Clinical profile of rheumatic fever: a study of 168 cases

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.

Acute rheumatic fever with advanced degree AV block

Five cases are described of acute rheumatic fever meeting the modified Jones criteria with evidence of second or third degree atrioventricular block (AVB). One patient required a temporary transvenous pacemaker and two patients were treated with corticosteroids. One patient had an associated valvulitis. There was no long-term sequelae due to the AVB in any of the patients. The duration of the advanced degree AVB had a range of about 2 to 12 days. The cause of this advanced degree AVB is uncertain. Advanced degree AVB with acute rheumatic fever appears to be self-limited in most instances. Unlike rheumatic valvulitis, it is not associated with significant permanent morbidity.