Rheumatic fever

In recent years, rheumatic fever has been declining in the industrialized countries, and has became a rare disease. In developing areas, nonetheless, the sequels of its cardiac involvement have important implications from the stance of public health, and this disease is still the main cause of heart disease in children and young adults. From a historical perspective, the long-term prevention and the control of socioeconomic problems have been proven to be effective, and it is these measures which have contributed to the decline of the disease in developed countries. But, due to its present high prevalence around the world, and the potential for his resurgence, this disease remains an unsolved problem. Furthermore, the complete understanding of its pathophysiology remains a challenge. In this presentation, we will discuss our experience with epidemiological, clinical and prophylatic aspects of this enigmatic disease, and the strategies we have developed to study and control heumatic fever in Minas Gerais, Brazil.

[The importance of clinical examination for the diagnosis of innocent heart murmur in adolescents]

PURPOSE

To determine the prevalence of innocent murmur among adolescents, and to evaluate the clinical features in comparison with echocardiogram (two-dimensional, M-mode, Doppler, and color-Doppler) in the assessment of heart murmurs.

METHODS

The study was carried out from March to December, 1992, and involved high school students coming from families of the medium and low-medium social classes. Considering the total of 1400 students registered in a public school, 536 adolescents aging from 10 to 20 years were admitted in this study. Twenty seven students with heart murmur were submitted to Echocardiography in order to find any cardiac lesions.

RESULTS

Among 536 adolescents, 171 (32%) had some kind of heart murmur. On the basis of the clinical diagnosis, 160 (29.9%) patients were classified as having innocent murmur and 11 (2.1%) as having "pathologic murmur". Out of 27 students submitted to echocardiography, 20 of them with clinical diagnosis of innocent murmur showed normal results. Among seven students with clinical diagnosis of "pathologic murmur", the echocardiography recognized cardiac lesions in two (small ventricular septal defect and rheumatic heart disease: combined mitral incompetence and stenosis, and aortic incompetence).

CONCLUSION

From the data obtained, the prevalence of innocent murmur among adolescents was 29.9% on the basis of clinical diagnosis. It is suggested that careful clinical examination by physicians skilled in cardiac examination is the recommended method for the diagnosis of innocent murmur (sensitivity of 100% and specificity of 80%).

Evaluation of secondary prophylactic schemes, based on benzathine penicillin G, for rheumatic fever in children

Serum concentrations of penicillin were measured in children with rheumatic fever. The adequacy of the values after administration of 1.2 million units of benzathine penicillin G every 2 or 3 weeks was confirmed; the adequacy of a 4-week regimen was questionable. The administration of 0.6 million units every 3 weeks was found to be inadequate to maintain serum levels high enough for the secondary prophylaxis of rheumatic fever.