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Clinical profile of acute rheumatic fever in Pakistan

Published online by Cambridge University Press:  18 April 2005

Hasina Suleman Chagani  and
Kalimuddin Aziz
Hasina Suleman Chagani
Affiliation:
Department of Cardiology, Dow Medical College, Civil Hospital Karachi, Karachi, Pakistan
Kalimuddin Aziz
Affiliation:
National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Abstract

We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.

Keywords

Jones criteriarecurrent acute rheumatic feverchoreacarditis
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 1 , February 2003 , pp. 28 - 35
Copyright
© 2003 Cambridge University Press

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References

Brittanica: Book of year 1991. Chicago, 1991.
Cheadle WB. The various manifestations of rheumatic fever as exemplified in childhood and early life. Smith and Co., London, 1889.
El-Sadr W, Taranta A. The spectrum and specter of rheumatic fever in 1980's. In: Clinical Immunology Up-Date. Edited by Franklin EC. Elsevier, New York, 1979, pp 183–203.
Majeed HA, Khan N, Dabbagh M, Naidi K. Acute rheumatic fever during childhood in Kuwait: The mild nature of initial attack. Ann Trop Paediatr 1981; 1: 13–20.Google Scholar
Haig-Brown C. Tonsillitis in adolescent, Bailliere Tendoll and Cox, London 1886.
Joshi MK, Kandoth PW, Barve RJ, Kamat JR. Rheumatic fever: Clinical profile of 339 cases with long term follow-up. Indian pediatr 1983; 20: 849–853.Google Scholar
Okoroma EO, Ihenacho HNC, Anyanwu CH. Rheumatic fever in Nigerian children. A prospective study of 66 patients. Am J Dis Child 1981; 35: 236–238.Google Scholar
Padmavati S. Rheumatic fever and rheumatic heart disease in developing countries. Bull. WHO 1979; 56: 543–550.Google Scholar
Sanyal SK, Thaper MK, Ahmed SA, Hooja V, Tewari P. The initial attack of acute rheumatic fever during childhood in North India. A prospective study of the clinical profile. Circulation 1974; 49: 7–12.Google Scholar
Alan L, Bisno. Group A streptococcal infection and acute rheumatic fever. N Engl J Med 1991; 325: 783–793.Google Scholar
Gharib R. Acute rheumatic fever in Shiraz, Iran. It's prevalence and characteristics in two socio-economic groups. Am J Dis Child 1969: 118: 694–699.Google Scholar
Ismail SA, El Amin A. Rheumatic fever in Sudanese children. Arab J Med 1983; 2: 21–24.Google Scholar
Rahimtoola RJ, Rehman H. Acute rheumatic fever in children. JPMA 1972; 22: 185–192.Google Scholar
Rahimtoola RJ, Shafqat H, Ramzan A. Acute rheumatic fever and rheumatic carditis in children. Pak Heart J 1980; 3: 2–9.Google Scholar
Robinson RD, Sultana S, Abbasi AS et al. Acute rheumatic fever in Karachi, Pakistan. Am J Cardiol 1966; 8: 548–551.Google Scholar
Strasser T. Rheumatic fever and rheumatic heart disease in the 1970's. WHO Chron. 1978; 32: 18–25.Google Scholar
Levine LI, Chapman SS, Guerra V, Cooper J, Krause RM. Studies on the transmission within the families of group A hemolytic streptococci. J Lab Clin Med 1966; 67: 483–494.Google Scholar
Shanks RA. Collagen and connective tissue diseases. In: Forfar JA, Arneil CC (eds) Textbook of Pediatrics. Churchill Livingstone, Edinburgh, 1978: 1501–1515.
Bland EF, Jones TD. Rheumatic fever and rheumatic heart disease. A twenty-year report on 1000 patients followed since childhood. Circulation 1951; 4: 836–843.Google Scholar
Baldwin JS, Kerr JM, Kuttner AG, Doyle EF. Observation in rheumatic nodules over 30 years period. J Pediatr 1960; 56: 465–470.Google Scholar
Ward C. The reappraisal of the clinical features in acute and chronic rheumatic heart disease. Etiology implications. Am Heart J 1979; 98: 298–306.Google Scholar
Brownell KD, Rese FB. Acute rheumatic fever in children. Incidence in Borough of New York city. JAMA. 1973; 224: 1593–1597.Google Scholar
Feinstein AR, Spagnuolo M. The clinical patterns of acute rheumatic fever; A reappraisal. Medicine 1962; 41: 279–305.Google Scholar
Sanyal SK, Berry AM, Duggal S, Hooja V, Ghosh S. Sequel of initial attack of acute rheumatic fever. A prospective 5-year follow-up study. Circulation 1982; 65: 375–379.Google Scholar
Strasser T, Dondong N, Elkholy A et al. The community control of rheumatic fever and rheumatic heart disease. Report of a WHO international co-operative project. Bull. WHO 1981; 59: 285–294.Google Scholar
Reale A, Colella C, Bruno AM. Mitral stenosis in childhood: Clinical and therapeutic aspects. Am Heart J 1963; 66: 15.Google Scholar
Billoo AG, Abbasi AS, Sultana S, Desa L, Syed SA. Prophylaxis against recurrence of rheumatic fever. Pak Heart J 1968; 1: 8–14.Google Scholar
Ehmke DA, Stehbens JA, Young L. Two studies of compliance with daily prophylaxis in rheumatic fever patients in Iowa. Am J Public Health 1980; 70: 1189–1193.Google Scholar
Hassel TA, Stuart KL. Rheumatic fever prophylaxis. A three-year study. Br Med J 1972; 2: 39–40.Google Scholar
Koshi G, Benjamin V, Cherian G. Rheumatic fever and rheumatic heart disease in rural south Indian children. Bull WHO 1981; 59: 599–603.Google Scholar
Gordis L. Effectiveness of comprehensive care program in preventing rheumatic fever. N Engl J Med 1973; 289: 331–335.Google Scholar
Intersociety commission for heart disease and resources. Rheumatic fever and rheumatic heart disease study group. Prevention of rheumatic fever and rheumatic heart disease. Circulation 1970; 41: A1–15.
Spagnuolo M, Pasternack B, Taranta A. Risk of rheumatic fever recurrences after streptococcal infections. Prospective study of clinical and social factors. N Engl J Med 1971; 285: 641–647.Google Scholar
Syed SA. Rheumatic heart disease. Pak Heart J 1972; 5: 14–16.Google Scholar
Watkins JH, Quinn JP. Rheumatic heart disease and overcrowding. Am J Public Health 1948; 38: 1071–1081.Google Scholar
Abbasi AS, Hashmi JA, Robinson RD, Suraya S, Syed SA. Prevalence of heart disease in school children of Karachi. Am J Cardiol 1966; 18: 544–547.Google Scholar
Malik SM, Jaffrey S, Ahmed S, Zubeda Khanum: Prevalence of heart disease in school children of Islamabad. Pakistan Heart Journal 1981; 14: 2–6.Google Scholar
Meyer RJ, Haggerty RJ. Streptococcal infections in families. Factors altering individual susceptibility. Pediatrics 1962; 29: 539–549.Google Scholar
Talbot R. Pockets of rheumatic fever in developed world. XI World Congress of Cardiology. Manila 1990.Google Scholar
Taranta A, Markowitz M. Rheumatic fever. A guide to its recognition, prevention and cure, with special reference to developing countries. M.T.P. Press Ltd., Boston, 1981.
Aziz KU. Incidence of heart disease in children at NICVD. JPMA 1984; 34: 300–305.Google Scholar
Wood HF, McCarty M. Laboratory aids in the diagnosis of rheumatic fever and evaluation of disease activity. Am J Med 1954; 17: 768–774.Google Scholar
Community control of rheumatic heart disease in developing countries-I. A major public health problem. WHO Chron 1980; 34: 336–345.
Community control of rheumatic heart disease in developing countries-II. Strategies for prevention and control. WHO Chron 1980; 34: 389–395.
Markowitz M. Eradication of rheumatic fever. An unfulfilled hope. Circulation 1970; 41: 1077–1084.Google Scholar
Aziz KU, Cheema L, Memon AD. Long-term observations of rheumatic carditis. Cardiol Young 1992; 2: 254–260.Google Scholar