| First-episode versus recurrent acute rheumatic fever: is it different? | |
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MedLine Citation:
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PMID: 19405931 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Recurrent episodes of acute rheumatic fever (RF) can lead to rheumatic heart disease with considerable disability and mortality in children. RF can recur in the absence of secondary prophylaxis. The differences in clinical manifestations and outcome between first-episode and recurrent RF have been less studied. METHODS: A cross-section of patients under 14 years was studied for 2 years (2003-2005) in order to compare the clinical, laboratory, echocardiographic profile and outcome of first-episode RF with recurrent attacks, and risk factors for recurrence and mortality. Patients without a previous history of RF and/or mitral stenosis (MS) and/or aortic stenosis (AS) were defined as first-episode patients, and patients with previous history of RF and/or MS and/or AS, were defined as recurrent RF patients based on the Jones criteria. RESULTS: Of 51 patients in total, 26 had first-episode RF and 25 had recurrent RF. Arthritis occurred in a significantly higher number of first-episode patients (P = 0.047) whereas shortness of breath (SOB; P = 0.003), palpitation (P = 0.034), and aortic regurgitation (AR; P = 0.001) occurred in a significantly higher number of recurrent RF patients. Audible murmur of corresponding echocardiographic regurgitation was present in all recurrent RF patients whereas audible murmur was present in 61.5% and echocardiographic regurgitation in 81% in first-episode patients (P = 0.007). Palpitation, SOB, audible murmur, thrill, age and AR on admission were independent predictors of recurrence. Palpitation, age and AS on admission were independent predictors of mortality. CONCLUSIONS: Subclinical carditis occurred only in the first-episode patients, which requires further evaluation for clinical significance. Because all deaths occurred in recurrent RF group (P = 0.02), secondary prophylaxis and management of sore throat need re-emphasis. |
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Authors:
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Ajit Rayamajhi; Deewakar Sharma; Urmila Shakya |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Pediatrics international : official journal of the Japan Pediatric Society Volume: 51 ISSN: 1442-200X ISO Abbreviation: Pediatr Int Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-05-01 Completed Date: 2009-08-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100886002 Medline TA: Pediatr Int Country: Australia |
Other Details:
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Languages: eng Pagination: 269-75 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, Cardiology Unit, National Academy of Medical Sciences, Kanti Children's Hospital, Kathmandu, Nepal. ajitrnp@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Aortic Valve Insufficiency / epidemiology Arthritis / epidemiology Child Child, Preschool Cross-Sectional Studies Heart Murmurs Heart Valve Diseases / epidemiology* Humans Hypertension, Pulmonary / epidemiology Mitral Valve Insufficiency / epidemiology, ultrasonography Nepal / epidemiology Recurrence Rheumatic Fever / diagnosis*, mortality Rheumatic Heart Disease / epidemiology* Risk Factors Tricuspid Valve Insufficiency / epidemiology, ultrasonography |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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