Rheumatic Fever in Children: A 15-Year Experience in a Developing Country (original) (raw)
Related papers
World Journal of Cardiovascular Diseases, 2018
Introduction: Acute rheumatic fever (ARF) and its complications including rheumatic heart disease (RHD) remain one of the leading causes of cardiovascular disease worldwide. In our setting with no cardiac surgery, data on RHD are therefore important to point out the need for such structure. In this study, we therefore describe rheumatic disease in terms of prevalence, patients' characteristics and management of patients. Methods: We performed a retrospective study from May to September 2012, involving children aged 3 to 15 years old and seen at the Mother and Child University Hospital Luxembourg (MC UHL). Included were all children diagnosed with RHD. The diagnosis of rheumatic fever (RF) was defined using the revised Jones criteria from 1992 and RHD defined according to the WHO/NIH joint criteria. Data of interview, clinical examination, complementary and those on evolution were recorded. Results: We found an hospital prevalence of 6.2%. Mean age was 15.33 years ± 6.005 (3 to 36), females representing 54.2% and students 70%. Mitral regurgitation (MR), Mitral Stenosis (MS) and concomitant MR + MS were most found RHD with resp. 43.3%, 15% and 13.3%. Complications occurred in 74.1% before surgery. An operative indication was set in 90% of all cases whereas only 36% underwent surgery. After surgery immediate complications were dominated by anemia (11.6%) and late ones by heart failure in 18.5% of cases. Conclusion: Despite advances in medical diagnostic approach and therapeutical progress which partly explained the relatively high prevalence, the evolution of rheumatic heart disease in our context is unfavorable How to cite this paper:
Journal of Liaquat University of Medical & Health Sciences, 2006
enrolled in the study. Demographic details of patients such as age, sex, socioeconomic status as well as their symptoms such as dysponea, palpitation and chest pain were noted on a proforma. Number of rheumatic fever attacks in the past were also noted. Patients were examined carefully for cardiac valvular lesions and for signs of acute rheumatic fever. Patients underwent different investigations such as blood complete picture, ESR, ASO titre, ECG, X-ray chest, echocardiography and Doppler. All patients had their calcium levels and collagen profile checked to exclude non rheumatic causes of valvular heart disease. RESULTS: One hundred adult patients of chronic rheumatic heart disease were studied for various valvular sequelae. Out of 100 patients studied, 49 (49%) patients were males and 51 (51%) were females. Seventy-three (73%) patients were below 30 years of age (Group A) and 27 (27%) patients were above 30 years of age (Group B). Patients age ranged between 12 and 60 years. Forty-eight (48%) patients had predominant mitral stenosis. Forty-two (42%) patients had predominant mitral regurgitation. Nine (9%) patients had aortic regurgitation and one (1%) had aortic stenosis along with mitral valve disease. CONCLUSION: From this study, it is concluded that mitral valve stenosis is frequently observed than mitral regurgitation and aortic valve is least affected, therefore, in every case of chronic rheumatic fever mitral valve should be thoroughly examined.
Rheumatic Fever and Rheumatic Heart Disease
Circulation, 1951
Herewith is presented an interim report on a long-term study of 1000 patients followed since their childhood rheumatism. The dominant role of rheumatic recurrences and the fatal features are reviewed. The benign nature of uncomplicated chorea is stressed, the disappearance of physical signs of heart disease in some patients is contrasted with the delayed and even remote appearance of valvular deformity in others, and finally, the favorable course to date in the majority of cases is emphasized.
Pediatric Cardiology, 2008
Background This study aimed to evaluate prospectively clinical and echocardiographic findings of patients who had rheumatic fever with and without clinical features of cardiac involvement. Methods For this study, 56 consecutive patients (mean age, 11.4 years) with acute rheumatic fever diagnosed according to the 1992 modified Jones criteria were evaluated at diagnosis, after 3 and 6 months, then at 2 and 5 years. All assessments were performed blindly and included physical and cardiac examination, electrocardiogram, chest X-ray, and two-dimensional color-flow Doppler echocardiography. Results Initial clinical carditis was observed for 27 patients (48.2%), all of whom had positive echocardiographic abnormalities. Echocardiographic abnormalities were observed in 11 patients who had arthritis or chorea presentation without initial clinical carditis. Persistence of the abnormalities was observed at a late follow-up evaluation in 72.7% of the cases. Sydenham’s chorea was present in 8 patients with clinical carditis and in 10 without this disorder, 8 of whom had echocardiographic abnormalities. Conclusion Patients who had acute rheumatic fever without clinical signs of carditis showed acute and late follow-up echocardiographic abnormalities suggestive of cardiac involvement. Clinicians should be attentive for the presence of cardiac involvement among patients with chorea.
Frontiers in Surgery, 2020
Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults. Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018. Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge. Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.
The new face of rheumatic heart disease in South West Nigeria
International Journal of General Medicine, 2013
To determine the current prevalence of rheumatic heart disease (RHD), clinical features, types of valvular lesions, complications and mortality, at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, South West Nigeria. Methods: We conducted a retrospective, descriptive study of all the cases of RHD seen in the medical outpatient clinics and wards of LAUTECH for 9 years, from January 2003 to December 2011. Statistical analysis of data obtained was done using SPSS 16. Results: The total number of attendees of all the medical outpatient clinics during the 9-year period was 67,378, with a subset of 9423 attending the cardiology clinic. There were 11 cases of RHD, which translates to a prevalence of 0.16/1000 and 1.2/1000 for medical outpatient clinics and the cardiology clinic respectively. The mean age of the patients was 25.64 ± 9.65 years, age range 14-40 years and male to female ratio of 1:1.2. The most common valve affected was mitral (90.9%), followed by the aortic (36.4%), and the tricuspid (18.2%). Mitral and aortic lesions coexisted in 18.2% of the patients, and late presentation was common in all RHD cases. Heart failure was the most common complication (90.9%). Other complications were secondary pulmonary hypertension (36.4%), infective endocarditis (27.3%), atrial fibrillation (27.3%), cardioembolic cerebrovascular disease (18.2%), and atrial flutter (9.1%). Mortality was 9.1%, while only one patient (9.1%) had definitive surgery. Financial constraints precluded others from having definitive surgery. Conclusion: The prevalence of RHD has declined considerably as a result of improvements in the primary health care delivery system, with widespread use of appropriate antibiotic therapy for sore throats resulting in the prevention of rheumatic fever and RHD. However, late presentation is still very common, hence we advocate a more aggressive drive to make the Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease functional in our practice area.
Rheumatic Heart Disease: Presentation and Management Dilemmas
2021
Rheumatic Heart Disease (RHD) is a major public health concern in developing countries. Late presentation and diagnosis, difficulties in accessing medications in remote areas, and loss of follow-up patients adequately may plausibly explain the suboptimal clinical outcomes. RHD is commonly encountered during childhood and young adulthood and is a major cause of disabilities and preventable deaths. The objective of this case report is to highlight on the occurrence of RHD and some challenges to care of RHD cases presenting to health facilities in resource-limited settings. This may also serve to alert authorities and medical practitioners of the need to ensure the early and adequate diagnosis of RHD given the availability of resources appropriate for its management. Further, although early diagnosis is key, preventive measures need to be put in place, medications made available, and reliable patient follow-up teams established as a holistic package of care.
Rheumatic heart disease revisited
Journal of Cardiovascular Medicine, 2012
Background The burden of rheumatic heart disease (RHD) continues to be a major contributor to morbidity and premature death in poor and developing countries. We investigated patterns of valvular involvement in patients with RHD as observed in a large tertiary care hospital in eastern Nepal. Methods We retrospectively reviewed transthoracic echocardiography reports from patients diagnosed with RHD between June 1999 and February 2011. Results Among 10 860 transthoracic echocardiography studies, 1055 female and 658 male patients were diagnosed with RHD, 25.7% of the patients being below 20 years of age. Mitral regurgitation was the most common valvular lesion across all age groups irrespective of sex (n U 1321, 77.1%). Female patients were significantly older as compared to male patients at the time of presentation (32.8 W 15.2 versus 28.5 W 15.4 years; P < 0.001) and more commonly presented with mitral stenosis as compared to male patients (62.8 versus 51.5%; P < 0.001), with a peak between the age of 30 and 49 years. Conversely, aortic regurgitation was more common in men as compared to women (55.6 versus 48.9%; P U 0.007). Involvement of both the mitral and the aortic valve was observed in 49.8% of the patients and was more common in men as compared to women (52.7 versus 47.8%; P U 0.047). Conclusion In this consecutive cohort of patients with RHD in Nepal differential patterns of valvular involvement are observed across sex and age categories.
Complicated Case of Rheumatic Heart Disease; Unexplored for Years
OnLine Journal of Biological Sciences, 2014
Rheumatic heart disease is a one of the very common heart problem commonly prevalent among the children of developing countries, may occur in adults in their fourties also, if undiagnosed in early ages, similar in symptoms to 'rheumatism' but quite difficult to diagnose or are often misdiagnosed. The main objective of this article is to make acquainted about the disease and its further consequences, since initially it appears to be just a simple general fever but may prove deadly if undiagnosed or misdiagnosed leading to severe heart valve damage and consequent complications. The methods involved in the case include Bilateral Femoral Embolectomy (BFE), fasciotomy and Balloon Mitral Valvotomy (BMV). Through this case study an attempt has been made by the authors to make the people especially from the medical and related field, well acquainted about this deadly, silent, heart disease and its consequent complications.