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Evaluation of Children with Acute Rheumatic Fever: A Single-Center Experience
Ahmet Güneş1, Alper Akın2, Mehmet Türe2
1Department of Pediatrics, Dicle University Medical Faculty, Diyarbakır, Turkey.
Insights
Acute rheumatic fever (ARF) recurrence in children is linked to poor prophylaxis adherence, increased valve damage, and higher alanine transaminase (ALT) levels. Early diagnosis and consistent treatment are crucial for preventing ARF complications.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Infectious Diseases
Background:
- Acute rheumatic fever (ARF) is a significant concern in pediatric cardiology, necessitating a thorough understanding of its epidemiological profile and risk factors.
- Accurate diagnosis and differentiation from other conditions presenting with similar symptoms are critical for effective management.
Purpose of the Study:
- To evaluate the epidemiological characteristics, risk factors, clinical presentation, and treatment outcomes of pediatric patients with a pre-diagnosis of ARF.
- To identify factors associated with ARF recurrence and its impact on disease severity.
Main Methods:
- Retrospective analysis of 166 patients diagnosed with ARF and 51 patients without ARF from a Pediatric Cardiology Outpatient Clinic.
- Evaluation of patient demographics, clinical symptoms, laboratory findings, diagnostic criteria, and treatment adherence.
Main Results:
- ARF patients ranged from 5 to 18 years old, with peak incidence in winter months (December-February).
- The most common initial presentation was isolated joint pain/swelling (50.6%), with carditis being the most frequent major criterion (94.6%).
- ARF recurrence (8.5%) was associated with non-compliance with prophylaxis, higher rates of valve regurgitation and monoarthritis, lower Anti-streptolysin O titers, and elevated alanine transaminase (ALT) levels.
Conclusions:
- Differential diagnosis is essential for patients presenting with suspected ARF, especially those with isolated joint complaints.
- Non-compliance with prophylactic treatment is a key factor in ARF recurrence.
- Recurrent ARF is linked to more severe valve damage and elevated ALT levels, highlighting the importance of adherence to preventive strategies.
Objective:
The epidemiological characteristics, risk factors, complications, recurrence status, clinical and laboratory features, and treatment methods of the patients who admitted to our Pediatric Cardiology Outpatient Clinic with a pre-diagnosis of acute rheumatic fever (ARF) were evaluated.
Materials And Methods:
The data of 166 patients who admitted with a pre-diagnosis of ARF and were diagnosed with ARF, and the data of 51 patients who were not diagnosed with ARF, were retrospectively analyzed.
Results:
The patients with ARF were between the ages of 5 and 18. Most of the patients with ARF attack admitted in December (15.6%), January (13.8%), and February (13.2%). The most common complaints of the patients diagnosed with ARF were isolated joint pain and/or swelling, at 50.6%. While 91.5% of the patients were diagnosed for the first time, 8.5% had ARF recurrence. It was seen that the most common major criterion was carditis (94.6%). The severity of valve regurgitation and the rates of monoarthritis were significantly higher in patients with recurrence (P < .05). Non-compliance with prophylaxis was observed in 10 (71.4%) of 14 patients with recurrence, and in 43 (28.2%) of 152 patients without recurrence. Anti-streptolysin O was lower (P = .021) and alanine transaminase (ALT) was higher (P = .019) in the recurrence group.
Conclusion:
Our study showed that in patients with a pre-diagnosis of ARF, a differential diagnosis should be made with other diseases. Especially in patients with joint complaints as the only major symptom, a differential diagnosis should be made. ARF recurrence is associated with non-compliance with prophylaxis, and both the severity of valve regurgitation and monoarthritis rates are higher in patients who develop recurrence. Alanine aminotransferase is significantly higher in patients with ARF recurrence.
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Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
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Acute pharyngitis can be categorized based on its underlying cause: