Rheumatic chorea in northern Australia: a clinical and epidemiological study
a Menzies School of
Health Research, PO Box 41096, Casuarina, NT 0811, Australia, b Division of Infectious Diseases,
Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
Correspondence to: Dr Carapetis. email: jonathan.carapetis{at}utoronto.ca
Accepted 24
September 1998
To describe the epidemiology and clinical features of
Sydenham's chorea in the Aboriginal population of northern Australia a
review was conducted of 158 episodes in 108 people: 106 were Aborigines, 79 were female, and the mean age was 10.9 years at first
episode. Chorea occurred in 28% of cases of acute rheumatic fever,
carditis occurred in 25% of episodes of chorea, and arthritis in 8%.
Patients with carditis or arthritis tended to have raised acute phase
reactants and streptococcal serology. Two episodes lasted at least 30 months. Mean time to first recurrence of chorea was 2.1 years compared
with 1.2 years to second recurrence. Established rheumatic heart
disease developed in 58% of cases and was more likely in those
presenting with acute carditis, although most people who developed
rheumatic heart disease did not have evidence of acute carditis with
chorea. Differences in the patterns of chorea and other manifestations
of acute rheumatic fever in different populations may hold clues to its
pathogenesis. Long term adherence to secondary prophylaxis is crucial
following all episodes of acute rheumatic fever, including chorea, to
prevent recurrence.
© 1999 by Archives of Disease in Childhood
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