Sydenham's Chorea in Children with Acute Rheumatic Fever: An Echocardiographic Survey of Pediatric Patients in
Ahmad Jamei Khosroshahi1, Vida Kahani2, Milad Shirvaliloo3
1Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Sydenham's chorea (SC) in children with acute rheumatic fever (ARF) can indicate cardiac issues, particularly mitral valve regurgitation. Early cardiac and neurologic assessment is crucial for timely management of these potentially long-lasting conditions.
Area of Science:
- Pediatrics
- Neurology
- Cardiology
Background:
- Sydenham's chorea (SC), a neurological disorder, can arise from basal ganglia injury in children with acute rheumatic fever (ARF).
- Movement disorders associated with SC may serve as predictive markers for carditis.
- This study investigated neurologic and cardiologic symptoms in children with suspected SC post-ARF.
Purpose of the Study:
- To evaluate the association between Sydenham's chorea and cardiac involvement in children diagnosed with acute rheumatic fever.
- To assess the prevalence and pattern of valvulopathy in children with SC.
- To determine the long-term cardiac outcomes in this patient group.
Main Methods:
- Echocardiographic assessment and prospective follow-up (6 and 12 months) of 85 children (aged 5-16) diagnosed with ARF and SC.
- Evaluation of valvulopathy patterns, severity, and Jones criteria for rheumatic fever.
- Statistical analysis using Chi-square and Fisher's exact tests (P<0.05 significance).
Main Results:
- 42.4% of patients exhibited mitral valve regurgitation (MR) on initial echocardiography, more common in females.
- Among SC patients (n=18), 66.7% showed cardiac involvement, with a higher prevalence of MR.
- Cardiac involvement patterns differed significantly at 6 months (P=0.04) but not at 12 months (P=0.07).
- Female sex was significantly associated with SC localization (P=0.01).
Conclusions:
- Sydenham's chorea in ARF patients can be linked to subclinical cardiac valve dysfunction persisting over a year.
- Precise cardiac and neurologic assessments during admission and follow-up are recommended for early detection and management.
- Findings highlight the importance of a comprehensive approach to managing children with SC post-ARF.
Background:
Although infrequent, Sydenham's chorea (SC) may occur as a result of injury to the basal ganglia in children with acute rheumatic fever (ARF) secondary to group A Streptococcal infection. Certain hallmarks of SC, such as movement disorders, could be utilized as a predictive marker for carditis. The present study aimed to investigate neurologic and cardiologic symptoms in children with suspected SC after ARF.
Methods:
All children aged 5-16 who were admitted at Shahid Madani Pediatric Hospital (Tabriz, Iran), with an initial diagnosis of ARF and SC between 2009 and 2022 were included for echocardiographic assessment and prospective follow-up within 6 and 12 months after the start point. The pattern and severity of valvulopathy, as well as the prevalence of Jones criteria for rheumatic fever, were used to assess the effect. The collected data were analyzed using SPSS Statistics software (version 22.0) using Chi square and Fisher's exact tests. P<0.05 was considered statistically significant.
Results:
The study enrolled 85 children, 36 girls and 49 boys, with a mean age of 9.7±2.7. On the first echocardiography, 42.4% of patients had mitral valve regurgitation (MR), with a predominance of female patients (P=0.04). Of those diagnosed with SC (12 girls and 6 boys), 66.7% showed cardiac involvement, with a higher prevalence of MR in both sexes (P=0.04). The pattern of cardiac involvement after 6 months was significantly different between the groups (P=0.04). However, no such difference was observed during the one-year follow-up (P=0.07). Female sex was found to have a significant relationship with SC localization (P=0.01).
Conclusion:
In addition to its neurological manifestations, SC can be associated with clinical or subclinical cardiac valve dysfunction that might last for more than a year. In addition to attempting early detection and appropriate management, a precise cardiac and neurologic assessment during admission and follow-up is recommended.A preprint version of this manuscript is available at DOI: 10.21203/rs.3.rs-772662/v1 (https://www.researchsquare.com/article/rs-772662/v1).
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