Increase in Activated T Cells and Reduction in Suppressor/Cytotoxic T Cells in Acute Rheumatic Fever and Active Rheumatic Heart Disease: A Longitudinal Study

In a prospective study, patients with acute rheumatic fever (ARF) and active rheumatic heart disease (ARHD) showed a significant increase in CD4⁺ T cells, CD22⁺ B cells, and CD4:CD8 cell ratio but a significant decrease in the percentages of CD8⁺ and CD3⁺ T lymphocytes compared with patients with quiescent RHD (CRHD) or streptococcal pharyngitis (SP) and normal controls. The proportion of interleukin-2 receptor (IL-2R)⁺ (CD2S⁺) cells was higher in peripheral blood mononuclear cell cultures (both before and after phytohemagglutinin stimulation) of ARF and ARHD patients than in those of CRHD or SP patients or controls; this finding persisted up to 48 weeks. In ARF patients, the percentage of CD8⁺ cells returned to within normal range at 48 weeks. Furthermore, the percentage of IL-2R⁺ cells correlated positively with the percentage of CD4⁺ but not of CD8⁺ lymphocytes, suggesting that helper/inducer T cells are in an immunologically activated state and may account for aberrations in the distribution of lymphocyte populations in peripheral blood of ARF and ARHD patients.