Episodes Of Acute Rheumatic Fever Research Articles

Incidence of acute rheumatic fever in the world: a systematic review of population-based studies

Background:There is no systematic overview of prospective studies of incidence of acute rheumatic fever (ARF) in the world.Aim:To summarise all population-based studies of the incidence of ARF world wide.Method:A systematic...

Echocardiographic screening for rheumatic heart disease

Rheumatic fever is a delayed sequel to throat infection by a group A streptococcus. More than one third of affected children develop carditis, followed many years later – especially in the case of recurrent rheumatic infections – by progressive and permanent valvular lesions, known as rheumatic heart disease. 2 Rheumatic heart disease is now largely restricted to developing countries and most of the reduction in its incidence in wealthy countries is attributable to better living conditions with consequent reductions in the transmission of group A streptococci. Nevertheless, with the decline in rheumatic fever in industrialized countries and the emphasis on diseases such as malaria and HIV in developing countries, there has been a parallel reduction in research into this still prevalent and important condition. 3 Rheumatic heart disease remains an obvious public health burden across the developing world causing more than 200 000 deaths a year. 4 An exaggerated immune response to specific bacterial epitopes in a susceptible host is thought to be the basis of the disease. 5 Rheumatic heart disease usually results from the cumulative damage from recurrent episodes of acute rheumatic fever. It has been reported that after a first episode of carditis, cardiac ausculta tion becomes unremarkable in one-third of children but even these children may progress to significant rheumatic valve disease in later life, as confirmed by echocardiography. 6 Thus early detection of “subclini cal” rheumatic valve disease is vital, as it presents an opportunity for case detection at a time when prophylactic penicillin – to prevent recurrent episodes – can prevent progression to important valve disease in young adult life. Early detection of rheumatic heart disease in school children is traditionally done by listening for murmurs by stethoscope, followed by echocardiographic confir mation only in suspected cases. Recently, we did systematic echocardiographic screening in schools in Cambodia and Mozambique, to assess whether early case detection could be improved by using portable ultrasound. 7 We achieved a case detection rate by echocardiography approximately 10-fold that achieved by clinical examination only. Such screening thus makes it possible to identify children at risk of developing severe rheumatic valve disease for whom secondary prevention with penicillin prophylaxis may be effective. Acute rheumatic fever episodes can be prevented by antibiotic treatment of group A streptococcal throat infections, a strategy known as primary prophy

Acute rheumatic fever: an important differential diagnosis of septic arthritis

We present three cases of suspected septic arthritis in which the joint fluid was sterile. Subsequently all three patients were diagnosed with established moderate-severe rheumatic heart disease. In retrospect it is likely that the earlier presentations were in fact episodes of acute rheumatic fever but were not recognized as such. These cases underline the importance of acute rheumatic fever as a differential diagnosis of septic arthritis when the joint fluid is sterile, particularly in regions where there are high rates of acute rheumatic fever and rheumatic heart disease.

Evolution of valve damage in Sydenham's chorea during recurrence of rheumatic fever

Background The evolution of valve damage during a recurrence, in a patient who did not have apparent carditis in the initial attack of Sydenham's chorea, has been a subject of debate. Methods Thirty-six patients with an initial episode of acute rheumatic fever and Sydenham's chorea (3 patients with subclinical mitral regurgitation) were followed up prospectively for 5 years. Clinical examinations and transthoracic color Doppler echocardiography were done for each patient at initial attacks of Sydenham's chorea and at recurrences of rheumatic fever. Results Six recurrences of rheumatic fever occurred in 6 of the 36 patients. One recurrence developed in the regular secondary prophylaxis group (27 patients) with a recurrence rate of 0.007 per patient-year. Three of the 18 patients who initially had no heart murmur and no echocardiographic finding of valvular regurgitation had three recurrences of pure chorea with no echocardiographic evidence of significant valvular regurgitation. Interestingly, one of the 3 patients with previous pure chorea and echocardiographic finding of significant mitral regurgitation had a recurrence of pure chorea and new echocardiographic evidence of mitral, aortic and tricuspid regurgitations. Furthermore, two recurrences occurring in 2 of the 15 patients with previous carditis developed echocardiographic evidence of new carditis. Conclusions Rheumatic recurrence can develop new valve damage evident by echocardiography for the patient with pure Sydenham's chorea who had previous subclinical valvulitis. Longer duration of secondary prophylaxis is recommended to prevent a recurrence of rheumatic fever in the patient with pure Sydenham's chorea who initially had subclinical valvulitis.

Acute rheumatic fever

<h2>Abstract</h2> Aetiology: acute rheumatic fever (ARF) is a systemic inflammatory disease that occurs 2–3 weeks after a group A streptococcal infection. ARF is mediated by an autoimmune response to antigenic components of the organism that cross-react with similar epitopes in the heart, joints, brain and skin. Presentation: ARF is characterized by major and minor manifestations. Major manifestations are arthritis (migratory polyarthritis), cardiac abnormalities (pericarditis, myocarditis, and valvulitis), neurological changes (Sydenham's chorea), and cutaneous involvement (erythema marginatum, subcutaneous nodules). Minor manifestations of ARF are fever, arthralgia, a prolonged PR interval, and elevated acute phase reactants (ESR, C-reactive protein). Diagnosis: the diagnosis of the initial episode of ARF requires the presence of two major manifestations or one major and two minor manifestations, plus evidence of preceding group A streptococcal infection (e.g. elevated or rising streptococcal antibody titre). A recurrence may be diagnosed on the basis of a single major or several minor manifestations in a patient with a history of ARF or established rheumatic heart disease. Management: the aims of treatment of ARF are to suppress the inflammatory response so as to minimize cardiac damage, to provide symptomatic relief and eradicate streptococcal infection. All patients with ARF require long-term secondary antibiotic prophylaxis to prevent recurrent attacks. Prognosis: carditis is the most serious manifestation of ARF as it may lead to severe life-threatening heart failure. If antibiotic prophylaxis is not used, repeated attacks of ARF lead to chronic rheumatic heart valve disease, heart failure, and a shortened life span.

Use of the Jones Criteria in the diagnosis of acute rheumatic fever in an Australian rural setting

Objective: To answer the question, are the Jones Criteria being used appropriately in the diagnosis of acute rheumatic fever (ARF) by non‐specialist medical staff in a remote Australian setting?Methods: The medical records of all patients discharged from Katherine Hospital (Northern Territory) with a diagnosis of ARF between January 2000 and April 2004 were retrospectively reviewed for adherence to the Jones Criteria. Data were also collected on specialist follow‐up and need for transfer to a tertiary hospital.Results: Twenty‐five patients had a diagnosis of ARF and all were Aboriginal or Torres Strait Islander. Thirty‐two per cent did not fulfil the Jones Criteria and of these 63% were recurrent cases. Eighty‐eight per cent received specialist follow‐up and of those who did not fulfil the Jones Criteria, all were diagnosed as ARF by the specialist. Only 20% required transfer to a tertiary hospital for higher‐level care.Conclusion: The Jones Criteria are being used appropriately to diagnose initial episodes of ARF but less successfully in recurrent episodes. Specialist follow‐up is essential but acute episodes can be managed in remote settings, reducing the need to transfer patients to tertiary care with resultant patient dislocation and social isolation.Implications: The diagnosis of ARF results in long‐term penicillin prophylaxis. This is a major public health undertaking that requires correct diagnosis. This study demonstrates that the Jones Criteria are being used appropriately to diagnose ARF in a remote setting. The ability to diagnose and treat Indigenous patients within their local region reduces social isolation and creates a more positive health care experience.

The Challenge of Acute Rheumatic Fever Diagnosis in a High-Incidence Population: A Prospective Study and Proposed Guidelines for Diagnosis in Australia's Northern Territory

Accurate diagnosis of acute rheumatic fever (ARF) remains problematic in high-incidence settings and especially in the Aboriginal population of Australia's Northern Territory. Previous investigators have demonstrated that strict application of the 1992 Updated Jones Criteria results in under-diagnosis. This study's objectives were to review use of the Jones Criteria (1992 Update) in diagnosing ARF in Australian Aboriginal patients presenting with suspected rheumatic fever, and formulate a locally relevant algorithm to improve diagnosis. Patients presenting to Royal Darwin Hospital with suspected ARF were prospectively assessed during a 15-month period. Demographic information, clinical history, examination, laboratory and echocardiographic findings were documented in order to determine whether the Jones Criteria were fulfilled, and to identify alternative diagnoses. The hospital discharge diagnosis was recorded and patients were followed up 18-33 months later. Out of 35 patients with suspected ARF, all were Aboriginal Australians, 17 (49%) had a discharge diagnosis of definite ARF, 7 (20%) had definite non-rheumatic fever diagnoses (disseminated gonococcal infection, systemic lupus erythematosis, buttock abscess and other febrile illnesses in children with cardiac murmur due to previously undiagnosed RHD). The remaining 11 (31%) posed diagnostic difficulties because of mild symptoms that failed to fulfil Jones Criteria (attracting diagnoses such as 'unexplained arthralgia') or atypical features such as older age. Two patients whose illness initially failed to fulfil the Jones Criteria, who were neither diagnosed with ARF nor commenced on secondary benzathine penicillin prophylaxis, were found on follow-up to have definite and probable ARF, respectively. At least 29% (8/28) of patients without prior recognised ARF/RHD had echocardiographic evidence of established RHD, indicating that previous episodes were missed. Individual mild episodes of ARF may be overlooked, with patients missing out on the timely institution of secondary prophylaxis. The Jones Criteria should be supplemented by active exclusion of differential diagnoses and vigilant follow-up including echocardiography. 'Probable' and 'possible ARF' should be recognised as diagnostic categories applying to patients not fulfilling the Jones Criteria but who nevertheless should be offered prophylactic penicillin at least until further follow-up. A set of diagnostic guidelines is proposed.

The epidemiology of acute rheumatic fever in Indigenous people in north Queensland

Objective: To describe the epidemiology and features of acute rheumatic fever (ARF) in Indigenous people in north Queensland from mid‐1999 to mid‐2004.Methods: Enhanced surveillance, including regular reminder letters to relevant clinicians and computer searches of hospital discharge diagnoses, was implemented to capture cases of ARRResults: Over the five years, 144 episodes of ARF occurred in 133 Indigenous people in seven of the Health Service Districts in north Queensland. The annual incidences of ARF were 61 cases/100,000 Indigenous people in these seven districts, and 54/100,000 throughout north Queensland. The median age of the cases was 12.0 years, and 76% of the cases occurred in children <15 years. More than one‐third of the definite cases were recurrences of ARF, and carditis was present in 42% of all cases.Conclusions: Within north Queensland, the incidences of ARF were greatest in the Cape York and the Torres Strait and Northern Peninsula Area Districts. However, the incidence of ARF in north Queensland is considerably lower than that reported from the Top End of the Northern Territory (NT). Furthermore, there appears to be less chorea and less monoarthritis, but more group A streptococci isolated from throat swabs, in ARF cases in north Queensland compared with those from the Top End of the NT.Implications: There is a need for greater awareness of ARF and its complications among both ARF patients and primary health care workers in the region, and for more reliable mechanisms for recalling patients for their prophylaxis and clinical reviews.

Clinical profile of acute rheumatic fever in Pakistan.

We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.

Rheumatic chorea in northern Australia: a clinical and epidemiological study.

To describe the epidemiology and clinical features of Sydenham's chorea in the Aboriginal population of northern Australia a review was conducted of 158 episodes in 108 people: 106 were Aborigines, 79 were female, and the mean age was 10.9 years at first episode. Chorea occurred in 28% of cases of acute rheumatic fever, carditis occurred in 25% of episodes of chorea, and arthritis in 8%. Patients with carditis or arthritis tended to have raised acute phase reactants and streptococcal serology. Two episodes lasted at least 30 months. Mean time to first recurrence of chorea was 2.1 years compared with 1.2 years to second recurrence. Established rheumatic heart disease developed in 58% of cases and was more likely in those presenting with acute carditis, although most people who developed rheumatic heart disease did not have evidence of acute carditis with chorea. Differences in the patterns of chorea and other manifestations of acute rheumatic fever in different populations may hold clues to its pathogenesis. Long term adherence to secondary prophylaxis is crucial following all episodes of acute rheumatic fever, including chorea, to prevent recurrence.

A Randomized, Placebo-Controlled Trial of Intravenous Immune Globulin (IVIG) in the Treatment of Acute Rheumatic Fever (ARF). † 148

There is no therapeutic agent proven to alter the outcome of ARF. This prospective, double-blind, randomized, placebo-controlled trial evaluated IVIG, a proven immunomodulator, in patients with a first episode of ARF. Patients were stratified by presence and severity of carditis prior to randomization. 61 patients (34 male, aged 6.2-15.9 years) were randomly allocated to receive lg/kg IVIG on day 1 and 2, and 0.4g/kg on day 14 and 28, or a placebo infusion. Clinical, laboratory and echocardiographic evaluation was performed at 0, 2, 4, 6, 26, and 52 weeks. The majority of patients presented with clinical carditis (38) and/or migratory polyarthritis (39). There was no difference between groups in duration of arthritis (2.9 vs 3.7 days), length of time receiving aspirin (17 vs 20 days), or normalisation of ESR and acute phase proteins at 6 weeks. By echocardiography, 67% in the IVIG group and 69% in the placebo group had carditis at baseline. There was no significant difference in cardiac outcome at 2, 4, 6, and 26 and 52 weeks. At 1 year, clinical and echocardiographic carditis was present in 26 and 41% of those receiving IVIG, compared with 31 and 50% of those receiving placebo, respectively. There was also no difference between groups in the proportion of valves with valvulitis, or the severity of mitral or aortic regurgitation at 1 year. IVIG does not alter the natural history of ARF, with no significant difference in the rate of improvement of clinical, laboratory or echocardiographic parameters.

Acute rheumatic fever and rheumatic heart disease in the top end of Australia's Northern Territory.

To describe the epidemiological and clinical features of acute rheumatic fever and rheumatic heart disease in the Top End of the Northern Territory. A retrospective review (in some instances as far back as the 1960s) of all cases of known or suspected acute rheumatic fever or rheumatic heart diseases, with prospective validation of clinical status where necessary. Cases were ascertained from hospital and community medical clinic records and medical staff; and from records and health staff of 10 rural communities. Three hundred and eighty-six revised Jones criteria-confirmed episodes of acute rheumatic fever were documented in 249 individuals (99% Aboriginal). The annual incidence of confirmed acute rheumatic fever between 1989 and 1993 was 254 per 100,000 Aboriginal people aged 5 to 14 years. A more accurate estimate of 651 per 100,000 came from 10 rural communities with more complete information. As of 1995, there were 286 people living with established rheumatic heart disease (95% Aboriginal). The point prevalence of rheumatic heart disease among Aboriginal people was 9.6 per 1000, with a rate of 24 per 1000 in one large rural community. Sydenham's chorea was common, and associated with later rheumatic heart disease in 49% of cases. There was a preponderance of females with acute rheumatic fever, rheumatic heart disease and chorea. In Aboriginal people in rural northern Australia the incidence of acute rheumatic fever is higher than that reported anywhere in the world, and the prevalence of rheumatic heart disease is among the highest in the world. While continuing attention must be paid to alleviating the causes of these diseases of poverty, immediate action is needed to improve diagnosis of acute rheumatic fever, adherence to secondary benzathine penicillin prophylaxis regimens, and follow-up of rheumatic heart disease cases.

Serum-Soluble Receptors for Tumor Necrosis Factor-α and Interleukin-2, and Neopterin in Acute Rheumatic Fever

Immune activation may play an important role in the pathogenesis of acute rheumatic fever (ARF). The objective of the present study was to investigate serum concentrations of various markers of immune activation in ARF patients. Sera of 32 patients with ARF were investigated, 20 of them in follow-up. Radioimmunoassay was used to quantify neopterin and ELISA for the measurement of 55-kDa-type soluble tumor necrosis factor receptor (sTNF-R) and soluble interleukin-2 receptor (sIL2-R). Markers of immune activation were found to be raised in 48% (sTNF-R), 28% (sIL2-R), and 78% (neopterin) of patients at the onset of ARF. There were significant correlations between the concentrations of neopterin and sTNF-R (rs = 0.60, P < 0.001) or sIL2-R (rs = 0.35, P < 0.05). Higher neopterin concentrations were found in patients with combined aortic and mitral insufficiency than in patients with mitral valve lesions alone (U = 2.67, P <0.05) or without valve lesion (U = 2.36, P < 0.05). Increased concentrations of neopterin, sTNF-R, and sIL2-R demonstrate activation of the cellular immune system in patients with ARF. Higher serum neopterin concentrations are associated with development of combined aortic and mitral insufficiency during the first episode of ARF.

Long-term observations of rheumatic carditis

AbstractA total of 246 consecutive patients were seen with the diagnosis of acute rheumatic fever (and/or rheumatic heart disease) and were followed for 587.7 patient years. The episode of acute rheumatic fever was the first in 64 of these patients, whereas recurrent acute rheumatic fever was seen in 26 and the other 156 patients had chronic rheumatic carditis. At presentation, those suffering an initial attack had less frequent and less severe carditis when compared to those suffering recurrent infection (p&lt;0.05). Improvement in carditis during follow-up was noted in those having an initial attack (p&lt;0.1), while deterioration occurred following recurrent infection (p&lt;0.01), and no change was noted for those with chronic infection. Recurrences of acute rheumatic fever were most frequent in those presenting with their initial infection (21%) or reinfection (35%), and dropout from follow-up was highest in the group with first infection (38%) compared to those with recurrent infection (15%) and chronic carditis (25%). Non-recognition of the first episode of acute rheumatic fever and failure of secondary prophylaxis were found to be the major contributors to the observed increased pool of recurrent and chronic rheumatic heart disease. We conclude that, in the absence of programmed primary prophylaxis of acute rheumatic fever, the best chance of controlling the progression of carditis or affecting cure is to recognize the first episode ofacute rheumatic fever and then ensure strict adherence to secondary prophylaxis. Since the prognosis of recurrent carditis is poor, the best management of moderate to severe recurrent carditis is early reparative valvar surgery wherever possible.

Occurrence of valvar heart disease in acute rheumatic fever without evident carditis: colour-flow Doppler identification.

To determine the frequency of occurrence of mitral and aortic valvar regurgitation in rheumatic children in whom there was no evidence of carditis acutely or at an earlier attack. Colour flow Doppler imaging was used in a non-randomised study of sequentially admitted children who met the criteria for acute rheumatic fever without clinically evident carditis and patients in whom the disease was quiescent after a previous attack of rheumatic fever. Two separate control groups were used for comparison of the echocardiographic findings, and a group of patients with confirmed rheumatic carditis was included for comparison of acute phase and antistreptococcal reactants. A general hospital with the only paediatric inpatient department in Qatar. From November 1988 to October 1990, 11 children were studied during the acute rheumatic period. In seven additional children the disease was quiescent when they were studied 18 to 36 months after a documented episode of acute rheumatic fever in which there was no evidence of carditis. The control patients were all studied during the same period. Detection of mitral and aortic regurgitation in patients without clinical evidence of rheumatic carditis in the acute or quiescent stages of the disease. Mitral or mitral and aortic regurgitation was found in 10 of the 11 children studied in the acute rheumatic period. None had a murmur or other evidence of carditis. In all the cases studied the valvar insufficiency was mild. Four of the children studied late in the quiescent period had either aortic or mitral insufficiency by colour flow Doppler evaluation; two children who had previously had valvar insufficiency no longer showed this, and one child without positive findings in the acute phase remained without insufficiency. None of the non-rheumatic control subjects showed mitral or aortic regurgitation. Colour flow Doppler imaging is a useful method of identifying subclinical mitral and aortic valvar disease at all stages of rheumatic fever when carditis cannot be otherwise detected and is a valuable addition to current diagnostic criteria.

Acute rheumatic fever during childhood in Saudi Arabia

During a 5-year period ending in December 1989, 73 episodes of acute rheumatic fever in 67 children aged 4-14 years were prospectively studied to ascertain the clinical profile of the disease in initial attacks and recurrences, and to compare the findings with those from other countries. Among 51 children with a first episode of acute rheumatic fever, 76% had arthritis and 43% had carditis. In 22 children with recurrences, arthritis was present in 45% and carditis in 91%. Carditis was more severe among the cases with recurrences. Mitral insufficiency was the most common valvular lesion, but no case of mitral stenosis was detected. Chorea, subcutaneous nodules, and Erythema marginatum were relatively rare. The demographic, clinical and laboratory findings of this study resemble those from Western countries, in contrast with data from tropical countries. Efforts aimed at prompt recognition and adequate treatment of streptococcal pharyngitis and maintenance of anti-streptococcal chemoprophylaxis would be rewarding in reducing the incidence of this disease and its sequelae.

Surgical Pathology of Pure Aortic Stenosis: A Study of 374 Cases

The gross surgical pathologic features of the aortic valve were reviewed in 374 patients who had had clinically pure aortic stenosis and aortic valve replacement at our institution during the years 1965, 1970, 1975, and 1980. The most common cause of aortic stenosis, accounting for 46% of our cases, was calcification of a congenitally bicuspid valve. In the remainder, stenosis was produced by postinflammatory fibrocalcific disease (including rheumatic disease) in 35%, by degenerative calcification of an aging valve in 10%, and by calcification of a congenitally unicommissural valve in 6%. The cause of aortic stenosis was indeterminate in 4%. Valvular lesions included various degrees of dystrophic calcification, commissural fusion, and cuspid fibrosis. Calcification tended to occur more extensively and at a younger age in men than in women. Furthermore, it tended to produce stenosis and to necessitate valve replacement earliest in patients with unicommissural valves (mean age, 48 years), later in those with bicuspid or postinflammatory valves (mean age, 59 and 60 years, respectively), and latest in those with degenerative stenosis (mean age, 72 years). In our study, the relative incidence of postinflammatory aortic stenosis remained unchanged from 1965 to 1980, despite the steadily decreasing incidence of acute rheumatic fever reported in western countries. Our data suggest that (1) the incidence of chronic rheumatic heart disease has not yet begun to decrease appreciably, (2) many episodes of acute rheumatic fever may be subclinical, or (3) some forms of nonrheumatic aortic valve disease may produce gross alterations indistinguishable from those of classic chronic rheumatic valvulitis.

Clinical-Echocardiographic Correlations in Acute Rheumatic Fever

Thirty-three children with acute rheumatic fever were studied using echocardiography to characterize heart involvement in this disease. Among 26 subjects with a first episode of acute rheumatic fever, 18 had a clinical diagnosis of carditis and six had heart failure. Heart failure usually resulted from valvular incompetence rather than from myocardial failure in these patients. Conversely, among seven subjects with recurrent rheumatic fever, five had a clinical diagnosis of carditis and four had heart failure. Severe left ventricular dysfunction noted on echocardiography probably contributed significantly to the appearance of heart failure in two of these four subjects. Ten patients were initially believed not to have carditis: a diagnosis of mitral valvulitis was made in two of these ten on the basis of the results of the echocardiographic examination. Echocardiography, which provides important information on the cardiac status of patients with acute rheumatic fever, may help in assessing the prognosis and may be useful in the therapy of these patients.

Acute rheumatic fever in a South Florida county hospital, 1967-1971.

It has been previously reported that the incidence of acute rheumatic fever (ARF) in South Florida is less than in other metropolitan areas of the United States. It has been suggested that when acute rheumatic fever does occur the morbidity and mortality are significantly decreased. A five-year retrospective study of hospitalized cases revealed 98 episodes of ARF in 95 patients. The clinical manifestations paralleled data from recent surveys in two northern cities and included arthritis in 78 episodes, carditis in 54, chorea in two, and erythema marginatum and subcutaneous nodules in one case each. There were three deaths due to malignant pancarditis. Clinical, laboratory, and demographic data were also similar for this group and indicate rheumatic fever in Miami is not unlike the pattern of illness in other endemic areas of this country.

Pitfalls in the Diagnosis of Acute Rheumatic Fever

DOI: http://dx.doi.org/10.3329/cardio.v4i1.9394Cardiovasc. J. 2011; 4(1): 75-79