Sydenham's chorea in Jerusalem: still present.
BACKGROUND
In developed countries the incidence of Sydenham's chorea, a major sign of rheumatic fever, has declined, but outbreaks are still encountered worldwide.


OBJECTIVE
To report the characteristics of a cohort of SC patients in the Jerusalem area.


METHODS
We conducted a prospective assessment of rheumatic fever and SC between 1985 and 2002. The diagnosis of rheumatic fever was based on the revised Jones criteria. Other etiologies of chorea were excluded. Recurrence was defined as the development of new signs lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. Patients were followed for 1 to 14 years following the initial SC episode, and at least one year after recurrence.


RESULTS
Among 180 children with rheumatic fever, 24 had SC. Most of them came from large families of Ashkenazi origin. In 19 patients (79%) the chorea was associated with other rheumatic fever signs, while 5 had pure chorea. Due to the systematic use of two-dimensional color Doppler echocardiography, cardiac involvement was detected in 75% of the patients. Ten patients (42%, 7 females) developed 11 recurrent episodes of chorea 3 months to 10 years after the initial episode. At recurrence, chorea was the sole rheumatic sign in all nine patients who recurred once. None of the patients had persistent chorea.


CONCLUSIONS
SC is still prevalent in the pediatric population of Jerusalem, and may recur years later. Recognition of the disease and adequate treatment is necessary.
Neurological Service, Bikur Cholim Hospital, Jerusalem, Israel. ikl@md.huji.ac.il
Isabelle
I
Korn-Lubetzki
Abraham
A
Brand
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002819:Chorea / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012213:Rheumatic Fever / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology