Evaluation and Correlation Of Biomarkers and Echocaradiography in the diagnosis of Rheumatic Fever and Rheumatic Heart Disease

Abstract

Introduction: Rheumatic heart disease (RHD) is preventable, yet serious public health problem in low and middle income countries. This study focusses on genetic marker and biomarker that would correlate with the clinical and echocardiographic findings which will enable us to detect the presence and severity of an infection at the earlier stages thereby preventing the complications. newlineMaterials and Methods: This prospective study was conducted in Chettinad Hospital and Research Institute. A total of 300 blood samples and 300 throat swabs were collected from patients suffering with pharyngitis, RF and RHD. Multiplex PCR was carried out for virulent genes emm, spe B and sof among the study groups. Biomarkers like Procollagen Type I carboxy terminal peptide (PICP) and soluble Suppression of Tumorigenicity (sST2) were measured by ELISA method. Electrocardiogram (ECG) and Echocardiography were performed. newlineResults: Our study consisted of pharyngitis ( n = 50 ), RF ( n = 50 ), RHD ( n = 50 ) and healthy controls ( n = 150 ). Females were affected predominantly in RF/RHD. Genotypic screening confirmed the presence of three genes ( emm, spe B, sof ) in 29.3% patients, two genes (emm, spe B) in 14.6% patients and (emm, sof) in 16% patients. Presence of three genes showed severe regurgitation/ stenosis in RF and RHD. A significantly high (plt0.0001) concentration of PICP was observed in RHD (1203 ± 114.7 ng/ml) and sST2 was markedly elevated in RHD patients ( 29.2 ± 5.0 ng/ml ). newlineConclusion: Analysis of data in Pharyngitis group and screening of virulent gene may help us to have close monitoring of high risk patients who may develop RHD in future. Periodic Biomarkers screening in RF and RHD may help to interpret the severity of valvular lesions and it may considered as a prognostic indicator. Significant changes in the marker assays, echocardiography and clinical findings will indicate the need of effective treatment, improving clinical management of patients suffering from rheumatic fever. newlineKeywords: Rheumatic Heart Disease (RHD), Rheumatic Fever (RF), Group A Streptococcus pyogenes (GAS) newline newline