Reoccurrence of Acute Rheumatic Fever

Background: Acute rheumatic fever (AARF) is a known complication of type A streptococcus infection mediated by immune system responses. ARF is an acquired but preventable heart disease and a major differential diagnosis in many clinical and also paraclinical settings also. ARF can leads to important cardiac and neurologic complications. Nowadays Jones criteria are used to diagnose of ARF.Although incidence and prevalence of ARF decreased in the world but not eradicated in many countries and the aim of our study was determination of reoccurrence of this old disease in northeast of Iran.Methods: A cross sectional study on children (less than 18 years old age) with ARF diagnosed by using the Jones Criteria at department of pediatrics of Imam Reza hospital and Ghaem hospital (Two important and tertiary referral hospitals) of Mashhad University of medical sciences between September 2006-2016. Data collected and analyzed statistically by SPSS (16) software.Results: From 180 cases 89 patients (49.4%) were male. The mean age was 10.4+3.37 years old (Range 3-18 Y). Arthritis and arthralgia was most common referring chief complaint. Carditis is found in 123 patients, arthritis in 96, and subcutaneous nodule in 2 and erythema marginatum in 28 and chorea in 13 patients.The most common minor criteria were fever and arthralgia in 105, high ESR in 87 and prolong PR is found in only 8 patients. ARF frequency increased during 2011 to 2015. The most common echocardiographic findings in order were MR, AI and MR& AI. Frequency of carditis increased significantly with older age and reported murmur in less than one thirds of cases. Only two cases need valve replacement.Conclusion: ARF is an important but preventable heart disease in childhood. It is not eradicated and even increased reoccurrence in recent years. Carditis was the most common serious complication that often was subclinical and underdiagnosed especially in older ages. Echocardiography is a sensitive and noninvasive diagnostic tool and Clinical suspicious in endemic area needed for early diagnosis and treatment.