A Single-center Experience in Children with Acute Rheumatic Fever

Objective: This retrospective study aimed to emphasize the importance of subclinical carditis in children with acute rheumatic fever before the revised 2015 Jones criteria.Method: Throat culture, antistreptolysin O test, C-reactive protein and erythrocyte sedimentation titers, telecardiogram, electrocardiogram, and Doppler echocardiography findings of each patient were evaluated.Doppler echocardiography, examined by pediatric cardiologists was applied to each patient especially to screen subclinical carditis. Results:In our study of 54 patients with acute rheumatic fever, the frequency of carditis including cases with subclinical carditis was found to be 74.1% (40 patients).And the other clinical findings were arthritis 70.3% (38 patients), Sydenham's chorea 13% (7 patients), erythema marginatum 1.9% (1 patient), while subcutaneous nodule was not seen in any of our patients.Cardiac involvement was not observed in 14 (25.9%) of 54 cases diagnosed with acute rheumatic fever.Of 54 acute rheumatic fever cases, isolated mitral valve regurgitation in 14 (25.9%),isolated aortic valve regurgitation in 2 (3.8%), and coexistence of mitral and aortic regurgitation in 24 (44.4%)cases were detected.Eighteen patients (45%) with mild carditis detected by echocardiography did not have clinical findings of carditis; these cases were considered as subclinical carditis. Conclusion:To consider subclinic carditis long before 2015 Jones criteria provided our center to get more favourable outcomes in regard to morbidity and possible mortality in these patients.We think that physicians living in populations with moderate-and high-risk for acute rheumatic fever should pay more attentions to newly publicated issues related to carditis in addition to diagnostic criteria.