On the Gravity of the Acute Rheumatic Fever in Children from Pernambuco, Brazil

Saraiva, Lurildo R.; Santos, Cleusa Lapa; Ventura, Cristina; Sobral, Maria Auxiliadora; Barbosa, Breno José Alencar Pires; Parente, Giordano Bruno; Moraes, Fernando

doi:10.5935/abc.20130172

Cited by 3 publications

(3 citation statements)

References 6 publications

(8 reference statements)

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“…In hospitalized children for rheumatic activity, it is not uncommon to find disseminated subcutaneous nodules, inserted in the dorsal region of the hands or feet, in the clavicular region, on tendons or on the scalp, mainly in the occipital region of the skull; curiously, Dr. Cleusa Lapa and I have recently seen subcutaneous nodules along the spine of an eight-year-old boy from the crountryside (northeastern` backwoods "Sertão") of Pernambuco, admitted to the IMIP, similar to those seen by CHEADLE 13,14 in London in 1889, as one of his acute patients with signs of malnutrition, which allows us to conclude that, after more than 100 years, the ARF, in areas of the Brazil, presents with stigmas similar to those of 19th century England, in patients from regions with striking signs of poverty (Fig. 2) Another controversial aspect accepted by DÉCOURT 1 is the so-called "rheumatic pneumonia", almost always located in the lower third of the right lung, in a justcardiac position.…”

Section: Disease Presentation In Children and Adolescents In Rheumatic Activitymentioning

confidence: 87%

Clinical Aspects of Acute Rheumatic Fever in Pernambuco, Brazil

Saraiva¹,

Lapa²,

Leão³

2018

J Infectiology

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Rheumatic fever and subsequent rheumatic heart disease remain high in areas with high levels of poverty as in our country as in Pernambuco State, northeast of the Brasil. Clinical aspects peculiar to the disease, once easily found in rich countries, are still present in our infirmaries, including curious alterations in the electrocardiogram. Elongated QTc and cardiac arrhythmias can be recorded in about 30% of acute cases, with the possibility of sudden death. Cardiac surgery imposes itself for the cure of heart failure rebel against newly introduced drugs in medical practice.

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Section: Disease Presentation In Children and Adolescents In Rheumatic Activitymentioning

confidence: 87%

Clinical Aspects of Acute Rheumatic Fever in Pernambuco, Brazil

Saraiva¹,

Lapa²,

Leão³

2018

J Infectiology

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“…There has also been a resurgence of interest in ARF in recent years due to improved resources in developing countries as well as due to ongoing ARF/RHD in some indigenous populations in developed countries [3][4][5][6]. The current gold standard for the diagnosis of ARF are the modified Jones criteria (2015) [7].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Children with Acute Rheumatic Carditis from a High-Incidence Region: Importance of Unexplained Worsening of Functional Class

et al. 2020

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Background: Acute rheumatic fever (ARF) and acute rheumatic carditis (ARC) continue to be a major public health problem in developing countries. Objective: To study the characteristics of children with ARC being treated at a tertiary centre. Methods and Results: We studied 126 children (mean age 10.4 ± 2.3 years, range 5-15 years, 60% males) diagnosed with ARC by treating cardiologists. Most had lower socioeconomic status. Fifty of 126 (40%) presented with a first episode of ARC. Joint symptoms were present in 29% and fever in 25%. Only 2.4% had subcutaneous nodules and none had erythema marginatum or chorea. Fifty-one percent presented in NYHA class II and 29% in NYHA class III or IV. Tachycardia and heart failure were present in 53% and 21%, respectively. Recent worsening of NYHA class (dyspnoea) was the commonest feature (48%). Laboratory investigations showed raised antistreptolysin O titres (> 333 units) in only 36.7% of patients. Raised C-reactive protein (CRP) was present in 70%, while raised erythrocyte sedimentation rate was found in only 37% of patients. On the basis of above findings, the modified Jones criteria (2015) for the diagnosis of ARF were satisfied only in 46% of children. Echocardiography showed mitral valve thickening in 77% and small nodules on the tip of the leaflets in 43% (27 and 8%, respectively for aortic valve). Left ventricular ejection fraction was < 50% in only 3 patients. The dominant valve lesion was mitral regurgitation (MR) (present in 95% of patients; severe in 78%, moderate in 15%), while aortic regurgitation was present in 44% (severe in 14%). Conclusions: The criteria are often not satisfied by patients being treated for ARC. Recent unexplained worsening of dyspnoea, young age, significant MR, echocardiographic nodules, and elevated CRP are important indicators.

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“… 5 In Pernambuco, severe forms of chronic rheumatic heart disease have been reported, mainly due to lack of adequate treatment for patients with streptococcal pharyngotonsillitis and failure of secondary prophylaxis in patients with cardiac sequelae. 6 …”

Section: Introductionmentioning

confidence: 99%

Tolerância Ao Exercício, Função Pulmonar, Força Muscular Respiratória E Qualidade De Vida Em Crianças E Adolescentes Com Cardiopatia Reumática

Melo

Lira

Lima

et al. 2018

Rev. paul. pediatr.

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Objective: Despite the high prevalence of rheumatic heart disease in Brazil, the occurrence of functional impairment in children and adolescents with rheumatic heart disease is not clear. The aim of this study was to evaluate exercise tolerance, respiratory muscle strength, lung function, and quality of life of children and adolescents with rheumatic heart disease. Methods: Cross-sectional study, conducted from August to December 2014 with children and adolescents with rheumatic heart disease aged 8 to 16 years. The participants, after completing the socioeconomic, clinical, and quality of life questionnaires were tested by spirometry, manovacuometry and in a 6-minute walk test. The variables and their reference values were compared using the paired Student’s t-test. Comparisons between predicted and observed walking distance were done also by Student’s t-test, consdiering the categorization of the participants. Correlations between these differences and quantitative variables were assessed by Pearson’s coefficient, being significant p<0.05. Results: All 56 participants had a walked distance lower than predicted (p<0.001). The differences between predicted and observed distances were positively correlated with the baseline heart rate (r=0.3545; p=0.007). Expiratory muscle strength was also lower than the predicted values (p<0,001). Regarding quality of life assessment, the mean scores were 70, 77 and 67% for general, physical, and psychosocial aspects, respectively. Conclusions: Children and adolescents with rheumatic heart disease have reduced exercise tolerance, which is related to their higher baseline heart rate; they also show impaired expiratory strength and quality of life.

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On the Gravity of the Acute Rheumatic Fever in Children from Pernambuco, Brazil

Cited by 3 publications

References 6 publications

Clinical Aspects of Acute Rheumatic Fever in Pernambuco, Brazil

Clinical Aspects of Acute Rheumatic Fever in Pernambuco, Brazil

Characteristics of Children with Acute Rheumatic Carditis from a High-Incidence Region: Importance of Unexplained Worsening of Functional Class

Tolerância Ao Exercício, Função Pulmonar, Força Muscular Respiratória E Qualidade De Vida Em Crianças E Adolescentes Com Cardiopatia Reumática

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