Acute rheumatic fever outbreak in southern central European country.
A decline in the incidence of acute rheumatic fever (ARF) in developed countries over the past century can be attributed to the improved public hygiene and to widespread use of antibiotics. ARF seemed to be a rare disease in southern central European country, Slovenia, up to 2010 when we noticed an increase in the number of patients with ARF. In order to assess the current incidence of ARF, we performed a retrospective study of all patients with ARF treated at the University Children's Hospital Ljubljana from January 2008 until the end of December 2014. In a period of 7 years, 19 patients with ARF were identified. The estimated annual incidence of ARF during the study period was 1.25 cases per 100,000 children. Carditis was present in all patients, arthritis in 37 % and Sydenham chorea in 32 %.


CONCLUSIONS
Recent ARF outbreak in Slovenia revealed that this disease is still present in southern central Europe with an estimated annual incidence of 1.25 cases per 100,000 children. Unrecognized or inadequately treated ARF could be the cause of acquired heart disease and must be even nowadays included among the differential diagnoses in a febrile child with arthritis, heart murmur or movement disorder. What is Known: • Acute rheumatic fever (ARF) is diagnosed based on the major and minor Jones Criteria. • A decline in the incidence of ARF in developed countries over the past century can be attributed to the improved public hygiene and to widespread use of antibiotics. What is New: • In the last decade, an increase in the incidence of ARF was observed in Slovenia which has a central European geographic position. • Our paper highlights the importance of including ARF in the differential diagnosis of a febrile child with arthritis/arthralgia and/or heart murmur and/or acute chorea.
Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia. urska.j.kocevar@gmail.com.
Urška
U
Kočevar
Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia.|Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia.
Nataša
N
Toplak
Department of Cardiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
Blaž
B
Kosmač
Department of Child, Adolescent and Developmental Neurology, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
Luka
L
Kopač
Department of Cardiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
Samo
S
Vesel
Department of Child, Adolescent and Developmental Neurology, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
Natalija
N
Krajnc
Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia.|Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
Matjaž
M
Homan
Department of Nephrology, University Children's Hospital, University Medical Center, Ljubljana, Slovenia.
Rina
R
Rus
Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia.|Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia.
Tadej
T
Avčin
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D010406:Penicillins / Q000008:administration & dosage; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000175:diagnosis / Q000453:epidemiology*; D055502:Secondary Prevention / Q000379:methods; D017524:Slovenia / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D010406:Penicillins
Acute rheumatic fever; Arthritis; Central Europe; Heart valve disease