Rheumatic fever: experience in madina Al-Munawara

ABSTRACT

Acute rheumatic fever [ARF] and rheumatic heart disease [RHD] continue to be a major problem in the developing countries. A press study was carried out to find the magnitude and clinical pattern of rheumatic fever in the region of Madina Al-Munawara and the usefulness of echocardiography in the diagnosis and evaluation of rheumatic fever. All new cases of ARF and RHD admitted to Madina Hospital from February 1995 to August 1996 were included in the study. A total of 73 children under 14 years of age were included in the study. All the cases were assessed by a thorough clinical examination, chest x-ray, ECG and conventional M and B mode, and color Doppler echocardiography. Diagnosis of ARF was made strictly on modified Jones criteria. Males and females were almost equally affected. Of the 73 cases, 64 were admitted with ARF while 9 were cases of established [RHD]. Thirteen [20%] cases with ARF were admitted with recurrence. One of these patients was on regular four-weekly penicillin prophylaxis but others took either no or irregular prophylaxis. The majority of our cases [56%] were less than 10 years of age. Most cases were from urban/suburban population. Arthritis was the most common clinical manifestation, being present in 62% of the cases with ARF, and followed closely by carditis in 59% of the cases. Echocardiographic evidence of carditis was seen in as much as 75% cases. Rheumatic chorea was the presenting feature in 14% of cases. Rheumatic nodules and erythema marginatum were rare. Mitral regurgitation was the most common valvular lesion. Auscultation was found less sensitive than echocardiography in detecting valvular lesions. In conclusion, rheumatic fever continues to be a serious clinical problem in the Madina region of Saudi Arabia, and the high recurrence rate can be decreased by penicillin prophylaxis. Echocardiography can diagnose many cases of subclinical carditis and valvular lesions