Clinical characteristics and cardiac outcome of acute rheumatic fever in italy in the last 15 years

A. Grassi, V. Fesslová, V. Carnelli, E. Boati, L. Dell'Era, P. Sauce, M. Bardare, F. Corona

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To analyze clinical characteristics, cardiac outcome and response to therapy of an Italian pediatric population aJft'cted with acute rheumatic fever (ARF) in the last 15 years. Methods 135 patients with ARF (aged 2-14.9 years, mean 8.4±2.5 sears) diagnosed from 1992 to 2006 at the Pediatric Rheumatology Centre oft/ic University of Milan (Italy) were retrospectively reviewed. All patients underwent physical examination, laboratory evaluation, electrocardiogram and echocardio graphs. Patients were divided into 2 groups: group 1 - patients with complete adherence to updated Jones criteria (107 patients), and group 2 - exceptions (28 patients). Echocardiographic criteria were used to confirm the presence of carditis and to evaluate severity of mitral (MR) and aortic regurgitation (AR) at diagnosis and after treatment with steroids or acetylsalicylic acid (ASA)/non-steroidal anti-inflammatory drugs (NSAIDs). Results We observed a persistence of ARF in the last 15 years (mean 9 new cases/year with a peak of /9 cases in 2000). Carditis and arthritis were the main major criteria observed (102/135 and 71/135 patients respectively), then chorea (29/135), erythema marginatum (8/135) and subcutaneous nodules (1/135). Arthritis and chorea resolved completely with i'ariou rapies. At the last follow-up (5 years) in group 1, loss of MR was observed in 46% steroid-treated (26/56 cases) and in 39% ASA/NSAID -treated (7/18 cases) patients and loss of AR in 59% steroid-treated (22/38) and 2/7 ASAINSAID-treated patients (p>O.O5). Conclusion Incidence of ARE is clinically important currently in the area of northern Italy. Non-suppurative complications of streptococcal phars'ngitis should be considered when deciding therapy in a pediatric patient that presents with sore throat.

Original languageEnglish
Pages (from-to)366-372
Number of pages7
JournalClinical and Experimental Rheumatology
Issue number2
Publication statusPublished - Mar 2009


  • child
  • Italy
  • pharyngitis.
  • Rheumatic fever
  • rheumatic heart disease
  • streptococcal infections

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy


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