Clinical characteristics and the role of echocardiography in diagnosing acute rheumatic fever in patients referred to the Lady Ridgeway Hospital for Children, Colombo, Sri Lanka

Background: Acute Rheumatic Fever (ARF) is a systemic illness that may occur following group-A beta-haemolytic streptococcal pharyngitis in children. Rheumatic Heart Disease (RHD) is the most serious complication of ARF.

Objectives: To describe the demographic, socio-economical background and clinical profile in children with ARF referred to the Lady Ridgeway Hospital for Children (LRH), Sri Lanka, to assess the place of echocardiogram in diagnosis of ARF and to assess the predictive criteria to identify high risk patients with rheumatic carditis.

Method: Eighty patients with ARF formed cohort. Socio-demographic, clinical and laboratory characteristics were summarized using frequencies. Analysis was done to identify carditis risk predictors using Pearson Chi square test with 95% confidence interval. p<0.05 was considered significant.

Results: Of 80 children with ARF, 65 (81.3%) were on follow up for ARF and 15 (18.7%) were newly diagnosed patients. Seventy one (88.8%) patients were diagnosed as having a definite episode of ARF, 7 (8.8%) as possible ARF and 2 (2.4%) as probable ARF. Most ARF patients were diagnosed between the ages of 5 to 10 years. Mean age was 9.5 years. Cohort showed a 1.75: 1 male: female ratio. Arthritis was the commonest major manifestation of ARF being seen in 73 (91.3%) children. Cardiac involvement occurred in 52 (65%) cases of which 34 (65%) were subclinical. Fever (>38⁰C) occurred in 59 (73.8%) cases, erythrocyte sedimentation rate >30mm/hour in 74 (92.5%) and C-reactive protein above 3 mg/dl in 74 (92.5%) cases. Prolonged PR interval on electrocardiogram was seen in 8 (10%) patients. Increased rates of ARF were seen in children from urban, low-income, and crowded areas. When comparing the carditis group with the non-carditis group, low income, low maternal educational level, and low body mass index (BMI) showed positive correlation in predicting carditis.

Conclusions: In our study, arthritis was seen in 91% of children with ARF and carditis in 65%. Of children with carditis 65% were subclinical and diagnosed only with echocardiography. Low income, low maternal educational level and low BMI showed a positive correlation in predicting carditis.

Sri Lanka Journal of Child Health, 2022; 51(2): 182-188