Article
Rheumatic fever in a high incidence population: the importance of
monoarthritis and low grade fever
J R Carapetisa, B J Currieb
a University of
Melbourne Dept of Paediatrics, Dept of General Paediatrics and Murdoch
Children's Research Institute, Royal Children's Hospital, Parkville,
Vic 3052, Australia, b Menzies School of Health Research and Royal
Darwin Hospital Clinical School, PO Box 41096, Casuarina, NT 0811, Australia
Correspondence to: Dr Carapetis carapetj{at}cryptic.rch.unimelb.edu.au
Accepted 29 May 2001
AIMS
To describe the clinical
features of rheumatic fever and to assess the Jones criteria in a
population and setting similar to that in many developing countries.
METHODSThe charts of 555 cases of
confirmed acute rheumatic fever in 367 patients (97% Aboriginal) and
more than 200 possible rheumatic fever cases from the tropical "Top
End" of Australia's Northern Territory were reviewed retrospectively.
RESULTSMost clinical features were
similar to classic descriptions. However, monoarthritis occurred in
17% of confirmed non-chorea cases and 35% of unconfirmed cases,
including up to 27 in whom the diagnosis was missed because
monoarthritis is not a major manifestation. Only 71% and 25% of
confirmed non-chorea cases would have had fever using cut off values of
38°C and 39°C, respectively. In 17% of confirmed non-chorea cases,
anti-DNase B titres were raised but antistreptolysin O titres were
normal. Although features of recurrences tended to correlate with
initial episodes, there were numerous exceptions.
CONCLUSIONSMonoarthritis and low
grade fever are important manifestations of rheumatic fever in this
population. Streptococcal serology results may support a possible role
for pyoderma in rheumatic fever pathogenesis. When recurrences of
rheumatic fever are common, the absence of carditis at the first
episode does not reliably predict the absence of carditis with recurrences.
Keywords: rheumatic fever; monoarthritis; carditis; streptococcus
© 2001 by Archives of Disease in Childhood
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