Clinical Characteristics of Patients with Acute Rheumatic Fever and Rheumatic Heart Disease in Kosovo, Evaluation of the Long-Term Results

Abstract

Background. Rheumatic fever, also known as acute rheumatic fever (ARF), is an inflammatory disease that can involve the heart, joints, skin, and brain.[1] The disease typically develops two to four weeks after a throat infection.[2] Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and a characteristic but uncommon nonitchy rash known as erythema marginatum. Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. Aims. Our study aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with the first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. Methods. To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children who were hospitalized and treated before 1999, diagnosis of rheumatic fever was decided to base on the clinical and laboratory findings whereas in the second group (221 children treated from1999 to 2010), clinical and lab diagnosis was amplified also on the detection by echocardiography. Conclusion. In the second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over-diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Keywords: rheumatic fever, rheumatic heart disease, chorea minor, echocardiography.