Rheumatic Fever in Children and Adolescents in Hawaii
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Abstract:
Case records of hospitalized children (age 4 to 18 years) with acute rheumatic fever on Oahu, HI, were reviewed for the 4-year period from Oct 1, 1980, to Sept 30, 1984. Ninety-eight cases met the modified Jones criteria. The overall incidence of rheumatic fever was 13.4 hospitalized children per 100,000 children per year and that for recurrent attacks was 2.5. Of the 98 with rheumatic fever, 73 had polyarthritis, 33 had carditis, and ten had chorea. Polynesian/part-Polynesian children accounted for 76 of the 98 cases. The incidence of rheumatic fever in Hawaiian/part-Hawaiian was 18.0 and for Samoan children was 206 hospitalized children per 100,000 per year. The relative risks were 7.7 and 88 times that of the white children, respectively. Rheumatic fever continues to cause significant morbidity in children in Hawaii, especially in Polynesian children.Keywords:
Carditis
Acute rheumatic fever
Samoan
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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.
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Acute rheumatic fever
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Between 1977-1989, 143 children with acute rheumatic fever were hospitalized here. In contrast to western countries, there has been no decline in the absolute number of hospitalizations for this disease here. A high prevalence of rheumatic fever was found among Bedouins and non-Ashkenazi Jews (2.5 and 1.5 times greater than the expected incidence, respectively). The affected children were usually from large families and lived in crowded conditions. Recurrences of rheumatic fever were more frequent among girls, and they were affected at an older age. The manifestations, in order of frequency, were arthritis, carditis and chorea. Chorea was found only among girls.
Carditis
Acute rheumatic fever
Rheumatic disease
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Carditis
Subclinical infection
Acute rheumatic fever
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Carditis
Subclinical infection
Acute rheumatic fever
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Acute rheumatic fever is reported to have declined and perhaps be vanishing. Prompted by the occurrence of 17 cases of acute rheumatic fever in an 18-month period in 1985 and 1986, we reviewed the records of 243 children with acute rheumatic fever who were cared for at Children's Hospital of Pittsburgh or Mercy Hospital between 1965 and 1986. Acute rheumatic fever was diagnosed using the modified Jones criteria and cases were classified by major criteria as arthritis, arthritis and carditis, carditis alone, carditis and chorea, chorea alone, and arthritis and chorea. Among the 17 recent patients, 59% had carditis, 30% had chorea, and 24% had arthritis alone. The proportion of children who had particular major manifestations was similar in the last two decades and in 1985 to 1986. The recent children with acute rheumatic fever ranged in age from 6 to 13 years with a mean and median age of 10 years. There were 16 white children and one Asian child. Only four children lived in an urban setting. When demographic features of the children were contrasted with those in the previous two decades, a decrease in the proportion of children who lived in urban areas and who were black was noted. Four children had a history of preceding sore throat but only three sought medical care; nine children had no memorable illness and four had either a nonrespiratory illness or a respiratory infection without sore throat. This resurgence of rheumatic fever serves as a reminder that a diligent approach to the diagnosis and therapy of streptococcal infections remains essential.
Carditis
Sore throat
Acute rheumatic fever
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Carditis
Acute rheumatic fever
Rheumatism
Rheumatic disease
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Acute rheumatic fever
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THE control of symptoms of acute rheumatic fever is easily attained by several methods of therapy, but no form of treatment has had a marked effect on acute carditis and valvular heart disease, the two complications that determine the ultimate prognosis. Since the initiating event of the acute rheumatic episode is infection by the Group A streptococcus, it appeared logical to attempt to alter the course of established rheumatic fever by removing the original inciting agent. To accomplish this objective, 49 patients with acute rheumatic fever received large doses of penicillin, and 48 patients received no antibiotic and served as . . .
Acute rheumatic fever
Carditis
valvular heart disease
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The kinetics of the group A specific polysaccharide antibody were studied in children with acute rheumatic fever who had no carditis, children with acute rheumatic fever who had carditis and developed rheumatic heard disease and in children with acute poststreptococcal glomerulonephritis. The children with rheumatic fever who had carditis and those who did not, were kept on continuous antistreptococcal prophylaxis. In the group of children who developed rheumatic heart disease the titer of the antibody at onset was significantly higher than those who had rheumatic fever but no carditis (P = 0.01). After a mean follow-up period of three years, a high titer was maintained in children who developed rheumatic heart disease only and was significantly higher than that found in children with rheumatic fever who had no carditis (P = 0.001) and in children with poststerptococcal nephritis (P = 0.001).
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Acute rheumatic fever
Antibody titer
Group A
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