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[Acute rheumatic fever: a report]
A Boccazzi1, C Bellosta, P Tonelli
1Clinica Pediatrica I, Università degli Studi, Milano.
Insights
Acute rheumatic fever (ARF) remains a significant concern. Many ARF cases lack clear preceding strep throat symptoms, highlighting diagnostic challenges for this pediatric and adult disease.
Area of Science:
- Rheumatology
- Pediatrics
- Infectious Diseases
Context:
- Acute rheumatic fever (ARF) is a significant global health issue, particularly affecting pediatric populations.
- Recent literature indicates a potential increase in ARF cases, necessitating further investigation into its epidemiology and clinical presentation.
- Understanding ARF's varied manifestations, including joint involvement, cardiac disease, and chorea minor, is crucial for timely diagnosis and management.
Purpose:
- To evaluate the clinical characteristics and epidemiological trends of acute rheumatic fever (ARF) cases diagnosed at a Pediatric Teaching Hospital between 1988 and 1997.
- To assess the association between ARF presentation and preceding streptococcal pharyngitis, including clinical history and laboratory findings.
Summary:
- The study analyzed ARF cases from 1988-1997, observing frequent joint involvement alongside cardiac disease and chorea minor.
- Approximately 50% of pediatric ARF patients did not report a history of febrile tonsillopharyngitis preceding ARF.
- Crucially, no throat swabs were positive for group A beta-hemolytic streptococci, suggesting ARF can occur without overt signs of streptococcal infection.
Impact:
- These findings underscore the importance of prompt diagnosis and treatment of streptococcal pharyngitis to prevent ARF.
- The study suggests that ARF may develop even in the absence of clear clinical or microbiological evidence of a preceding streptococcal infection, complicating diagnosis.
- This highlights the need for heightened clinical suspicion for ARF in pediatric patients, even with atypical or absent preceding infection history.
Abstract:
Acute rheumatic fever (ARF) is still an important disease of the pediatric and adult age. The increased number of cases described in the literature in the last 10 years brought us to evaluate the ARF cases diagnosed in a Pediatric Teaching Hospital in the period 1988-1997. Most of the children with ARF presented with joint involvement even if patients with cardiac disease or chorea minor were numerous. About 50% of our patients with ARF did not refer a history of a febrile tonsillopharyngitis in the 15-60 days before the presentation of ARF. The remaining patients have had a preceding pharyngitis not adequately treated. In none of the subjects a throat swab positive for group A beta hemolytic streptococci was available. These results confirm the importance of the correct diagnosis and treatment of streptococcal pharyngitis but suggest that ARF can develop without any outstanding clinical evidence of streptococcal infection.