Clinical Presentation of Acute Rheumatic Fever in Egyptian Children

Background: Rheumatic fever (RF) is an illness that occurs as a complication of untreated or inadequately treated streptococcal throat infection. It is the most common cause of acquired heart disease in children and young adults in developing countries. Diagnosis depends on modified Jones criteria. This crosssectional study was carried out to describe the clinical profile of acute rheumatic fever in the Egyptian children to increase the awareness of practitioners involved in the health care of young children. Sixty four children with ARF, who were admitted to the Children hospital of Cairo university from April 2006 to March 2007 , were included in this study. Methods: Laboratory tests and results from echocardiographic examinations and clinical findings were analyzed. Results: Male: female ratio was 1:1 and the mean agewas 9.78±2.89 years. 57.8% were from rural areas with RF recurrence in 37.5%. Carditis was the most common manifestation followed by arthritis. Atypical arthritis was detected in 8% and silent carditis was found in 4.6%. None had subcutaneous nodules or erythema marginatum. The mitral valve was most commonly affected (88.5%); both mitral and aortic valves were affected in 72%. Pericarditis was seen in14.8% Conclusion Recommendations; Most clinical features were similar to the classic description. However atypical arthritis and silent carditis were detected. Rate of patient dropout from penicillinprophylaxis was high. Practitioners should be aware of the diverse clinical presentations of ARF and emphasize strict adherence to prophylaxis guidelines.