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Acute rheumatic fever - A pathological analysis of clinically missed cases

Ashutosh Goyal1, Pradeep Vaideeswar2, Pawan Daga1

  • 1Intern, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Indian Journal of Pathology & Microbiology
|October 21, 2021
PubMed
Abstract

Insights

Many acute rheumatic fever (ARF) cases are missed due to atypical presentations, especially recurrent ones. Diagnosis may require considering minor Jones criteria or clinical suspicion when typical signs are absent.

Area of Science:

  • Pathology
  • Cardiology
  • Rheumatology

Background:

  • Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are prevalent in India.
  • Many ARF cases are undiagnosed or missed despite current diagnostic criteria.

Purpose of the Study:

  • To analyze pathological profiles of missed ARF cases.
  • To evaluate the importance of these profiles in relation to clinical presentation and Jones criteria.

Main Methods:

  • A 22-year retrospective observational study of autopsied RHD cases.
  • Categorization of ARF cases based on adherence to Jones criteria.
  • Classification of cardiac lesions as mitral stenosis and/or regurgitation (MS ± MR) or pure mitral regurgitation (MR).

Main Results:

  • 59 (8.5%) of 697 RHD autopsies were ARF cases.
  • Only 7 ARF cases met Jones criteria; 5 were diagnosed clinically.
  • 52 (88.1%) ARF cases did not meet criteria and were undiagnosed, with 34 having MS ± MR and 18 MR.
  • Recurrences were noted in 69.5% of ARF patients.

Conclusions:

  • Typical Jones criteria manifestations may be absent in ARF, particularly in recurrent cases.
  • A presumptive diagnosis of ARF can be considered with minor criteria or strong clinical suspicion.
  • Pathological analysis is crucial for identifying missed ARF diagnoses.
Keywords:
Acute rheumatic feverautopsymyocarditisrheumatic heart diseasevalvular regurgitationvalvular stenosisvalvulitis

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