Acute rheumatic fever in north Florida

Area of Science:

• Cardiology
• Rheumatology
• Pediatrics

Background:

• Reports indicate declining incidence and severity of acute rheumatic fever (ARF) in the US and Europe.
• However, clinical experience at our institution suggests a persistent admission rate for ARF.
• This discrepancy necessitates a local review of ARF epidemiology and clinical presentation.

Purpose of the Study:

• To review clinical experiences with 128 cases of ARF.
• To compare local ARF trends with national data.
• To evaluate the severity and outcomes of ARF in our patient population.

Main Methods:

• Retrospective review of 128 patient cases admitted with ARF.
• Analysis of major clinical manifestations, including carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules.
• Assessment of carditis severity, residual cardiac lesions, and mortality rates.

Main Results:

• No decline in hospital admissions for ARF was observed.
• Carditis was the most frequent major manifestation, followed by arthritis.
• A significant percentage of patients experienced severe or moderate carditis, with a high rate of residual cardiac lesions and mortality exceeding national reports.

Conclusions:

• Despite national trends, ARF remains a significant concern in our region.
• The high prevalence of carditis and associated mortality highlight the need for sustained primary prevention strategies.
• Continued efforts in preventing streptococcal infections are crucial for reducing ARF burden.