Clinical, laboratory and echocardiographic profile of acute rheumatic fever in Nepali children.
BACKGROUND
Acute rheumatic fever (RF) is a common, preventable health problem in developing countries. Sporadic outbreaks and the prevalence in some indigenous populations have renewed interest in RF in developed countries also.


OBJECTIVE
To describe the clinical, laboratory and echocardiographic features, outcome and value of echocardiography in detecting valvular disease in RF.


METHODS
A prospective, cross-sectional study was conducted over 2 years. Patients under 14 years admitted to the cardiology unit of Kanti Children's Hospital, Kathmandu with RF using the Jones criteria were recruited consecutively.


RESULTS
The median age (range) of the 51 patients was 11 (5-14) years, the male:female ratio was 1.6:1 and 39% had a history of a sore throat. Clinical and laboratory features detected were as follows: carditis 92%, arthritis 33%, chorea 8%, subcutaneous nodules 4%, fever 51%, arthralgia 37%, elevated antistreptolysin O titre 94%, elevated CRP 78%, prolonged PR interval 45%, pericardial effusion 22% and cardiac failure 28%. In total, 36 patients (71%) complained of joint pains. A murmur on auscultation was significantly associated with underlying diseased valves confirmed by echocardiography (p=0.001). A murmur was audible in 78.4% and diseased valves were confirmed by echocardiography in 88.2%. The mitral valve was the most commonly involved valve (82%) and mitral regurgitation the commonest lesion (24%). A thickened mitral valve predicted carditis (p=0.007). Five (10%) patients died.


CONCLUSIONS
Inclusion of echocardiographic evidence of carditis and possibly arthralgia as major criteria would improve case detection.
Rayamajhi
Ajit
A
Cardiology Unit, Department of Paediatrics, National Academy of Medical Sciences, Kanti Children's Hospital, Kathmandu, Nepal. ajitrnp@yahoo.com
Sharma
Deewakar
D
Shakya
Urmila
U
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D009205:Myocarditis / Q000175:diagnosis / Q000000981:diagnostic imaging; D009390:Nepal; D011379:Prognosis; D011446:Prospective Studies; D012213:Rheumatic Fever / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000000981:diagnostic imaging; D014463:Ultrasonography