Aims To delineate the pattern of presentation of children with acute rheumatic fever (ARF) who were screened at a tertiary cardiology referral centre over a 10 year period.
Methods We identified cases using the cardiology HEARTSUITE database in addition to the hospital coding department. A total of 119 patients were identified and their database clinic letters screened. Of these 4 patients were too old at presentation and 43 were not ARF. We then looked at the hospital records for the remaining 72 patients and recorded demographic data, mode of presentation, diagnostic features, treatment and outcome at follow up. We analysed the results using Microsoft EXCEL software.
Results Of the 72 patients, on closer inspection 18 were deemed not to be ARF, 12 were ARF not strictly meeting the revised modified Jones criteria (1992) and 42 were ARF meeting the criteria. Of the definite ARF, the mean age at presentation was 13 with a range of 3 to 16 years. The number of cases per year increased with time. At presentation 60% of cases had chorea and when screened 80% of children had abnormalities on echocardiogram. Almost all children had prophylactic penicillin and the treatment most used for chorea was sodium valproate. Two children required valve surgery soon after presentation. Over 75% of those followed up had complete resolution of symptoms after a year and the majority of symptoms that persisted were due to cardiac involvement.
Conclusion This study suggests there may be a resurgence of this rare but potentially disabling disease. It highlights variations in presentation when compared to the literature. We propose to undertake a national surveillance study to look at the current presentation of acute rheumatic fever in the United Kingdom.
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