Current Status of Acute Rheumatic Fever and Relationship with Acute Rheumatic Heart Disease at the University Teaching Hospital of Brazzaville (Congo)

Bertrand Fikahem Ellenga Mbolla,Pierre Poathy,Gaston Ekouya-Bowassa,Suzy-Gisèle Kimbally-Kaky,Aurore Mbika-Cardorelle,Moyen Engoba,Annie Rachel Okoko

doi:10.4236/wjcd.2019.911072

Abstract

Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 to December 2016 (5 years) in the Department of Pediatrics. We had included patients aged from 5 to15 years old, admitted for ARF. Results: Twenty-nine black African children, 15 boys (51.7%) were included. The incidence was 5.8 cases/year. The mean age was 10.4 ± 2.7 years. The mean age of parents was 34.5 ± 6.9 years (range: 24-48) for mother and 41.2 ± 6.9 years (range: 28 - 56) for father. Parents were low-income 10 (34.5%), the delay of consultation was 17.7 ± 19.5 days. The medical history was: frequent pharyngitis 22 (76%), previous ARF 17 (58.6%), previous hospitalization 11 (38%). Signs were: polyarthralgia (n = 28, 96.6%), fever (n = 24, 82.8%), asthenia (n = 18, 62%), migratory polyarthritis (n = 12, 41.4%). Organic heart murmur has been reported in 13 cases (44.8%), and heart failure in 7 cases. The anomalies of blood analysis were inflammatory syndrome (100%), elevation of streptococcal enzymes (n = 27, 93%), and anemia (n = 16, 55.2%). In cardiac ultrasound, anomalies were: thickened valve (n = 13, 44.8%), mitral regurgitation (n = 13, 44.8%), dilatation of left ventricle (n = 9, 31%), aortic regurgitation (n = 5, 17.2%). The nosology of pathology was acute RHD (n = 15, 51.7%), ARF only (n = 14, 48.3%). Associated factors of acute RHD were: female sex (OR 1.52, 95%CI 0.35 - 6.6), low-income (OR 1.33, 95%CI 0.24 - 7.4), previous hospitalization (OR 2.7, 95%CI 0.58 - 13) and migratory polyarthritis (OR 1.12, 95%CI 0.25 - 4.9). Conclusion: The ARF remains prevalent in our countries. Its complications lead to sequelae that are difficult to treat, because of the lack of cardiac surgery centers in many sub-Saharan African countries including Congo. Prevention and effective treatment of angina should be applied by practitioners.

Highlights

Acute rheumatic fever (ARF) is an autoimmune condition secondary to infection with ß-hemolytic streptococcus [1] [2]
The ARF remains prevalent in our countries
In sub-Saharan Africa, their incidence varies across countries

Summary

Introduction

Acute rheumatic fever (ARF) is an autoimmune condition secondary to infection with ß-hemolytic streptococcus [1] [2]. Repeated infections and poor management lead to rheumatic heart diseases (RHD), the treatment of which requires cardiac surgery [1] [4]. Les RHD remains a public health problem in low income countries [5] [6] [7]. They are currently considered a neglected tropical disease [8] [9]. Screening studies in schools showed frequencies of 2.3‰ in Mozambique, and 3.5‰ in Brazzaville [11] [12] This prevalence is higher (30‰), during echocardiography screening [12]. This high prevalence is related to adverse socio-economic conditions, and the limits of access to care, justify the deficiency of effective management of pharyngitis, and prevention with penicillin in subjects at risk [5] [13]

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Conclusion