Retrospective evaluation of patients with the diagnosis of acute rheumatic fever: a single center experience of 5 years.

Abstract

Objective: To evaluate the demographic characteristics, clinical findings, laboratory values, treatment responses and prognosis of patients who followed up with acute rheumatic fever (ARF) in a pediatric cardiology clinic. Method: Two hundred and four patients followed up with the diagnosis of ARF, between December 2004 and April 2009, were reviewed retrospectively from archive files. Findings: Study population consisted of female (46.5%), and male (53.5%) aith a mean age of 10.3±2.8 years and a mean follow-up period of 26.8±13.3 months. The majority of the patients were between the ages of 6-15. The patients consulted to the hospital most frequently in winter and spring months. While the most common presenting symptom was joint findings, while the most rarely detected presenting symptom was the presence of subcutaneous nodules. The most common major, and minor findings were carditis (82.2%) and fever (28.9%), respectively. The frequency of minor criteria of fever and arthralgia associated with carditis was found to be significantly higher than those associated with other major findings (p<0.05). Frequency of cardiac murmur, cardiomegaly and tachycardia increased when the grade of carditis increased (p<0.05). The frequency of minor criteria of fever, leukocytosis, elevated CRP levels associated with arthritis was found to be significantly higher than that of associated with the other major findings (p<0,05). Artritis and chorea were not seen concurrently in any of the patients. CRP increment was rarely seen in patients with chorea which was found to be statistically significant (p<0,05). Most commonly mitral valve was involved. During the follow up, reactivation was seen in 18,8% of the patients, and 50% of these patients did not comply with the secondary preventive treatment properly. Reactivation occurred in 11% of the patients under proper secondary preventive treatment (p<0,05). Conclusion: Acute rheumatic fever is still the most common acquired cardiologic disease in underdeveloped and developing countries despite its decreasing importance and disease frequency in developed countries.