RESUMO
OBJECTIVE: To describe clinical presentation, electrocardiographic, and echocardiographic characteristics of carditis at the time of diagnosis of acute rheumatic fever (ARF) over a 13-year period. STUDY DESIGN: A single-center retrospective chart analysis was conducted involving all consecutive patients diagnosed with ARF between 2003 and 2015. Patient age, sex, clinical characteristics, recent medical history for group A streptococcal pharyngotonsillitis and antibiotic treatment, and laboratory, echocardiographic, and electrocardiographic findings were recorded. RESULTS: Of 98 patients (62 boys, mean age 8.81 ± 3.04 years), 59 (60.2%) reported a positive history of pharyngotonsillitis; 48 (49%) had received antibiotic (mean duration of treatment of 5.9 ± 3.1 days), and, among these, 28 (58.3%) had carditis. Carditis was the second most frequent finding, subclinical in 27% of patients. Mitral regurgitation was present in 49 of 56 patients (87.5%) and aortic regurgitation in 36/56 (64.3%) no stenosis was documented. CONCLUSIONS: ARF is still present in high-income countries and can develop despite primary prophylaxis, especially when given for a short course. Our findings highlight the need for 10 days of antistreptococcal treatment to prevent ARF. Echocardiography is important because 27% of cases with carditis were subclinical.
Assuntos
Miocardite/diagnóstico , Miocardite/epidemiologia , Febre Reumática/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Insuficiência da Valva Aórtica/diagnóstico por imagem , Artrite/microbiologia , Bloqueio Atrioventricular/diagnóstico , Sedimentação Sanguínea , Criança , Pré-Escolar , Coreia/microbiologia , Países Desenvolvidos , Ecocardiografia Doppler em Cores , Eletrocardiografia , Eritema/microbiologia , Feminino , Hemoglobinas/análise , Humanos , Itália/epidemiologia , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Faringite/epidemiologia , Estudos Retrospectivos , Febre Reumática/tratamento farmacológico , Febre Reumática/epidemiologia , Estações do Ano , Tonsilite/epidemiologiaRESUMO
Acute rheumatic fever is a post-infectious illness characterized by diffuse inflammation. Typically, high-dose anti-inflammatory agents are used as primary therapy for this disorder. In addition to their anti-inflammatory properties, these agents, most frequently aspirin, also have anti-platelet properties. We describe the case of an 11-year-old patient with rheumatic fever who needed to undergo surgery. The use of traditional anti-inflammatory agents would have posed a potential problem with post-surgical bleeding, so a lesser-used anti-inflammatory agent (i.e., choline magnesium trisalicylate) was selected.