Changing pattern of rheumatic fever in a paediatric ward : then and now.

ABSTRACT

Objectives: To describe the socio-demographic and clinical features of children with primary episode of rheumatic fever (RF) during two periods of time and to attempt a comparison of the clinical features with previously published data from the same ward at Lady Ridgeway Hospital (LRH), Colombo. Method: Children admitted to University Paediatric Unit with the primary episode of RF based on the revised Jones criteria, were studied. Socio-demographic and clinical features were recorded prospectively from August 1994 to August 1999 and compared with data collected retrospectively from January 2004 to December 2008. Respecting the limitations, an attempt was made to compare this data with previously published data from the same ward during a period of ten years from 1966, when the primary episode of RF was diagnosed based on the modified Jones criteria. Results: There were 91 children from 1994 to 1999 and 52 (57%) were boys. Majority were >5 years and from families with a monthly income <Rs.10,000.00 but 56 (62%) of their mothers were educated up to Grade 10. Migratory polyarthritis was seen in 56 (62%) and 58 (64%) had a significant murmur on admission. Echocardiography was done on 87 and 24 (28%) had evidence of rheumatic heart disease (RHD). There were 29 (17 boys) during the 4 years from January 2004. Echocardiography was done on all the patients and 8 (28%) had RHD. During 1966 - 1976, RHD diagnosed on clinical features, was reported in 42% of 158 children (92 girls). Chorea has progressively increased through the years, with girls being more commonly affected. Conclusions: Childhood RF has declined in Sri Lanka. Disease pattern has also changed with more boys being affected but chorea continues to manifest more commonly in girls. RHD continues to be an important manifestation.