Research Article
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Acute rheumatic fever: a single center experience

Year 2024, Volume: 7 Issue: 3, 321 - 326, 27.05.2024
https://doi.org/10.32322/jhsm.1469413

Abstract

Aims: Acute rheumatic fever continues to be a serious public health issue globally and in our country. The aim was to evaluate the socioeconomic, clinical characteristics, and echocardiographic findings of patients diagnosed with acute rheumatic fever in the Sancaktepe district of Istanbul province, and to compare them with Turkiye and global data.
Methods: The study was conducted retrospectively by reviewing the hospital records of 22 patients who presented to the pediatric cardiology outpatient clinic of Sancaktepe Training and Research Hospital and were diagnosed with acute rheumatic fever between March 2018 and October 2021. Demographic and socio-economic data, complaints, physical examination findings, clinical and laboratory features, initial echocardiographic findings at presentation, and follow-up data of the patients were identified.
Results: Out of the 22 patients diagnosed with acute rheumatic fever, 13 (59.1%) were male, with a mean age of 131.9 months ±32.9. The patients were followed up for an average of 23.2±11.5 months. Most patients (36.3%) presented during the winter months. The average number of individuals living in the patients’ households was found to be 5.8±1. It was observed that 95% of the mothers and 45.5% of the fathers had completed primary education, none of the mothers were employed, and all employed fathers received minimum wage. A family history of acute rheumatic fever was present in 18.8% of the patients. When echocardiographic findings were evaluated, valve involvement was detected in 90.9% of the patients. While single valve involvement was observed in the majority (72.7%) of patients, mitral valve involvement was most common (81.8%). During the follow-up period, complete resolution was observed in 45.5% of patients with mild mitral regurgitation and 66.6% of patients with mild aortic valve regurgitation.
Conclusion: While the majority of the data in the study are consistent with the literature, attention has been drawn to the challenges associated with the low socioeconomic status of our patient population. With the increase in socioeconomic status in our country, as in developed countries around the world, the incidence of disease may decrease.

Ethical Statement

Ethics Committee Approval: The study received approval from the Hospital's Scientific Research Ethics Committee on January 24, 2021, with approval number 2021/124. Informed Consent: Because the study was designed retrospectively, no written informed consent form was obtained from patients. Referee Evaluation Process: Externally peer-reviewed. Conflict of Interest Statement: The author has no conflicts of interest to declare. Financial Disclosure: The author declared that this study has received no financial support. Author Contributions: The author declares that he has participated in the design, execution, and analysis of the paper and that they have approved the final version.

References

  • Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol. 2011;3:68-84.
  • Tibazarwa KB, Volmink JA, Mayosi BM. Incidence of acute rheumatic fever in the world: a systematic review of population-based studies. Heart. 2008;94(12):1534-1540.
  • Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones criteria for the diagnosis of the rheumatic fever in the era of Doppler echocardiography: a scientific statement of the American Heart Association. Circulation. 2015;131(20):1806-1818.
  • Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685-694.
  • Oliver J, Baker MG, Pierse N, Carapetis J. Comparison of approaches to rheumatic fever surveillance across Organisation for Economic Cooperation and Development countries. J Pediatr Child Health. 2015;51(11):1071-1077.
  • Saraçlar M, Ertuğrul A, Özme S. Akut romatizmal ateş¸ insidansı ve romatizmal kalp hastalıkları prevelansı. Türk Kardiyol Dern Arş. 1978;7:50-54.
  • Beyazova U, Benli D, Beyazova M. Akut romatizmal ateş¸ görülme sıklığı. Çocuk Sağ Hast Der. 1987;2:76-80.
  • Karademir S, Demirçeken F, Atalay S, Demircin G, Sipahi T, Teziç T. Acute rheumatic fever in children in the Ankara area in 1990-1992 comparison with previous study in 1980-1989. Acta Paediatr. 1994;83(8):862-865.
  • Örün UA, Ceylan Ö, Bilici M, et al. Acute rheumatic fever in the Central Anatolia Region of Turkey: a 30-year experience in a single center. Eur J Pediatr. 2012;171(2):361-368.
  • Narin N, Mutlu F, Argun M, et al. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011. Cardiol Young. 2015;25(4):745-751.
  • Gürses D, Koçak G, Tutar E, Özbarlas N, Turkish ARF study group. Incidence and clinical characteristics of acute rheumatic fever in Turkey: Results of a nationwide multicentre study. J Paediatr Child Health. 2021;57(12):1949-1954.
  • Türkiye İstatistik Kurumu. 2021 Nüfus ve Konut Sayımı. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Population-and-Housing-Census-2021-45866
  • Acar S, Karagöz T, Meydan CM, Cinoğlu DŞ, Kayğısız G, Işık M. İlçelerin Sosyo-ekonomik Gelişmişlik Sıralaması. Republic of Türkiye Ministry of Industry and Technology. SEGE/2022. General Diroctorate of Development Agencies. No: 35. Research Report No: 8. February 2022, Ankara. ISBN: 978-605-7679-34-5. Available from: https://www.sanayi.gov.tr/assets/pdf/birimler/2022-ilce-sege.pdf
  • Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60(1):7-12.
  • Kut A, Salgür F. Sağlık alanında sosyoekonomik düzey belirleme: tıbbi araştırmalarda doğru uyguluyor muyuz? Türk Aile Hek Derg. 2015;19(1):4-13.
  • Yılmaz İ, Güvenç O, Yılmaz FH, Çimen D, Arslan D, Oran B. Akut romatizmal ateş tanısı konulan hastaların klinik özellikleri ve ekokardiyografik bulguları. Selçuk Tıp Derg. 2015;31(2):73-76.
  • Keskin M. Diffıculties in the diagnosis of acute rheumatic fever without carditis. Med J Süleyman Demirel Univ. 2020:27(3):353-357. doi: 10.17343/sdutfd.712570
  • Gasımova N, Sert A. Inflammatory biomarkers and echocardiographic findings in acute rheumatic fever patients. J Contemp Med. 2023;13(3):514-521.
  • Güler M, Laloğlu F, Olgun H, Ceviz N. Clinical characteristics of pediatric patients with first-attack acute rheumatic fever following the updated guideline. Türk Pediatri Arş. 2019; 54(4):220-224.
  • Çağatay D, Yıldız F, Temel Ö, Arslan Ö , İnalhan M. Akut romatizmal ateş: klinik bir değerlendirme. J Child. 2010; 10(4):183-189.
  • Baker MG, Gurney J, Oliver J, et al. Risk factors for acute rheumatic fever: literature review and protocol for a case-control study in New Zealand. Int J Environ Res Public Health. 2019; 15;16(22):4515.
  • Silvilairat S, Sornwai A, Sethasathien S, et al. Outcome following acute and recurrent rheumatic fever. Paediatr Int Child Health. 2024;44(1):13-17.
  • Parks T, Narube L, Perman ML, et al. Population-based assessment of cardiovascular complications of rheumatic heart disease in Fiji: a record-linkage analysis. BMJ Open. 2023; 13(4):e070629.
  • Stacey I, Hung J, Cannon J, et al. Long-term outcomes following rheumatic heart disease diagnosis in Australia. Eur Heart J Open. 2021;1(3):oeab035.
  • Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: a systematic review. PLoS Negl Trop Dis. 2018;12(6):e0006577.
  • Narang R, Saxena A, Ramakrishnan, Gupta KS, Juneja R, Kothari SS. Characteristics of children with acute rheumatic carditis from a high-incidence region: importance of unexplained worsening of functional class. Cardiology. 2020;145(8):522-528.
  • Bhardwaj R, Sood A. Clinical profile of acute rheumatic fever patients in a tertiary care institute in present era. J Assoc Physicians India. 2015;63(4):22-24.
  • Currie B, Ralph A, eds. The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 3.2 edition, March 2022. Available from: https://www.rhdaustralia.org.au/system/files/fileuploads/arf_rhd_guidelines_3.2_edition_march_2022.pdf
  • Loizaga SR, ArthurL, Arya B, et al. Rheumatic heart disease in the United States: forgotten but not gone. J Am Heart Assoc. 2021;10(16):e020992.
  • Tal R, Saied MH, Zidani R, et al. Rheumatic fever in a developed country – is it still relevant? A retrospective, 25 years follow-up. Pediatr Rheumatol. 2022;20(1):20
  • Yavrum BE, Gul AEK, Azak E, Gursu HA, Cetin II. Changing face of acute rheumatic fever in childhood and our clinical results. North Clin Istanb. 2023;10(2):237-247.
  • Alam S, Hye MA, Ahmed S, et al. Subclinical carditis in acute rheumatic fever: a single center experience. Cardiol Cardiovasc Med. 2023;7(4):311-315.
  • Erol N, Özen M, Bozaykut A. A major diagnostic criterion for acute rheumatic fever: clinical and sub-clinical carditis accompaniment with Sydenham chorea. Zeynep Kamil Med J. 2021;52(4):198-201.
  • Ekure EN, Amadi C, Sokunbi O, et al. Echocardiographic screening of 4107 Nigerian school children for rheumatic heart disease. Trop Med Int Health. 2019;24(6):757-765.
  • Kaewpechsanguan A, Chungsomprasong P, Durongpisitkul K, et al. Manifestations of rheumatic carditis, regression of valvular regurgitation, and independent predictors of mitral regurgitation improvement after rheumatic carditis in thai children. Global Heart. 2024;19(1):16.
  • Erdem S, Demir F, Ayana M, et al. Acute rheumatic fever in south-east of Turkey: clinical features and epidemiological evaluation of the patients over the last 25 years. Cardiol Young. 2020;30(8):1086-1094.
Year 2024, Volume: 7 Issue: 3, 321 - 326, 27.05.2024
https://doi.org/10.32322/jhsm.1469413

Abstract

References

  • Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol. 2011;3:68-84.
  • Tibazarwa KB, Volmink JA, Mayosi BM. Incidence of acute rheumatic fever in the world: a systematic review of population-based studies. Heart. 2008;94(12):1534-1540.
  • Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones criteria for the diagnosis of the rheumatic fever in the era of Doppler echocardiography: a scientific statement of the American Heart Association. Circulation. 2015;131(20):1806-1818.
  • Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685-694.
  • Oliver J, Baker MG, Pierse N, Carapetis J. Comparison of approaches to rheumatic fever surveillance across Organisation for Economic Cooperation and Development countries. J Pediatr Child Health. 2015;51(11):1071-1077.
  • Saraçlar M, Ertuğrul A, Özme S. Akut romatizmal ateş¸ insidansı ve romatizmal kalp hastalıkları prevelansı. Türk Kardiyol Dern Arş. 1978;7:50-54.
  • Beyazova U, Benli D, Beyazova M. Akut romatizmal ateş¸ görülme sıklığı. Çocuk Sağ Hast Der. 1987;2:76-80.
  • Karademir S, Demirçeken F, Atalay S, Demircin G, Sipahi T, Teziç T. Acute rheumatic fever in children in the Ankara area in 1990-1992 comparison with previous study in 1980-1989. Acta Paediatr. 1994;83(8):862-865.
  • Örün UA, Ceylan Ö, Bilici M, et al. Acute rheumatic fever in the Central Anatolia Region of Turkey: a 30-year experience in a single center. Eur J Pediatr. 2012;171(2):361-368.
  • Narin N, Mutlu F, Argun M, et al. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011. Cardiol Young. 2015;25(4):745-751.
  • Gürses D, Koçak G, Tutar E, Özbarlas N, Turkish ARF study group. Incidence and clinical characteristics of acute rheumatic fever in Turkey: Results of a nationwide multicentre study. J Paediatr Child Health. 2021;57(12):1949-1954.
  • Türkiye İstatistik Kurumu. 2021 Nüfus ve Konut Sayımı. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Population-and-Housing-Census-2021-45866
  • Acar S, Karagöz T, Meydan CM, Cinoğlu DŞ, Kayğısız G, Işık M. İlçelerin Sosyo-ekonomik Gelişmişlik Sıralaması. Republic of Türkiye Ministry of Industry and Technology. SEGE/2022. General Diroctorate of Development Agencies. No: 35. Research Report No: 8. February 2022, Ankara. ISBN: 978-605-7679-34-5. Available from: https://www.sanayi.gov.tr/assets/pdf/birimler/2022-ilce-sege.pdf
  • Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60(1):7-12.
  • Kut A, Salgür F. Sağlık alanında sosyoekonomik düzey belirleme: tıbbi araştırmalarda doğru uyguluyor muyuz? Türk Aile Hek Derg. 2015;19(1):4-13.
  • Yılmaz İ, Güvenç O, Yılmaz FH, Çimen D, Arslan D, Oran B. Akut romatizmal ateş tanısı konulan hastaların klinik özellikleri ve ekokardiyografik bulguları. Selçuk Tıp Derg. 2015;31(2):73-76.
  • Keskin M. Diffıculties in the diagnosis of acute rheumatic fever without carditis. Med J Süleyman Demirel Univ. 2020:27(3):353-357. doi: 10.17343/sdutfd.712570
  • Gasımova N, Sert A. Inflammatory biomarkers and echocardiographic findings in acute rheumatic fever patients. J Contemp Med. 2023;13(3):514-521.
  • Güler M, Laloğlu F, Olgun H, Ceviz N. Clinical characteristics of pediatric patients with first-attack acute rheumatic fever following the updated guideline. Türk Pediatri Arş. 2019; 54(4):220-224.
  • Çağatay D, Yıldız F, Temel Ö, Arslan Ö , İnalhan M. Akut romatizmal ateş: klinik bir değerlendirme. J Child. 2010; 10(4):183-189.
  • Baker MG, Gurney J, Oliver J, et al. Risk factors for acute rheumatic fever: literature review and protocol for a case-control study in New Zealand. Int J Environ Res Public Health. 2019; 15;16(22):4515.
  • Silvilairat S, Sornwai A, Sethasathien S, et al. Outcome following acute and recurrent rheumatic fever. Paediatr Int Child Health. 2024;44(1):13-17.
  • Parks T, Narube L, Perman ML, et al. Population-based assessment of cardiovascular complications of rheumatic heart disease in Fiji: a record-linkage analysis. BMJ Open. 2023; 13(4):e070629.
  • Stacey I, Hung J, Cannon J, et al. Long-term outcomes following rheumatic heart disease diagnosis in Australia. Eur Heart J Open. 2021;1(3):oeab035.
  • Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: a systematic review. PLoS Negl Trop Dis. 2018;12(6):e0006577.
  • Narang R, Saxena A, Ramakrishnan, Gupta KS, Juneja R, Kothari SS. Characteristics of children with acute rheumatic carditis from a high-incidence region: importance of unexplained worsening of functional class. Cardiology. 2020;145(8):522-528.
  • Bhardwaj R, Sood A. Clinical profile of acute rheumatic fever patients in a tertiary care institute in present era. J Assoc Physicians India. 2015;63(4):22-24.
  • Currie B, Ralph A, eds. The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 3.2 edition, March 2022. Available from: https://www.rhdaustralia.org.au/system/files/fileuploads/arf_rhd_guidelines_3.2_edition_march_2022.pdf
  • Loizaga SR, ArthurL, Arya B, et al. Rheumatic heart disease in the United States: forgotten but not gone. J Am Heart Assoc. 2021;10(16):e020992.
  • Tal R, Saied MH, Zidani R, et al. Rheumatic fever in a developed country – is it still relevant? A retrospective, 25 years follow-up. Pediatr Rheumatol. 2022;20(1):20
  • Yavrum BE, Gul AEK, Azak E, Gursu HA, Cetin II. Changing face of acute rheumatic fever in childhood and our clinical results. North Clin Istanb. 2023;10(2):237-247.
  • Alam S, Hye MA, Ahmed S, et al. Subclinical carditis in acute rheumatic fever: a single center experience. Cardiol Cardiovasc Med. 2023;7(4):311-315.
  • Erol N, Özen M, Bozaykut A. A major diagnostic criterion for acute rheumatic fever: clinical and sub-clinical carditis accompaniment with Sydenham chorea. Zeynep Kamil Med J. 2021;52(4):198-201.
  • Ekure EN, Amadi C, Sokunbi O, et al. Echocardiographic screening of 4107 Nigerian school children for rheumatic heart disease. Trop Med Int Health. 2019;24(6):757-765.
  • Kaewpechsanguan A, Chungsomprasong P, Durongpisitkul K, et al. Manifestations of rheumatic carditis, regression of valvular regurgitation, and independent predictors of mitral regurgitation improvement after rheumatic carditis in thai children. Global Heart. 2024;19(1):16.
  • Erdem S, Demir F, Ayana M, et al. Acute rheumatic fever in south-east of Turkey: clinical features and epidemiological evaluation of the patients over the last 25 years. Cardiol Young. 2020;30(8):1086-1094.
There are 36 citations in total.

Details

Primary Language English
Subjects Pediatric Cardiology
Journal Section Original Article
Authors

Tunç Tunçer 0000-0003-2558-8851

Publication Date May 27, 2024
Submission Date April 17, 2024
Acceptance Date May 12, 2024
Published in Issue Year 2024 Volume: 7 Issue: 3

Cite

AMA Tunçer T. Acute rheumatic fever: a single center experience. J Health Sci Med / JHSM. May 2024;7(3):321-326. doi:10.32322/jhsm.1469413

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