RHEUMATIC FEVER IN CHILDREN TODAY
Kelmendi M, Bejiqi R, Doqiqi Sh, Ismaili V, Grajqevci V
University Children's Hospital, Prishtine, Kosove
Like many developing
countries, the incidence of acute rheumatic fever (ARF) and rheumatic heart
disease (RHD) is great in Kosova too. Objective:
1. To describe the epidemiological and clinical features of ARF and RHD in
children. 2. To compare RF in early 80s with RF in late 90s. Methods: retrospective review of
all known cases of ARF and RHD hospitalized in Prishtina's Children's
Hospital from 1974 to 2000. The diagnosis has been established according to
Jones modified criteria, laboratory, X ray, ECG and recently by
echocardiography
Results: in a 27 year period number of patients with ARF
and RHD was 1101, from that 941 children (85.5%) had one attack, while 160
(14.5%) one ore more recurrences. Arthritis was the most common major
manifestation, occured in 65% (25.5% pure arthritis and 39.5% in
combination with carditis). The prevalence of carditis was also pretty
high-58.7% (pure carditis in 16.5%, in combination with arthritis 39.5% and
in combination with chorea minor 2.7%). Chorea minor was manifested in 16%
while erythema marginatum and noduli rheumatici very rare.Of 1101 children,
129 of them (11.7%) have signs of RHD. >From 1974 to 2000 there were two
peaks in the appearance of RF (every ten year). Last one was in 1991 when
number of patients with RF hospitalized in our clinic was 79, to be after
that decreased gradually to 23 patients in 1996. Again, the incidence of RF
is going to be higher, so in 2000 number of pts with RF was 31. Preleminary
data shows that number of pts with RF in 2001 will be very high. In
comparison with RF in early 80s, there were some changes in RF clinical
features in late 90s, but there is no doubt that consequences remain the
same. Primary and secondary prophylaxis of RF has been made following the
WHO recommendations.
Conclusion: Despite the fact that RF is a
preventable disease, it seems that it will probably be a problem for the
21st century.