title: Clinical spectrum of rheumatic Fever and rheumatic heart disease: a 10 year experience in an urban area of South India.
abstract: BACKGROUND
  Rheumatic fever (RF) is an important problem concerning developing countries like India. Rheumatic heart disease (RHD) is one of the most readily preventable chronic diseases.
  
  
  OBJECTIVE
  This study was done to find out the clinical profile, risk factors, compliance with treatment and outcome among RF/RHD cases so as to suggest better case management strategies.
  
  
  METHODS
  Clinical records of 51 RF and 71 RHD cases admitted in tertiary care hospitals in Mangalore between 2001 and 2010 were reviewed retrospectively.
  
  
  RESULTS
  Mean age of RF cases were 17.4 ± 12.1 years and RHD cases were 33.2 ± 18.6 years. More than half of RF and RHD cases were males. Commonest risk factors among RF cases were poor socioeconomic status (60.4%), history of upper respiratory tract infection before disease onset (58.8%) and undernutrition (35.3%). Commonest clinical manifestation among RF cases was fever 39 (76.5%) followed by polyarthritis 34 (66.7%). Commonest valvular lesions among RHD cases was mitral stenosis with mitral regurgitation found in 42.9% cases. Compliance of patients with prophylactic antibiotics was found to be 37 (30.3%). Mortality rate was significantly more among RHD cases (P = 0.0399).
  
  
  CONCLUSIONS
  Improvement of socioeconomic and nutritional factors is an important task required for primary prophylaxis and of compliance for secondary prophylaxis of RF.
authors.affiliation: Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Joseph
authors.affiliation: Department of Internal Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Madi
authors.affiliation: Department of Community Medicine, JIPMER, Puducherry, India.
authors.forename: Ganesh S
authors.initials: GS
authors.lastname: Kumar
authors.affiliation: Department of Community Medicine, A J Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India.
authors.forename: Maria
authors.initials: M
authors.lastname: Nelliyanil
authors.affiliation: Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Vittal
authors.initials: V
authors.lastname: Saralaya
authors.affiliation: Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Sharada
authors.initials: S
authors.lastname: Rai
keywords: Clinical features; Compliance; Rheumatic fever; Rheumatic heart disease; Risk factors; Valvular lesions