Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T06:45:43.157Z Has data issue: false hasContentIssue false
  • English
  • Français

Acute rheumatic fever in south-east of Turkey: clinical features and epidemiological evaluation of the patients over the last 25 years

Published online by Cambridge University Press:  02 July 2020

Sevcan Erdem Open the ORCID record for Sevcan Erdem [Opens in a new window] ,
Fadli Demir Open the ORCID record for Fadli Demir [Opens in a new window] ,
Mustafa Ayana ,
Oguz Canan ,
Yankı Kaan Okuducu ,
Alev Arslan ,
Osman Kucukosmanoglu  and
Nazan Özbarlas
Sevcan Erdem*
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
Fadli Demir
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
Mustafa Ayana
Affiliation:
Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
Oguz Canan
Affiliation:
Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
Yankı Kaan Okuducu
Affiliation:
Faculty of Medicine, Çukurova University, Adana, Turkey
Alev Arslan
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
Osman Kucukosmanoglu
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
Nazan Özbarlas
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey
*
Author for correspondence: Sevcan ERDEM, MD, Department of Pediatric Cardiology, Medical Faculty, Balcali Hospital, Çukurova University, Saricam/Adana01330, Turkey. Tel: +905323378563; Fax: +90 322 338 68 32; E-mail: hserdem@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

This study evaluates clinical and epidemiological features of acute rheumatic fever using the data of last 25 years in our hospital in south-east of Turkey. The medical records of 377 patients with acute rheumatic fever admitted to Pediatric Cardiology Department of Çukurova University during 1993–2017 were retrospectively analysed. Two hundred and six patients were admitted between 1993 and 2000, 91 between 2001 and 2008, and 80 between 2009 and 2017. The largest age group (52%) were between 9 to 12 years of age and approximately two-thirds of the patients presented in the spring and winter seasons (62.8%). Among the major findings, the most common included carditis 83.6% (n = 315), arthritis at 74% (n = 279), Sydenham’s chorea at 13.5% (n = 51), and only two patients (0.5%) had erythema marginatum and two patients (0.5%) had subcutaneous nodule. Carditis was the most common manifestation observed in 315 patients (83.6%). The most commonly affected valve was the mitral valve alone (54.9%), followed by a combined mitral and aortic valves (34%) and aortic valve alone (5.7%). Of the patients with carditis, 48.6% (n = 153) had mild carditis, of which 45 had a subclinical. Sixty-two patients (19.7%) had moderate and 100 patients (31.7%) had severe carditis. At the follow-up, 2 patients died and 16 patients underwent valve surgery. Twenty-eight (7.4%) patients’ valve lesions were completely resolved. Conclusion: Although the incidence of acute rheumatic fever decreased, it still is an important disease that can cause serious increases in morbidity and mortality rates in our country.

Keywords

Acute rheumatic feverclinical presentationJones criteria
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 8 , August 2020 , pp. 1086 - 1094
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Marijon, E, Mirabel, M, Celermajer, DS, Jouven, X.Rheumatic heart disease. Lancet 2012;379:953–964.CrossRefGoogle ScholarPubMed
Carapetis, JR, Steer, AC, Mulholland, EK, Weber, M.The global burden of group A streptococcal diseases. Lancet Infect Dis 2005;11:685–694.CrossRefGoogle Scholar
Azevedo, PM, Pereira, RR, Guilherme, L.Understanding rheumatic fever. Rheumatol Int 2012;32:1113–1120.CrossRefGoogle ScholarPubMed
Seckeler, MD, Hoke, TR.The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol 2011;22:67–84.CrossRefGoogle Scholar
Kočevar, U, Toplak, N, Kosmač, B, et al.Acute rheumatic fever outbreak in southern central European country. Eur J Pediatr 2017;176:23–29.CrossRefGoogle ScholarPubMed
Narin, N, Mutlu, F, Argun, Met al.Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998–2011. Cardiol Young 2015;25:745–751.CrossRefGoogle ScholarPubMed
Atalay, S, Tutar, E, Uçar, T, Topçu, S, Köse, SK, Doğan, MT.Echocardiographic screening for rheumatic heart disease in Turkish schoolchildren. Cardiol Young 2019;29:1272–1277.CrossRefGoogle ScholarPubMed
Carapetis, JR, Currie, BJ, Mathews, JD.Cumulative incidence of rheumatic fever in an endemic region: a guide to the susceptibility of the population? Epidemiol Infect 2000;124:239–244.CrossRefGoogle Scholar
Carapetis, JR.Rheumatic heart disease in developing countries. N Engl J Med 2007;357:439–441.CrossRefGoogle ScholarPubMed
Watkins, DA, Johnson, CO, Colquhoun, SM, et al.Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med 2017;377:713–722.CrossRefGoogle ScholarPubMed
Tibazarwa, KB, Volmink, JA, Mayosi, BM.Incidence of acute rheumatic fever in the world: a systematic review of population-based studies. Heart 2008;94:1534–1540.CrossRefGoogle ScholarPubMed
Pastore, S, De Cunto, A, Benettoni, A, Berton, E, Taddio, A, Lepore, L.The resurgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatol 2011;50:396–400.CrossRefGoogle Scholar
Gewitz, MH, Baltimore, RS, Tani, LY, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography. A scientific statement from the American Heart Association. Circulation 2015;131:1806–1818.CrossRefGoogle Scholar
Beyazova, U, Benli, D, Beyazova, M.Akut romatizmal ateş görülme sıklığı. Çocuk Sağ Hast Derg 1987;2:76–80.Google Scholar
Saraçlar, M, Ertuğrul, A, Özme ve Ajun, A.Akut romatizmal ateş insidansı ve romatizmal kalp hastalıklarının prevalansı. Türk Kardiyoloji Derneği Arşivi 1978;7:50–55.Google Scholar
Örün, UA, Ceylan, Ö, Bilici, M, et al.Acute rheumatic fever in the Central Anatolia Region of Turkey: a 30-year experience in a single center. Eur J Pediatr 2012;171:361–368.CrossRefGoogle ScholarPubMed
Anita, K, Zaidi, M, Goldman, DA.Rheumatic fever. In: Kliegman, RM, Behrman, RE, Jenson, HB, Stanton, BF (eds). Nelson Textbook of Pediatrics, 18th edn. WB Saunders Company, Philadelphia, 2007: 1140–1145.Google Scholar
Veasy, LG, Lloyd, Y.Persistence of acute rheumatic fever in the intermountain area of the United State. J Pediatr 1994;124:9–16.CrossRefGoogle Scholar
Karantana, A, Anagnostopoulos, G.Childhood acute rheumatic fever n Greece. Acta Pediatr 2001;90:809–812.CrossRefGoogle Scholar
Bitar, FF, Hayek, P.Rheumatic fever in children: a 15 year experience in a developing country. Pediatric Cardiol 2000;21:119–124.CrossRefGoogle ScholarPubMed
Currie, BJ, Carapetis, JR.Rheumatic chorea in northern Australia: a clinical and epidemiological study. Arch Dis Child 1999;80:353–358.Google Scholar
Bostan, OM, Cil, E.Evaluation of acute rheumatic fever in Bursa. Turkiye Klinikleri J Cardiol 2001;14:276–281.Google Scholar
Cleonice, C, Mota, C, Aiello, VD, Anderson, RH.Rheumatic fever. In: Anderson, RH, Baker, EJ, Penny, D, Redington, AN, Rigby, ML, Wernovsky, G (eds). Pediatric Cardiology, 3rd edn. Churchill Livingstone, Philadelphia, 2010: 1091–1113.Google Scholar
Boyarchuk, O, Boytsanyuk, S, Hariyan, T.Acute rheumatic fever: clinical profile in children in western Ukraine. Ann Trop Pediatr 2007;27:169–177.Google Scholar
Ramakrishnan, S.Echocardiography in acute rheumatic fever. Ann Pediatr Cardiol 2009;2:61–64.CrossRefGoogle ScholarPubMed
Cann, MP, Sive, AA, Norton, RE, McBride, WJ, Ketheesan, N.Clinical presentation of rheumatic fever in an endemic area. Arch Dis Child 2010;95:455–457.CrossRefGoogle Scholar
Jamal, M, Abbas, KA.Clinical profile of acute rheumatic fever in children. J Trop Pediatr 1989;35:10–13.CrossRefGoogle ScholarPubMed
Vinker, S, Zohar, E, Hoffman, R, Elhayany, A.Incidence and clinical manifestations of rheumatic fever: a 6 year community-based survey. Isr Med Assoc J 2010;12:78–81.Google ScholarPubMed
Grassi, A, Fesslovà, V, Carnelli, V, et al.Clinical characteristics and cardiac outcome of acute rheumatic fever in Italy in the last 15 years. Clin Exp Rheumatol 2009;27:366–372.Google ScholarPubMed
Lee, JL, Naguwa, SM, Cheema, GS, Gershwin, ME.Acute rheumatic fever and its onsequences: a persistent threat to developing nations in the 21st century. Autoimmun Rev 2009;9:117–123.CrossRefGoogle Scholar
Cimen, O, Oran, B, Cimen, D, et al.Release of N-terminal pro-brain natriuretic peptide in children with acute rheumatic carditis. Cardiol Young 2010;20:297–301.CrossRefGoogle ScholarPubMed
Beaton, A, Carapetis, JR.The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries. Heart Asia 2015;7:7–11CrossRefGoogle Scholar
Haydardedeoğlu, FE, Tutkak, H, Köse, K, Düzgün, N.Genetic susceptibility to rheumatic heart disease and streptococcal pharyngitis: association with HLA-DR alleles. Tissue Antigens 2006;68:293–296.CrossRefGoogle ScholarPubMed
Arora, R, Subramanyam, G, Khalilullah, M, Gupta, MP.Clinical profile of rheumatic fever and rheumatic heart disease: a study of 2,500 cases. Indian Heart J 1981;33:264–269.Google ScholarPubMed
Barash, Y, Matityahu, A.Acute rheumatic fever. Isr J Fam Pract 2005;15:7–13.Google Scholar
Lloyd, Y, Tani, L, George Veasy, L, Minich, L, Shaddy, RE. Rheumatic fever in children younger than 5 years: is the presentation different?. Pediatrics 2003;112:1065–1068.Google Scholar
Rathore, MH, Barton, LL.Acute rheumatic pericarditis. Pediatr Infect Dis J 1989;8:183–184.Google ScholarPubMed
Kula, S, Olgunturk, R, Ozdemir, O.Two unusual presentations of acute rheumatic fever. Cardiol Young 2005;15:514–516CrossRefGoogle ScholarPubMed
Balli, S, Oflaz, MB, Kibar, AE, Ece, I.Rhythm and conduction analysis of patients with acute rheumatic fever. Pediatr Cardiol 2013;34:383–389.CrossRefGoogle ScholarPubMed
Martins, TB, Veasy, LG, Hill, HR.Antibody responses to group A streptococcal infections in acute rheumatic fever. Pediatr Infect Dis J 2006;25:832–837.CrossRefGoogle ScholarPubMed
Joseph, N, Madi, D, Kumar, GS, Nelliyanil, M, Saralaya, V, Rai, S.Clinical spectrum of rheumatic fever and rheumatic heart disease: a 10 year experience in an urban area of south India. N Am J Med Sci 2013;5:647–652.CrossRefGoogle Scholar
Carapetis, JR, Currie, BJ.Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Arch Dis Child 2001;85:223–227.CrossRefGoogle Scholar
Parks, T, Kado, J, Colquhoun, S, Carapetis, J, Steer, A.Underdiagnosis of acute rheumatic fever in primary care settings in a developing country [published correction appears in Trop Med Int Health. 2010;15:384]. Trop Med Int Health 2009;14:1407–1413.CrossRefGoogle Scholar
Noonan, S, Zurynski, YA, Currie, BJ, et al.A national prospective surveillance study of acute rheumatic fever in Australian children. Pediatr Infect Dis J 2013;32:e26–e32.CrossRefGoogle ScholarPubMed
Sanyal, SK, Thapar, MK, Ahmed, SH, Hooja, V, Tewari, P.The initial attack of acute rheumatic fever during childhood in North India: a prospective study of the clinical profile. Circulation 1974;49:7–12.CrossRefGoogle ScholarPubMed
Rayamajhi, A, Sharma, D, Shakya, U. Clinical, laboratory and echocardiographic profile of acute rheumatic fever in Nepali children. Ann Trop Paediatr 2007;27:169–177.CrossRefGoogle ScholarPubMed
Grover, A, Dhawan, A, Iyengar, SD, Anand, IS, Wahi, PL, Ganguly, NK.Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India. Bull World Health Organ 1993;71:59–66.Google Scholar
Agarwal, BL, Agrawal, R.Rheumatic fever: clinical profile of the initial attack in India. Bull World Health Organ 1986;64:573–578.Google ScholarPubMed
Thakur, JS, Negi, PC, Ahluwalia, SK, Vaidya, NK.Epidemiological survey of rheumatic heart disease among school children in the Shimla Hills of northern India: prevalence and risk factors. J Epidemiol Community Health 1996;50:62–67.CrossRefGoogle Scholar
Ravisha, MS, Tullu, MS, Kamat, JR.Rheumatic fever and rheumatic heart disease: clinical profile of 550 cases in India. Arch Med Res 2003;34:382–387.CrossRefGoogle ScholarPubMed
Vasan, SR, Shrivastava, S, Vijayakumar, M, Narang, R, Lister, BC, Narula, J.Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996;94:73–82.CrossRefGoogle ScholarPubMed
Carceller, A, Taoiero, B, Rubin, E, Miro, J.Acute rheumatic fever: 27 year experience from the Montreal’s pediatric tertiary care centers. An Pediatr (Barc) 2007;67:5–10.CrossRefGoogle ScholarPubMed
Olguntürk, R, Canter, B, Tunaoğlu, FS, Kula, S.Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria. Int J Cardiol 2006;112:91–98.CrossRefGoogle ScholarPubMed
Ozer, S, Hallioğlu, O, Ozkutlu, S, Celiker, A, Alehan, D, Karagöz, T.Childhood acute rheumatic fever in Ankara, Turkey. Turk J Pediatr 2005;47:120–124.Google ScholarPubMed
Remenyi, B, ElGuindy, A, Smith, SC Jr, Yacoub, M, Holmes, DR Jr. Valvular aspects of rheumatic heart disease. Lancet 2016;387:1335–1346.CrossRefGoogle ScholarPubMed
Qurashi, MA.The pattern of acute rheumatic fever in children: experience at the children’s hospital, Riyadh, Saudi Arabia. J Saudi Heart Assoc 2009;21:215–220.CrossRefGoogle ScholarPubMed