Acute rheumatic fever

Incidence and diagnosis of acute rheumatic fever in Denmark, 1980 and 1983. A retrospective analysis of the fulfillment of the revised Jones criteria in hospitalized patients

A review of 1547 official hospital record summaries concerning discharges during the period 1980 through 1983 of patients whose diagnoses had been coded as acute rheumatic fever revealed that in only 61% of the cases had this illness been diagnosed or suspected. A substantial proportion of the remaining patients had had acute non-rheumatic pericarditis diagnosed. The medical records were analyzed for 141 patients diagnosed in 1980 or 1983 by hospital departments as having acute rheumatic fever with regard to the revised Jones criteria. They were fulfilled in 47 patients, 23 of whom were considered unlikely cases of rheumatic fever. Eight patients were considered possible cases, although they did not fulfill the revised Jones criteria. The current annual incidence of acute rheumatic fever was estimated to be at most 0.3 per 100,000 inhabitants.

Survey of rheumatic heart disease in school children of Kinshasa town

STUDY OBJECTIVE

To determine the prevalence of rheumatic heart disease and study the association of this disease to factor such as personal host and environment.

DESIGN

A cross sectional survey was carried out by a specially trained medical team.

SETTING

The study involved high risk school children aged 5-16 years from Binza-Kinshasa urban area and adjoining slums in semi-urban area of Kinshasa town.

METHODS

A total of 4848 children randomly selected on the list of semi-urban and urban schools and representing 10% of the schools population were included in the survey with clinical echocardiographic examinations.

RESULTS

Of the 4848 children screened, prevalence of rheumatic heart disease was 14.03/1000. The prevalence was significantly greater in slums schools (22.2/1000) than in urban school (4/1000). In slums area, the mitral valve was the valve most commonly affected by rheumatic heart disease. Risk factors such as birth in rainy season (RR=2.2), low birth weight (RR=1.81), low socioeconomic status (RR=2.68), malnutrition<mean BMI-1 SD (RR=2.64), crowding>8 persons/household (RR=4.10) and migrant status (RR=4.79) predicted significantly rheumatic heart disease occurrence in children living in the semi-urban area (slums). Only birth in rainy season (RR=3.24) predicted significantly rheumatic heart disease onset in children having residence in the urban area.

CONCLUSIONS

Rheumatic heart disease runs a more severe course in Kinshasa, because appropriate medical care, sanitary conditions, primary and secondary prophylaxis are not available. Echocardiograpy is necessary to identify cases of rheumatic heart disease.

Outbreak of acute rheumatic fever in northeast Ohio

An outbreak of acute rheumatic fever in 23 patients was seen in northeastern Ohio in 1986, with polyarthritis (78%) and carditis (30%) the major manifestations. Results of a questionnaire completed by the parents of all 23 patients indicated that they were generally nonindigent, with good access to medical care, and from a nonurban setting. Records of inpatients with acute rheumatic fever were reviewed for the 10 years prior to 1986. The clinical manifestations in inpatients from 1976 to 1985 were not significantly different from those of inpatients seen during 1986. Similar outbreaks have been reported elsewhere, and physicians should be aware of a possible resurgence of classic acute rheumatic fever and ensure compliance with an adequate course of therapy for patients with streptococcal pharyngitis.

Acute rheumatic fever in Swedish children 1971-80

Hospital records from all Swedish children 0-15 years old diagnosed as having acute rheumatic fever (ARF) during 1971-80 were studied. Thirty-one children fully met with Jones' modified criterias which gives an incidence of 0.2 cases per 100 000 children and year. Carditis was the most common major manifestation of ARF. In most children the carditis was mild but in three cases there was a persistent cardial affection. 16 of the children received prophylactic antibiotic treatment. No recurrent attacks of ARF were found during the study period.

Rheumatic fever in the West Kimberley

A retrospective study was performed to document the high incidence of rheumatic fever in the West Kimberley region of Western Australia. Derby Regional Hospital case records from 1970 to 1979 were examined. Population estimates were calculated using data of the Australian Bureau of Statistics and the Community Health Department, Perth. Rheumatic fever was shown to be a relatively common condition with significant morbidity in certain population groups. The disease has a high mean age of onset (14.5 years), and is significantly more common in females than males, and in Aborigines than in non-Aborigines. Case numbers show no downward trend. The incidence of hospitalized cases of rheumatic fever in Aboriginal schoolchildren for 1975 to 1979 is between 2.3 and 3.5 per 1000. The limitations of the study are discussed. The importance of accurate diagnosis and a comprehensive system for future prevention of rheumatic fever and rheumatic heart disease at a community level is stressed.

Rheumatic fever in Minnesota. II. Evaluation of hospitalized patients and utilization of a State Rheumatic Fever Registry

We studied the hospital records of 124 patients with a discharge diagnosis of acute rheumatic fever who were hospitalized in 21 Minneapolis-St. Paul hospitals during 1975 and 1976. After careful review of the hospital records, we found that 83 (67 per cent) of these patients did not have an acute illness. Seventeen (41 per cent) of the 41 cases with an acute illness were thought to adequately fulfill the Jones' Criteria for acute rheumatic fever. Upon review of the rheumatic fever registry of the Minnesota State Health Department, we found that less than one-half of the hospitalized patients had been reported to the registry. Cases that fulfilled and did not fulfill the Jones' Criteria were reported with equal frequency, indicating significant underreporting and overreporting of rheumatic fever. Evaluation of secondary rheumatic fever prophylaxis, both in those patients with acute rheumatic fever as well as in those with rheumatic heart disease, indicated that many patients who, in theory, should be receiving prophylaxis were not receiving it. These studies indicate a need for more thorough evaluation of the current epidemiology of rheumatic fever and the role of a rheumatic fever registry, and imply a need for reevaluation of these programs. (Am J Public Health 69:767-771, 1979).