Acute rheumatic fever: clinical profile in children in western Ukraine

Acute rheumatic fever (ARF) may have different clinical manifestations in different countries according to the genetic predisposition, prevalence of rheumatogenic strains, social and economic conditions. The purpose of this study was to determine the clinical characteristics of ARF in Western Ukraine and to improve the detection of the cases. A retrospective analysis of 85 medical clinical cases of in-hospital patients aged from 4 to 17 years old was performed. The cases covered patients who underwent treatment in the City Children's Hospital of Ternopil during 2000 and 2013 with the ARF diagnosis, which was established according to Jones criteria. 65.9% of the ARF patients were admitted to the hospital from October to March. Fever (65.9%) and joint syndrome (78.8%) were the most common causes for admission to the medical care. The admission diagnosis was wrong in 34 (40.0%) children who underwent the treatment. The most frequent major Jones criteria of ARF were carditis (84.7%) and polyarthritis (54.1%). Chorea was significantly less common than carditis (р < 0,001). The adequate treatment of the preceding streptococcal infection was administered in 25 children (53.2%).

The significant incidence of misdiagnoses in the ARF children during admission to the hospital, especially the interpretation of joint syndrome, indicates that physicians need an extra awareness. The lack of specific clinical signs of rheumatic carditis makes it a diagnostic challenge. The revised Jones criteria (2015) for the diagnosis of ARF can improve carditis detection. The adequate treatment of the preceding streptococcal infection may prevent ARF. Abbreviations: ARF = acute rheumatic fever.