Profile of secondary prophylaxis among children with rheumatic heart disease in Alexandria, Egypt

A cross-sectional study was conducted in specialist children's hospitals in Alexandria, which aimed to evaluate the current regimen of secondary prophylaxis for children suffering from rheumatic heart disease. Two-thirds of the patients had complied with their prophylactic regimen. Prophylactic failure occurred in one-third of the patients, raising doubts about the efficacy of the brands of penicillin prescribed. Recurrence of rheumatic fever was recorded in 37.3% of the patients, with semiurban or rural residence and non-compliance with secondary prophylaxis the significant risk factors. These unsatisfactory findings suggest the need for a more effective strategy of primary and secondary prophylaxis for controlling rheumatic fever in our community

Evidence of valve regurgitation by Doppler echocardiography in patients with rheumatic fever without clinical carditis

Because of the observation that patients with acute rheumatic fever without clinical carditis develop later rheumatic heart disease, and the postulation that such patients may have a subclinical [silent] carditis in the initial attack, we studied the heart in a group of such patients using Doppler echocardiography. Twenty five patients with recent isolated rheumatic arthritis and 25 patients with recent isolated rheumatic chorea in their initial attack were the subject of the study. They all had no past history of rheumatic fever or rheumatic heart disease. Doppler studies were done one to 28 days from the onset of symptoms. It was found that 50% of the patients had Doppler evidence of valve regurgitation, most commonly of the mitral and aortic valves. The severity of regurgitation was mild in most cases [75%] and moderate in the rest. 28% of the sample had two valves affected simultaneously. The results explain the finding of rheumatic heart disease in patients initially free of carditis several years after the first attack. They demonstrate that the use of Doppler echocardiography in the diagnosis of carditis in initial rheumatic fever attacks is essential They also demonstrate the importance of more prolonged bed rest, treatment with corticosteroids, and possibly life time prophylaxis in rheumatic fever patients who have Doppler evidence of valve regurgitation in the absence of acardiac murmur