Current profile of acute rheumatic fever and valvulitis in southern India

BACKGROUND AND AIM OF THE STUDY: Rheumatic fever (RF) incidence has declined dramatically in the West, but still accounts for a major percentage of cardiac debility in developing countries. The study aim was to analyze the incidence, clinical profile and echocardiography findings in acute RF over the past decade. METHODS: The records of acute RF admissions to a tertiary care medical college hospital in southern India during the past 10 years were analyzed retrospectively. Chronic rheumatic heart disease and recurrence of RF were excluded from the study. Patients with a first episode of acute RF were studied only if the case records were available, and basic laboratory and echocardiography studies were completed. Thus, a total of 163 patients (81 males, 82 females) qualified for the study. RESULTS: There was no significant decline in the annual incidence of the first episode of acute RE The most common presenting symptoms were arthralgiaarthritis (n = 157), fever (n = 137) and breathlessness (n = 81). Carditis (67.5%) and arthritis (44.2%) were the most often-reported Jones criteria. Trivial to mild mitral regurgitation by echocardiography occurred in 81%, followed by significant mitral regurgitation in 5.5% and mild aortic regurgitation in 25%. The 'youngest' and 'oldest' first episodes of RF were recorded at ages of 2 and 29 years, respectively. CONCLUSION: The incidence of RF in India does not show the declining trends of the Western world. The application of Jones criteria for diagnosis remains relevant, though echocardiography is increasingly called upon to 'confirm' clinical diagnosis and help manage these patients in an appropriate manner.