title: [Acute rheumatic fever in children, a diagnostic problem].
abstract: Three girls of Moroccan descent, aged 9, 10 and 7 years, presented with fever, joint pain and other symptoms. After Streptococcus infection and carditis were confirmed and the Jones criteria for acute rheumatic fever were met, the patients were treated with penicillin and acetylsalicylic acid. All 3 patients recovered. However, the second girl presented 2 months later with cardiac decompensation caused by valve disorders, after which aortic and mitral valvuloplasty was performed. The third girl developed joint pain again after 3 weeks and was diagnosed with juvenile idiopathic arthritis; treatment was adjusted accordingly. The prevalence of rheumatic heart diseases is 10-20 times higher in developing countries than in industrialised nations. The diagnosis 'acute rheumatic fever' should be considered in children of school age with unexplained fever, also when the Jones criteria have not yet been met. This may apply to migrant children in particular.
authors.affiliation: Sint Lucas Andreas Ziekenhuis, afd Kindergeneeskunde, Amsterdam.
authors.forename: J W
authors.initials: JW
authors.lastname: Wieringa
authors.forename: C
authors.initials: C
authors.lastname: Ramaker
authors.forename: B H M
authors.initials: BH
authors.lastname: Wolf
mesh_terms: D000208:Acute Disease; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D018771:Arthralgia / Q000209:etiology; D001241:Aspirin / Q000627:therapeutic use; D002648:Child; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D009018:Morocco / Q000208:ethnology; D009426:Netherlands / Q000453:epidemiology; D010406:Penicillins / Q000627:therapeutic use; D012213:Rheumatic Fever / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010406:Penicillins; D001241:Aspirin