India
Thanka J Professor, Department of Pathology, Sree Balaji Medical College and Hospital, Chennai 600044, India, India
Priyadarshee Pradhan Professor and Head of Department, Forensic Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116,, India
Address for correspondence: Archana B , Demonstrator, Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116 India, India E-mail:
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Hussain MAZ, Archana B, Thanka J, et al. An autopsy study of rheumatic heart disease: a prevalent iceberg disease. Indian J Forensic Med Pathol. 2021;14(2):121-4.
Timeline
Received : April 02, 2021
Accepted : April 20, 2021
Published : June 30, 2021
Abstract
Cardiovascular diseases are a chief cause of sudden death. Rheumatic Heart Disease (RHD) exists as a hidden burden in developing countries. It occurs as a sequelae to Rheumatic Fever caused by Group A β Hemolytic Streptococcus. Despite the existence of antibiotics and prophylaxis by Penicillin it is still prevalent. A 33 year old male was found unresponsive in his house and was later declared dead. He had a history of abdominal pain for the past 6 months for which he was on medication. There was no other relevant family and past history. He had no history of alcohol intake or smoking. Complete medico legal autopsy was done and confirmed to be RHD. RHD is an “iceberg” disease which is still prevalent in developing countries. A cross reaction between foreign antigen and cardiac proteins leads to formation of autoantibodies causing autoimmune reaction. Mitral valve is commonly involved. RHD diagnosis can be established using Jones criteria during clinical examination. RHD still exists despite use of advanced antibiotics and Penicillin prophylaxis and needs to be therefore considered as a diagnosis of sudden death of young adults.
References
1. Sika-Paotonu D, Beaton A, Raghu A, Steer A, Carapetis J. Acute rheumatic fever and rheumatic heart disease. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: basic biology to clinical manifestations [Internet]. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2016 [cited 2021 Apr
2. Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J. 2015;36(18):1115-22.
3. Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017;377(8):713-22.
4. Watkins DA, Beaton AZ, Carapetis JR, Karthikeyan G, Mayosi BM, Wyber R, et al. Rheumatic heart disease worldwide: JACC scientific expert panel. J Am Coll Cardiol. 2018;72(12):1397-416.
5. Carapetis JR. Focus on research: rheumatic heart disease in developing countries. N Engl J Med. 2007;357(5):439-41.
6. Leal MT, Passos LS, Guarçoni FV, Aguiar JM, Silva RB, Paula TM, et al. Rheumatic heart disease in the modern era: recent developments and current challenges. Rev Soc Bras Med Trop. 2019;52:e20180414.
7. Zühlke LJ, Beaton A, Engel ME, Hugo-Hamman CT, Karthikeyan G, Katzenellenbogen JM, et al. Group A streptococcus, acute rheumatic fever and rheumatic heart disease: epidemiology and clinical considerations. Curr Treat Options Cardiovasc Med. 2017;19(2):15.
8. Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. 2016;2:15084.
9. Katzenellenbogen JM, Ralph AP, Wyber R, Carapetis JR. Rheumatic heart disease: infectious disease origin, chronic care approach. BMC Health Serv Res. 2017;17(1):793.
10. de Dassel JL, de Klerk N, Carapetis JR, Ralph AP. How many doses make a difference? An analysis of secondary prevention of rheumatic fever and rheumatic heart disease. J Am Heart Assoc. 2018;7(24):e010223.
About this article
Cite this article
Hussain MAZ, Archana B, Thanka J, et al. An autopsy study of rheumatic heart disease: a prevalent iceberg disease. Indian J Forensic Med Pathol. 2021;14(2):121-4.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.