Clinical Trends in Acute Rheumatic Fever in Korean Children: Mailed Questionnaire Survey from 1988 to 1997(Compared with 1978-1987)

ABSTRACT

PURPOSE: The purpose of this study was to assess the frequency of acute rheumatic fever(ARF) among children in Korea and to describe trends in its clinical characteristics compared to data from a previous study(1978-1987). METHODS: A mailed questionnaire survey sent to the pediatric departments of 13 general hospitals in Korea requested the total number of patients with ARF and its clinical manifestations from Jan. 1988 to Dec. 1997. These data were compared with the data from a previous study (1978-1987) to evaluate the clinical trends in occurrence and clinical manifestations of ARF during the last 20 years in Korea. RESULTS: The average number of patients with ARF for the 10-year period(1988-1997) was 0.74 per 1,000 annual pediatric inward patients. There was a significant decrease in incidence during the study period. There were 115 male and 85 female patients with ARF, and 97.5% of total patients were 6 to 15 years old. 126 out of 200 patients(63.0%) had a history of preceding upper respiratory infection(URI). The percentage of major manifestations were as follows; carditis(66.5%),polyarthritis(54.0%), erythema marginatum(12.0%), chorea(7.5%) and subcutaneous nodule (6.0%). Clinical findings of carditiswere cardiac murmur(91.0%), cardiomegaly in chest PA(34.6%), congestive heart failure(15.8%). The electrocardiographic findings were PR interval prolongation (37.6%), right ventricular hypertrophy (RVH) and left ventricular hypertrophy(LVH)(15.8%), QT interval prolongation(13.5%). Doppler echocardiographic valvular lesions were mitral insufficiency(96.2 %), aortic insufficiency(39.8%). Minor and other clinical manifestations were fever(69.0%), arthralgia (56.5%), sore throat(28.5%). CONCLUSION: There was a steady decrease in the number of patients with ARF during the study period from 1988 to 1997. A sudden decrease in number of patients with ARF between the two study periods is likely due to patients with valvular heart disease, possibility of double registration, and wide spread use of echocardiography for accurate diagnosis.