Acute rheumatic fever — a late complication of streptococcal infection: results of a 25-year study

Résumé fourni par la source

Despite a decline in incidence, acute rheumatic fever (ARF) and recurrent ARF is a late autoimmune complication of S. pyogenes infection — remain a significant public health problem, being a cause of chronic rheumatic heart disease. Objective : to provide a clinical and epidemiological characterization and describe the outcomes of ARF based on observations of patients hospitalized between 2001 and 2025 at the Morozovskaya children’s city clinical hospital of the Moscow Department of Health. Materials and methods . We observed 113 children (60 girls, 53 boys), aged 4—17 years (median age 10 [8; 13] years), with a diagnosis of ARF (101 children) or recurrent ARF (12 children). We assessed clinical and anamnestic data, laboratory test results (antistreptolysin-O (ASO), C-reactive protein), electrocardiography (ECG), and echocardiography. Children with Sydenham's chorea underwent additional examinations. Results. A high rate of underdiagnosis of ARF was identified (63.7%). The onset of ARF most commonly occurred during the winter-spring period (61.9 %). To confirm markers of previous streptococcal infection, measuring ASO levels is more informative; an elevated ASO level (median 795 [385; 1440] IU/mL) was detected in 86.7% of children. In theclinical presentation of ARF, carditis was the predominant manifestation (81.4 %), and its frequency increased with age (p = 0,003). The mitral valve (MV) was most commonly affected (54%); combined involvement of the MV and aortic valve (AV) was observed in 34.5% of children, while isolated AV involvement occurred in 11.5 %. Arthritis was detected in 44.2% of children, with a high frequency (36/50, 72%) of atypical joint syndrome. Our study recorded a high incidence of Sydenham's chorea (56 children, 49.6%), including isolated Sydenham's chorea in 30.4%. The incidence of Sydenham's chorea decreased with age (p = 0,004). Rare manifestations of ARF — erythema marginatum and subcutaneous nodules — were observed in 14.2% and 3.4% of patients, respectively. A high incidence of chronic rheumatic heart disease (42%) was noted, with the development of rheumatic heart valve defects in 38% of cases. Conclusion . The study highlights the need for vigilance regarding ARF in patients following streptococcal infection to prevent severe outcomes such as the development of acquired heart valve defects.

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