Toward the Knowledge of the Epidemiological Impact of Acute Rheumatic Fever in Italy.

Giulia Bini,Rita Consolini,Antonino Maria Quintilio Alberio,Susanna Cappelli,Alice Bonuccelli,Diego Peroni,Sarah Abu-Rumeileh,Filippo Pieroni,Nadia Assanta,Carla Gaggiano,Gabriele Simonini,Alessandro Orsini,Alessandro Di Gangi

doi:10.3389/fped.2021.746505

Abstract

Background: To estimate the incidence of Acute Rheumatic Fever (ARF) in Tuscany, a region of Central Italy, evaluating the epidemiological impact of the new diagnostic guidelines, and to analyse our outcomes in the context of the Italian overview.Methods: A multicenter and retrospective study was conducted involving children <18 years old living in Tuscany and diagnosed in the period between 2010 and 2019. Two groups were established based on the new diagnostic criteria: High-Risk (HR) group patients, n = 29 and Low-Risk group patients, n = 96.Results: ARF annual incidence ranged from 0.91 to 7.33 out of 100,000 children in the analyzed period, with peak of incidence registered in 2019. The application of HR criteria led to an increase of ARF diagnosis of 30%. Among the overall cohort joint involvement was the most represented criteria (68%), followed by carditis (58%). High prevalence of subclinical carditis was observed (59%).Conclusions: Tuscany should be considered an HR geographic area and HR criteria should be used for ARF diagnosis in this region.

Highlights

Acute Rheumatic Fever (ARF) is a multisystemic autoimmune response to infection of the group A streptococcus (GAS)
Demographic data from the Italian National Institute for Statistics (ISTAT: national and governmental registry that collects data relating to the permanent census of the population and housing) were used to define the number of childhood population at risk of GAS infection living in Tuscany in the 2010– 2019 period
The diagnosis of ARF is based on the criteria of American Heart Association (AHA) revised in the 2015 year, which distinguishes the populations in two groups, HR and LR, respectively, and includes both major criteria and minor criteria such as polyarthalgia, fever (≥38.5◦C), erythrocyte sedimentation rate (ESR ≥60 mm/h) in LR populations, while monoarthralgia, fever (≥38◦C), Erythrocyte sedimentation rate (ESR) ≥30 mm/h in HR populations, and in both populations C-reactive protein (CRP ≥3.0 mg/dl) and a prolonged PR interval for age variability

Summary

Introduction

Acute Rheumatic Fever (ARF) is a multisystemic autoimmune response to infection of the group A streptococcus (GAS). Jones criteria for ARF diagnosis were first established in 1944, revised in 1992 [12] and afterward in 2015 [13] by the American Heart Association (AHA), leading to a distinction between moderate to high-risk (HR) and low-risk (LR) populations (incidence cut-off

Methods

Results

Conclusion