Silent Acute Rheumatic Fever Unmasked by Using Handheld Echocardiography for Febrile Children Presenting in a Rheumatic Heart Disease-Endemic Area.

Autor: Ali S; Sudan Heart Center, Khartoum, Sudan; University of Khartoum, Khartoum, Sudan. Electronic address: sulafaali2000@gmail.com., Beaton A; Cincinnati Children's Hospital Medical Center, Cincinnati, OH; The University of Cincinnati School of Medicine, Cincinnati, OH., Ndagire E; The Uganda Heart Institute, Kampala, Uganda., Alhag L; Sudan Medical Specialization Board, Al Khurtum, Sudan.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2024 May; Vol. 268, pp. 113954. Date of Electronic Publication: 2024 Feb 08.
DOI: 10.1016/j.jpeds.2024.113954
Abstrakt: Objective: To understand the burden of acute rheumatic fever (ARF) among children living in low-income countries who present to the hospital with febrile illness and to determine the role of handheld echocardiography (HHE) in uncovering subclinical carditis as a major manifestation of ARF.
Study Design: This was a cross-sectional study carried at the Pediatric Hospital in Al Obeid, North Kordofan, Sudan, from September 2022 to January 2023 and including febrile children 3 through 18 years of age with or without clinical features of ARF and without another cause for their fever (not excluding malaria). History, examination, blood investigations, and HHE were done. ARF was diagnosed according to the Jones criteria. Clinical ARF was diagnosed if there was a major clinical Jones criterion and silent ARF if the only major Jones criteria was subclinical carditis.
Results: The study cohort included 400 children with a mean age of 9 years. Clinical ARF was diagnosed in 95 patients (95/400, 24%), most of whom presented with a joint major manifestation (88/95, 93%). Among the 281 children who did not present with a clinical manifestation of ARF, HHE revealed rheumatic heart disease (RHD) in 44 patients (44/281, 16%); 31 of them fulfilled criteria for silent ARF (31/281, 11%). HHE increased the detection of ARF by 24%. HHE revealed mild RHD in 41 of 66 (62%) and moderate or severe RHD in 25 of 66 (38%) patients. Both sensitivity and specificity of HHE compared with standard echocardiography were 88%.
Conclusions: There is a significant burden of ARF among febrile children in Sudan. HHE increased the sensitivity of diagnosis, with 11% of children having subclinical carditis as their only major manifestation (ie, silent ARF). RHD-prevention policies need to prioritize decentralization of echocardiography to improve ARF detection.
Competing Interests: Declaration of Competing Interest This study was funded by the first author; there is no organization or person who sponsored the study. The authors have no conflicts of interest.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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