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The changing pattern of rheumatic fever in childhood
Insights
Acute rheumatic fever (ARF) showed decreased early mortality between 1937-1940 and 1957-1960. However, cardiac involvement and congestive failure rates remained similar, suggesting evolving treatment impacts.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Acute rheumatic fever (ARF) is a significant cause of acquired heart disease in children.
- Historical data on ARF manifestations and outcomes are crucial for understanding disease progression and treatment efficacy.
Purpose of the Study:
- To compare the clinical manifestations and outcomes of acute rheumatic fever in children during two distinct historical periods.
- To identify changes in cardiac involvement, mortality, and recurrence rates over time.
Main Methods:
- Retrospective cohort study comparing two groups of pediatric patients admitted for ARF.
- Group 1: 231 children admitted from 1937-1940.
- Group 2: 252 children admitted from 1957-1960.
Main Results:
- Early mortality decreased significantly from 12/82 (14.6%) in the early group to 2/96 (2.1%) in the later group.
- Incidence of isolated mitral valve involvement (73% vs. 62%) and congestive failure (20% vs. 13%) remained comparable.
- Chorea incidence and recurrence frequency were lower in the later cohort.
Conclusions:
- While early mortality from ARF has decreased, potentially due to improved treatments (penicillin, corticosteroids) and socioeconomic factors, cardiac sequelae remain a concern.
- Further research is needed to understand the persistent rates of valvular heart disease and congestive failure in ARF patients.
Abstract:
The manifestations of acute rheumatic fever were compared in 231 children admitted to hospital from 1937 to 1940 with those in 252 children admitted from 1957 to 1960. Of the 178 in the early group seen during an initial attack, 82 had cardiac involvement; of these, 12 died early. Of the 218 patients in the later group with an initial attack, 96 had cardiac involvement; of these, two died early. Despite this decrease in early mortality, the incidence of isolated mitral value involvement (73% in the early group and 62% in the later group) and the incidence of congestive failure (20% and 13%) were similar. This reduction in the number of early deaths may be due to lowered virulence of the streptococcus, improved socioeconomic conditions, or therapy with penicillin and corticosteroids. The incidence of chorea and the frequency of recurrences were also less in the later group.