Document Detail


First-episode versus recurrent acute rheumatic fever: is it different?
MedLine Citation:
PMID:  19405931     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Ajit Rayamajhi; Deewakar Sharma; Urmila Shakya
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
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:
Created Date:  2009-05-01     Completed Date:  2009-08-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886002     Medline TA:  Pediatr Int     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  269-75     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Cardiology Unit, National Academy of Medical Sciences, Kanti Children's Hospital, Kathmandu, Nepal. ajitrnp@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
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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