English

Abstract

INTRODUCTION: Acute rheumatic fever is an auto-immune response to bacterial infection with group A streptococcus (GAS). Despite the dramatic nature of the acute episode, acute rheumatic fever leaves no lasting damage to the brain, joints or skin. Recurrences of acute rheumatic fever may cause further valve damage, leading to steady worsening of rheumatic heart disease. AIMS AND OBJECTIVE: To study prevalence of acute rheumatic fever and rheumatic heart disease as detected by 2D ECHOCARDIOGRAPHY in patients 05 years to 40 years of age attending OPD and IPD of medicine and pediatrics department Rama Medical College, Kanpur. MATERIAL AND METHODS: The present study was conducted on patients of 05 to 40 years of age. All patients were examined clinically and relevant investigations including 2D ECHOCARDIOGRAPHY was done in all patients. RESULTS: A total of 734 patients belonging to age group 05 to 40 years & attending the OPD & IPD of Medicine & pediatrics Department of Rama Medical College, Kanpur, were studied, Out of 734 patients, 42 patients (5.72%) had findings of RF & RHD on 2D ECHO. RF were present in 10 patients (1.36%), RHD in 28 patients (3.81%), and 04 patients (0.54%) had evidence of both RF & RHD, 38.09% had findings of RF & RHD, were >25 years of age, Out of 42 patients 61.90% were females & 38.09% were males, RF & RHD occurred more frequently (57.14%) in rural population as compared to urban population (42.86%). Among the Jones Minor Criteria, the most common manifestation (57.14%) was Arthralgia followed by Fever (50%). ESR was raised in 28.57%, CRP was elevated in 28.57% and PR-interval prolongation was seen in 14.28%.Clinically 04 patients had evidence of carditis. All these patients also had ECHO findings suggesting carditis. Other than that ECHO also identified 10 more patients with carditis. Mitral valve was most commonly involved. Isolated mitral stenosis was present in 25% of patients, isolated mitral regurgitation in 18.75% of patients, while combined mitral valve stenosis & regurgitation was present in 37.50% of patients. Multi valvular lesions were present in 18.25% of patients. CONCLUSION: Our study shows prevalence of RF to be 19.07 per 1000 patients and prevalence of RHD to be 43.59 per 1000 patients, there is higher sensitivity and positive predictive value of 2D ECHO in detecting RF and RHD. Maximum number of patients of RF and RHD belong to the >25 years age group, followed by 20-25 years, 15-20 years and 05-10 years with prevalence is higher in females than male, Polyarthritis was the most common manifestation among the Jones major criteria seen in 35.71% patients.2D ECHO had a sensitivity and positive predictive value of 100% in identifying carditis as compared to clinical methods of detecting carditis with sensitivity of 28.57%.