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Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic Heart Disease I: Introduction01:23

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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Myocarditis II: Clinical Features and Diagnostic Tests01:27

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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Pericarditis II: Clinical Features and Diagnostic Tests01:19

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Pericarditis is distinguished by inflammation of the pericardium, the fibrous sac that encases the heart. It can be acute, lasting less than six weeks, or chronic, persisting for over three months. Understanding its clinical manifestations and diagnostic findings is crucial for timely and effective management.Clinical ManifestationsWhile pericarditis can be asymptomatic, it usually presents with characteristic symptoms such as:Chest Pain: The most characteristic symptom of pericarditis is chest...
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Acute Rheumatic Fever: Where Do We Stand? An Epidemiological Study in Northern Italy.

Achille Marino1, Rolando Cimaz2,3, Maria Antonietta Pelagatti4

  • 1Department of Pediatrics, Desio Hospital, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy.

Frontiers in Medicine
|March 15, 2021
PubMed
Summary

Acute rheumatic fever (ARF) incidence in Monza-Brianza is high, exceeding low-risk thresholds. Diagnosis should consider moderate-high-risk criteria, with expert consultation advised for uncertain cases.

Keywords:
Jones criteriaacute rheumatic fevercarditisgroup A β-hemolytic streptococcuspenicillin

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Area of Science:

  • Rheumatology
  • Pediatrics
  • Infectious Diseases

Background:

  • Acute rheumatic fever (ARF) is a non-septic sequela of group A Streptococcus (GAS) pharyngitis.
  • The Jones criteria, established in 1944, are used for ARF diagnosis and have undergone revisions.
  • The 2015 Jones criteria revision emphasizes regional epidemiological data for accurate diagnosis.

Purpose of the Study:

  • To characterize ARF features in a 10-year retrospective cohort (2009-2018).
  • To determine the annual incidence of ARF in children within the Province of Monza-Brianza, Italy.
  • To assess the epidemiological risk status of the region based on updated ARF incidence data.

Main Methods:

  • Multicentric, cross-sectional/retrospective study design.
  • Analysis of 70 patients diagnosed with ARF between 2009 and 2018.
  • Calculation of annual ARF incidence using data from 47 resident children aged 5-14 years in Monza-Brianza.

Main Results:

  • The median age of ARF diagnosis was 8.5 years; carditis (40 cases) was the most frequent major Jones criterion, followed by arthritis (27) and chorea (20).
  • The median annual incidence of ARF in children aged 5-14 in Monza-Brianza was 5.7 per 100,000 (range: 2.8-8.3/100,000).
  • ARF incidence in the study region consistently surpassed the low-risk threshold defined by the 2015 Jones criteria.

Conclusions:

  • The Province of Monza-Brianza exhibits a moderate-to-high risk for ARF in children aged 5-14.
  • Diagnosis of ARF should incorporate the moderate-high-risk set of Jones criteria.
  • Given the implications for secondary prophylaxis, expert consultation is recommended for uncertain ARF diagnoses.