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[Rheumatic cardiopathy in children younger than 6 years of age]
C Vázquez-Antona1, J Calderón-Colmenero, F Attié
1Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
This study analyzed 211 young children with Rheumatic Fever (RF), finding carditis in most cases and a 20% death rate. Penicillin prophylaxis and parental cooperation reduced RF incidence and severity over time.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Rheumatology
Context:
- Rheumatic Fever (RF) research has historically underrepresented young children.
- This retrospective study analyzed 211 cases of RF in children under 6 years old, diagnosed between 1944 and 1982.
- The study aimed to understand the clinical presentation, progression, and outcomes of RF in this specific pediatric demographic.
Purpose:
- To retrospectively investigate the clinical characteristics of Rheumatic Fever (RF) in children under six years of age.
- To identify risk factors, common complications such as carditis and valve lesions, and mortality rates.
- To evaluate the impact of penicillin prophylaxis and parental cooperation on disease outcomes over time.
Summary:
- Carditis was prevalent in 209 out of 211 pediatric RF cases, with mitral valve lesions being the most common (80%).
- The death rate during the initial attack was 20%, primarily due to refractory heart failure. Rheumatic pneumonia also contributed to mortality.
- Incidence, mortality, and valvular damage associated with RF in young children have decreased over time, potentially due to penicillin prophylaxis and improved disease management.
Impact:
- Highlights the significant burden of Rheumatic Fever (RF) and its cardiac complications in young children.
- Suggests that early diagnosis, consistent penicillin prophylaxis, and parental involvement are crucial for improving outcomes and reducing long-term sequelae.
- Provides valuable historical data for understanding trends in pediatric RF and informing current clinical practice and public health strategies.
Unlabelled:
Most of the published papers on Rheumatic Fever (RF) have not included the younger population. We selected 211 cases of children with RF younger than 6 years of age from 9,471 clinical files from 1944 to 1982. These were followed retrospectively to identify the presence of rheumatic activity, subsequent attacks and penicillin profilaxis. From de 211 cases, 209 had carditis; 57% of them were girls and 43% boys. There were no previous infections of the upper respiratory tract in 36% of the patients. The number of cases with RF increased abruptly after 3 years of age and continued increasing until 5 years of age when 70.5% of the population had there first clinically recognized attack. Lesions were present in the mitral valve in 80% of the cases, in the aortic valve in 12%, in the tricuspid in 5% and in the pulmonary valve in 3%. The death rate during the first attack was 20% being refractory heart failure the main cause of death. Thirteen cases suffered rheumatic pneumonia, 9 of whom died (69.2%).
Conclusions:
1) The incidence of acute rheumatic fever in children under 6 years of age has decreased with time. 2) The death rate as well as the valvular damage decreased with the parents cooperation with the treatment. 3) The changes in the clinical picture and the severity of valve sequelea may be due to penicillin profilaxis and the better understanding of the disease.