Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents

OBJECTIVES

To investigate the progress of rheumatic fever (RF) and the predictors of severe chronic valvar disease.

DESIGN

Patients prospectively followed up since their first attack of acute RF (ARF).

SETTING

Universidade Federal de Minas Gerais, Brazil.

PATIENTS

258 children and adolescents who met the revised Jones criteria for RF. The follow up period ranged from 2-15 years.

MAIN OUTCOME MEASURES

The presence and severity of mitral or aortic valvar disease were determined by both clinical and Doppler echocardiographic examinations. The variables associated with severe chronic valvar disease were initially identified by the Kaplan-Meier method and, later, by multivariate analysis.

RESULTS

Doppler echocardiography of 258 patients studied showed that 186 (72.1%) developed chronic valvar disease and 41 (15.9%) progressed to severe chronic mitral or aortic lesions. Of 146 patients who developed carditis, 49 (33.6%) had a normal clinical examination in the chronic phase but only nine (6.2%) had normal Doppler echocardiographic findings--that is, 40 (27.4%) patients progressed to chronic subclinical valvar disease. Moderate or severe carditis, recurrences of ARF, and mother's low educational level were risk factors in predicting severe chronic valvar diseases.

CONCLUSION

The increased risk of progressing to severe chronic valvar disease was associated with moderate or severe carditis, recurrences of ARF, and mother's low educational level. Hence, in a country such as Brazil, the options available for disease control are mainly primary and secondary prophylaxis.

[Prevalence of rheumatic fever in children from a public high school in Belo Horizonte]

PURPOSE

To determine the prevalence of rheumatic fever (RF) among children of a public high school in Belo Horizonte, Brazil.

METHODS

The study was performed from March to December/92, and involved high school students coming from families of the medium and low-medium social classes. Considering the total of 1,400 students registered in a public school and the estimated RF prevalence in the developing country, 729 students were randomly chosen to be interviewed and examined by a researcher. The children suspected of being affect by RF were submitted to echocardiography in order to find any cardiac lesions.

RESULTS

Due to several different factors, only 550 students aging from 10 to 20 years were admitted in this study. Four children, previously under secondary prophylactics, had already had the diagnosis of RF. Among these children, only one had heart disease (combined mitral incompetence and stenosis, and aortic incompetence). From the other three children, only one had the diagnosis of RF confirmed according to the Jones criteria.

CONCLUSION

From the ata obtained, the prevalence of RF was calculated in 3.6/1000.