Acute Rheumatic Fever In Egyptian Children: A 30- YearExperience in a Tertiary Hospital

Doaa Mohamed Elamrousy, Hassan Al-Asy, Wegdan Mawlana
4.672 1.021

Abstract


Acute rheumatic fever (ARF) is a leading cause of pediatric acquired heart disease amongst indigenous populations in Egypt, mainly presenting in children aged 5–15 years. This retrospective study was carried out in Tanta University Hospital, Tanta, Egypt to determine the hospital average new cases of acute rheumatic fever (ARF), and its characteristics in the past 30 years. We reviewed and retrospectively analyzed the medical records of all children hospitalized and diagnosed with ARF based on Jones criteria in Pediatric Department of Tanta University Hospitals in the period between January 1982 and December 2011. 2946 children with ARF were admitted in this period. 40.9%were admitted between 1982 and 1991, 38.86% between 1991 and 2001, and only 20.3% between 2001 and 2011. Male/female ratio was 1:1.2.The mean age at diagnosis was 9 ± 3.0 years (range 3-16). Carditis was detected in 48.9%, arthritis in 37.5 %, chorea in 4.9%, and combined lesions in 8.7%. Mitral regurgitation was the most common echocardiographic finding in patients with carditis (43.3%), isolated aortic regurgitation in (11.1%); double mitral lesion in (1.4%), mitral stenosis in (0.76 %) and aortic stenosis in only (0.34%). Over the 30-year study period, there was average of annual new cases of 98 patients/year with peaks at 1982,1986,1987 and 1991.  Although the incidence of ARF has decreased in the last decade, it still continues to be an important public health problem in Egypt, despite the progress made in the socio-economic development of the country, and is often associated with cardiac involvement.


Keywords


Acute Rheumatic Fever, Children,

Full Text:

E220


DOI: http://dx.doi.org/10.17334/jps.57302

References


Lennon D. Acute rheumatic fever. In: Cherry F, ed. Textbook of Paediatric Infectious Diseases, 5th ed. Baltimore, MD: WB Saunders; 2004, 413–26.

Olivier C. Rheumatic fever-is it still a problem? Journal Antimicrob Chemother. 2000; 45:13-21.

Carapetis JR. Rheumatic heart disease in developing countries. N Engl J. Med.2007; 357, 439–441.

Örün UA,Ceylan Ö,BiliciM, et al. Acute rheumatic fever in the central antolia region of Turkey: a 30-year experience in a single center. Eur J Pediatr. 2012; 171:361-368.

Anonymous. Guidelines for the diagnosis of rheumatic fever. Jones Criteria, update (1992). Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA. 1992; 268:2069– 2073.

Adnan SD, Ayoub E, Bierman FZ, et al. Guidelines for the diagnosis of rheumatic fever. Jones criteria, updated 1992. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 1993; 87:302–307.

Olgunturk R, Canter B, Tunaoglu FS, Kula S. Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria. Int J Cardiol. 2006; 10:91–98.

Stewart T, McDonald R, Currie B. Use of the Jones criteria in the diagnosis of acute rheumatic fever in an Australian rural setting. Aust N Z J Public Health. 2005; 29:526–529.

Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet. 2005; 366:155–168.

Cleonice C, Mota C, Aiello VD. Rheumatic fever. In: Anderson RH, Baker EJ, Penny D, Redington AN, Rigby ML, Wernovsky G (eds) Pediatric cardiology, 3rd ed. Churchill Livingstone, Philadelphia, 2010. pp 1091– 1113

Faheem M, Hafiuzullah M, Gul A, Jan H, Asghar Khan M . Pattern of valvular lesions in rheumatic heart disease.J P M I. 2007; 91: 99Ahmed AM. Prevalence of rheumatic fever and rheumatic heart disease in a group of a school childrenin Giza governorate and concomitant association with mitral regurgitation. J A C.2005; 16:693-699.

Vinker S, Zohar E, Hoffman R, Elhayany A. Incidence and clinical manifestations of rheumatic fever: a 6 year community based survey. Isr Med Assoc J.2010; 12:78–81.

Atatoa-Carr P, Lennon D, Wilson N. New Zealand Rheumatic Fever Guidelines Writing Group. Rheumatic fever diagnosis, management, and secondary prevention: a New Zealand guideline. NZ Med J.2008; 121 (1271), 59–69.

Bitar FF, Hayek P, Obeid M, Gharzeddine W, Mikati M, Dbaibo GS. Rheumatic fever in children: a 15-year experience in a developing country. Pediatr Cardiol. 2000; 21:119–122.

Al Qurashi M. The pattern of acute rheumatic fever in children: experience at the children’s. J Saudi Heart Assoc. 2009; 21:215–220

Breda L, Marzetti V, Gaspari S, Del Torto M, Chiarelli F, Altobelli E. Population-based study of the incidence and clinical characteristics of rheumatic fever in Abruzzo, central Italy, 2000-2009. J Ped. 2012; 160:832-836.

Hamza HS, Hassan NE, Attia WA, Dwidar OH. Echo pattern of different cardiac lesions among Egyptian rheumatic heart children. Res J Medicine & Med Sci.2013; 8:23-30.

Yim D, Chidlow B, Tallon M, Woods S, Ramsay J. Twenty-three years experience of acute rheumatic fever in a tertiary hospital in Australia. Heart, Lung and Circulation.2010; 19S: S254.