Clinical Profile of Patients of Acute Rheumatic Fever in a Specialized Center

Author(s): Md. Saidul Alam, Mohammad Abdul Hye, Shuperna Ahmed, Mohammad Aminul Islam, Md. Arifur Rahman, Shamsi Sumaiya Ashique, Lohani Md Tajul Islam, Mohammad Jobayer

Background: Acute rheumatic fever (ARF) is an important preventable health problem in developing countries. Early detection of clinical manifestations leads to better management of the disease. The study was designed to analyze the clinical characteristics of patients of ARF in a specialized center.

Methods: This cross-sectional study was conducted from January 2019 to March 2021 in National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh. A total of 185 clinically diagnosed patients of ARF, irrespective of age and sex were enrolled. Clinical profile of patients based on revised Jones criteria 2015 were recorded and analyzed.

Results: Fever was the commonest presenting complaint of patients with ARF followed by joint pain. The most common major criterion of ARF was carditis (78.4%) among which 25.4% was clinical carditis and 53% was subclinical carditis detected by Doppler echocardiography. Polyarthralgia was present in 56.7% patients whereas migratory polyarthritis and monoarthritis was found in 5.4% and 7.5% patients respectively. Two patients had Sydenham chorea and there was a solitary case of Erythema marginatum and no case of subcutaneous nodules was detected. Raised ASO titer (>200IU/ml) was found in 88.6% patients; 82.7% had high ESR, elevated CRP was found in 62.2% and fever (≥380C) was recorded in 50.3% patients.

Conclusions: Carditis was the most common major criterion with clinical carditis and subclinical carditis in about one-third and two-third of patients respectively. Polyarthralgia was the main joint manifestation. Echocardiography is essential to diagnose subclinical carditis in ARF patients.