Rheumatic fever presentation and outcome: A case-series report
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Objective: To assess the clinical characteristics and outcome of a rheumatic fever case-series from a referral hospital over the last 20 years. Patients and methods: Patients under the age of 18 years, diagnosed with rheumatic fever between 1986 and 2007 were retrospectively assessed to estimate the carditis and relapse rates, by use of descriptive and survival analysis. Results: Of 178 cases identified, 134 were included. During the acute phase, 66.4% had polyarthritis, 56.8% had carditis, 28.6% had chorea, 1.5% had subcutaneous nodules, and 1.5% had erythema marginatum. The association of carditis and arthritis occurred in 40%. Carditis and chorea were more frequent among female gender. High antistreptolysin-O titres were found in 58.3%, and family history of rheumatic fever, in 14.5%. Mean follow-up was 6.8 years (1.1 to 16.9). Relapse was observed in 15%, hospital admissions in 27.6%, and follow-up discontinuation in 47.4% after a mean of 5.1 years. Carditis and relapse probabilities were 17.5% and 13.2%, respectively, five years after the initial attack. Conclusion: The risk of carditis and relapse of rheumatic fever was higher within the first five years. Follow-up discontinuation was frequent, pointing to the need of measures to improve adherence to prophylaxis and follow-up. © 2012 Elsevier Editora Ltda. All rights reserved.