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First-episode versus recurrent acute rheumatic fever: is it different?

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Year: 2009 Volume: 51 Issue: 1

Year: 2008 Volume: 50

Year: 2001 Volume: 43

First-episode versus recurrent acute rheumatic fever: is it different?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Rayamajhi, Ajit Sharma, Deewakar Shakya, Urmila
Spatial Coverage	Nepal
Description	Country affiliation: Nepal Author Affiliation: Rayamajhi A ( Department of Pediatrics, Cardiology Unit, National Academy of Medical Sciences, Kanti Children's Hospital, Kathmandu, Nepal. ajitrnp@yahoo.com)
Abstract	BACKGROUND: Recurrent episodes of acute rheumatic fever (RF) can lead to rheumatic heart disease with considerable disability and mortality in children. RF can recur in the absence of secondary prophylaxis. The differences in clinical manifestations and outcome between first-episode and recurrent RF have been less studied. METHODS: A cross-section of patients under 14 years was studied for 2 years (2003-2005) in order to compare the clinical, laboratory, echocardiographic profile and outcome of first-episode RF with recurrent attacks, and risk factors for recurrence and mortality. Patients without a previous history of RF and/or mitral stenosis (MS) and/or aortic stenosis (AS) were defined as first-episode patients, and patients with previous history of RF and/or MS and/or AS, were defined as recurrent RF patients based on the Jones criteria. RESULTS: Of 51 patients in total, 26 had first-episode RF and 25 had recurrent RF. Arthritis occurred in a significantly higher number of first-episode patients (P = 0.047) whereas shortness of breath (SOB; P = 0.003), palpitation (P = 0.034), and aortic regurgitation (AR; P = 0.001) occurred in a significantly higher number of recurrent RF patients. Audible murmur of corresponding echocardiographic regurgitation was present in all recurrent RF patients whereas audible murmur was present in 61.5% and echocardiographic regurgitation in 81% in first-episode patients (P = 0.007). Palpitation, SOB, audible murmur, thrill, age and AR on admission were independent predictors of recurrence. Palpitation, age and AS on admission were independent predictors of mortality. CONCLUSIONS: Subclinical carditis occurred only in the first-episode patients, which requires further evaluation for clinical significance. Because all deaths occurred in recurrent RF group (P = 0.02), secondary prophylaxis and management of sore throat need re-emphasis.
File Format	HTM / HTML
ISSN	13288067
Issue Number	2
Volume Number	51
e-ISSN	1442200X
Journal	Pediatrics International
Language	English
Publisher	Wiley
Publisher Date	2009-04-01
Publisher Place	Australia
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pediatrics Heart Valve Diseases Epidemiology Rheumatic Fever Diagnosis Rheumatic Heart Disease Adolescent Aortic Valve Insufficiency Arthritis Child Child, Preschool Cross-sectional Studies Heart Murmurs Humans Hypertension, Pulmonary Mitral Valve Insufficiency Nepal Recurrence Mortality Risk Factors Tricuspid Valve Insufficiency Ultrasonography Comparative Study Journal Article
Content Type	Text
Resource Type	Article
Subject	Pediatrics, Perinatology and Child Health

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