Akut Romatizmal Ateşe Bağlı Kardit Gelişen Hastalarda Penisilin Profilaksisinin Etkinliğinin Değerlendirilmesi

Year 2016, Volume: 10 Issue: 1, 7 - 12, 01.04.2016

Sibel Bozabalı Aynur Mammadova Caner Turan Yasemin Özdemir Şahan Ertürk Levent Ruhi Özyürek Zülal Ülger

Abstract

Amaç: Akut Romatizmal Ateşi (ARA) olan hastalarda primer ve sekonder penisilin profilaksisinin etkinliği değerlendirilmiştir.Gereç ve Yöntemler: Pediyatrik kardiyoloji polikliniğinde Kasım 1997–Ağustos 2012 tarihleri arasında ARA tanısıyla izlenen hastalar retrospektif olarak demografik ve klinik özellikleri açısından incelenmiştir.Bulgular: Çalışmaya ARA tanısı alan 71 hasta dahil edildi. Hastaların %53.5’i kız, %46.5’i erkekti. Hastaların ortalama yaşları 10.8±3.0 yıl’dı. En sık etkilenim kardiyak olup hastaların %90`nında görülmüştür. Karditli olguların %96`sında mitral kapak tutulumu gözlenmiştir. En sık tutulum şekli mitral yetersizliği (MY) ve aort yetersizliğinin (AY) birlikteliği olup, 33 (%51.6) hastada gözlenmiştir. ARA tanısı konulan tüm hastalar primer ve sekonder penisilin profilaksisi alıyordu. Tedavi sonrası ortalama 3.4±2.7 yıl izlenen karditli hastalardan; MY olan 62 hastanın 20’inde (%32.2) mitral kapak tutulum derecesinde gerileme, 7 (%11.3) hastada ise tam düzelme gözlendi. AY olan 35 hastanın 7’inde (%20) AY derecesinde gerileme, 10 (%28.6) hastada ise tam düzelme gözlendi.Sonuç: ARA, akut dönemde tedavi edilip primer ve sekonder penisillin profilaksisi yapıldığında mekanik kapak replasmanı gibi önemli morbiditelerin önlenebildiği bir hastalıktır.

Keywords

Romatizmal ateş, Benzatin penisilin, Antibiyotik profilaksisi

Evaluation of the Effi cacy of Penicillin Prophylaxis in Patients with Carditis due to Acute Rheumatic Fever

Abstract

Objective: To show the effectiveness of primary and secondary penicillin prophylaxis for acute rheumatic fever patients.Material and Methods: Patients diagnosed with acute rheumatic fever and followed-up at the pediatric cardiology department between November 1997 and August 2012 were studied retrospectively regarding their demographic and clinical characteristics. Results: We included 71 patients (53.5% female and 46.5% male) diagnosed with Acute Rheumatic Fever (ARF) in this study. The mean age of the patients was 10.8±3.0 years. Carditis was the most frequent clinical fi nding and was seen in 90%. The mitral valve was affected in 96% of the carditis patients. The most frequent valvular involvement was combined mitral regurgitation (MR) and aortic regurgitation (AR), seen in 33 (51.6%) of the patients. Primary and secondary penicillin prophylaxis were provided to all patients. The patients with carditis were followed up for a mean duration of 3.4±2.7 years after the diagnosis. The degree of MR was decreased in 20 (32.2%) cases and the MR completely recovered in 7 (11.3%) cases among the 62 patients with MR. The degree of AR decreased in 7 (20%) cases and the AR recovered completely in 10 (28.6%%) cases among the 35 AR patients.Conclusion: The important morbidity caused by ARF can be prevented with the primary penicillin prophylaxis in the acute phase and secondary penicillin prophylaxis afterwards

Keywords

Rheumatic fever, Penicillin G benzathine, Antibiotic prophylaxis

References

• Myung K Park. Pediatric cardiology for practitioners. 5th ed. Acute Rheumatic Fever 2008:469-77.
• Nordet P, Lopez R, Dueñas A, Sarmıento L. Prevention and control of rheumatic fever and rheumatic heart disease: The cuban experience (1986–1996–2002). Cardiovasc J Afr 2008;19:135–40.
• Carapetis JR, McDonald M, Wilson. Acute rheumatic fever. Lancet 2005;366:155−68.
• Mayosi B, Robertson K, Volmink J, Adebo W, Akinyore K, Amoah A, et al. The Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease in Africa. S Afr Med J 2006; 96:246.
• Roberson KA, Volmink JA, Mayosi BM. Towards a uniform plan for the control of rheumatic fever and rheumatic heart disease in Africa – The Awareness, Surveillance, Advocacy, Prevention (ASAP) programme. S Afr Med J 2006; 96: 241-5.
• Minch LL, Tani LY, Pagotta LT, Shaddy RE, Veasy LG. Doppler ec- hocardiography distinguishes between physiologic and pathologic silent mitral regurgitation in patients with rheumatic fever. Clin Car- diol 1997;20:924-6.
• Beaton A, Okello E, Lwabi P, Mondo C, McCarter R, Sable C. Echocardiography screening for rheumatic heart disease in ugandan schoolchildren. Circulation 2012;125:3127-32.