Clinical spectrum of rheumatic fever and rheumatic heart disease: A 10 year experience in an urban area of south

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.Aim: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.Materials and 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.

Spectrum of Clinical Presentation of Rheumatic Fever and Rheumatic Heart Disease Patients

“…[6] Chorea, subcutaneous nodules and erythema marginatum were reported by Joseph N, et al in 13.7%, 7.8% and 5.9% cases, respectively, but contrary to that none of the patients reported all three features in the present study. [7] Chockalingam A et al and other studies reported pericarditis in 37.5% and 41.2%, respectively which is very high as reported by the present study. In initial phase carditis is reported to have a mortality of about 70% and condition can progress to chronic RHD.…”

“…Similar findings were reported by present study using ECHO evaluation. [7] The study done by Melka A et al also reported MR combined with MS as most common lesions in 25.4% patients which supports out findings. [10] But Ravisha MS, et al reported MR to be the most common valvular lesion in RHD patients, which is similar to the findings reported by the present study clinically in 40% patients.…”

“…[8,9] Also the condition can recur in many of the patients, use of antibiotics should be continued for longer duration in RF patients. [7] In the present study, chest X-ray showed features of cardiomegaly, pericardial effusion, PAH and straightening of the border in 42.8%, 4.2%, 28.5% and 20% of patients respectively. The most common valvular lesion found clinically was pure MR in 40% patients followed by pure MS in 30% patients.…”

Fifteen-minute consultation: rheumatic fever

“…Valvulitis occurs in the mitral valve in 65–75% of cases, aortic valve in 7–30% of cases with the tricuspid valve affected in 10% of cases and involvement of the pulmonary valve being rare 2 6–9…”

Contemporary Issues in Rheumatic Fever and Chronic Rheumatic Heart Disease

“…37 What is clear, however, is that the use of secondary prophylaxis, even in clinically diagnosed RF and RHD is poor worldwide, averaging only ≈30% of patients eligible for penicillin. 69,70 It is therefore incumbent on proponents of mass echocardiographic screening for RHD to conduct prospective randomized controlled studies to provide the burden of proof that this strategy would result in superior clinical outcomes, 71 although some have pointed out that the logistics and ethics make this an unlikely proposition.…”