Clinical Laboratory and Echocardiographic Profile of Rheumatic Fever in Children

Introduction Rheumatic fever is a sequel of an immunological disorder initiated by group A beta haemolytic streptococcus (1). It continues to be a major problem in Pediatric population and is one of the leading causes of heart disease in children in the developing countries. The commonest age group involved is 5-15 years (2). Genetic predisposition and overcrowding associated with low socio-economic status are some of the predisposing factors (3). Rheumatic fever principally involves the heart, joints, central nervous system, skin and subcutaneous tissues. Although the name acute rheumatic fever emphasizes the involvement of the joints, rheumatic fever owes its importance to the involvement of the heart; as it leads to rheumatic heart disease because of scarring and deformity of the heart valves. Markowitz et al has reported a changing pattern of the disease (4). Some of the most characteristic manifestations have become less common and it has become more difficult to establish the diagnosis on clinical grounds. More patients are being seen who have arthritis as their only clinical finding. At times rheumatic fever is over diagnosed and also the immediate institution of anti-rheumatic drugs masks further development and may confuse the clinical profile leading to wrong label of rheumatic fever. In view of Abstract This prospective study includes clinical, laboratory and echocardiographic evaluation of 50 cases of rheumatic fever admitted to the Department of Pediatrics, Govt. Medical College, Jammu over a period of 34 months from October 1994 to July 1997. All cases were diagnosed according to modified Jones criteria. Rheumatic fever formed 0.18% of total hospital admissions with majority of children in age group of 5-15 years. Male preponderance was observed. Carditis was the most common manifestation seen in 70% followed by arthritis, subcutaneous nodules and chorea in 60%, 10% and 8% respectively. Erythema marginatum was not seen in any case.