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Clinical Trends in Acute Rheumatic Fever in Korean Children : Mailed Questionnaire Survey from 1988 to 1997 (Compared with 1978-1987)

Journal of the Korean Pediatric Society 1999;42(10):1381-1391.
Published online October 15, 1999.
Clinical Trends in Acute Rheumatic Fever in Korean Children : Mailed Questionnaire Survey from 1988 to 1997 (Compared with 1978-1987)
Hyeon-Ho Kang1, Sung-Ho Cha1, Kyong-Su Lee2, Sang-Bum Lee3, Tae-Chan Kwon4, Young-Chang Tockgo5, Chang-Sung Son5, Jin-A Son6, Hee-Ju Park7, Yong-Soo Yun8, Jung-Yun Choi8, Chang-Hwi Kim9, Chul-Ho Kim10, Tai-Ju Hwang11, Jae-Sook Ma11, Chan-Uhng Joo12, Nam-Su Kim13
1Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
2Department of Pediatrics, College of Medicine, Catholic University, Korea
3Department of Pediatrics, College of Medicine, Kyungpook National University, Korea
4Department of Pediatrics, College of Medicine, Keimyung University, Korea
5Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
6Department of Pediatrics, National Medical Center, Seoul, Korea
7Department of Pediatrics, College of Medicine, Pusan University, Korea
8Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
9Department of Pediatrics, College of Medicine, Soonchunhyang University, Korea
10Department of Pediatrics, College of Medicine, Inje University, Korea
11Department of Pediatrics, College of Medicine, Chonnam University, Korea
12Department of Pediatrics, College of Medicine, Chonbuk National University, Chonju, Korea
13Department of Pediatrics, College of Medicine, Hanyang University, Korea
전국 13개 종합병원의 10년(1988-1997년)간 소아 급성 류마티열 환아의 임상적 고찰 : 1978-1987년 보고와의 비교
강현호1, 차성호1, 이경수2, 이상범3, 권태찬4, 독고영창5, 손창성5, 손진아6, 박희주7, 윤용수8, 최정연8, 김창휘9, 김철호10, 황태주11, 마재숙11, 주찬웅12, 김남수13
1경희대학교 의과대학 소아과학교실
2가톨릭대학교 의과대학 소아과학교실
3경북대학교 의과대학 소아과학교실
4계명대학교 의과대학 소아과
5고려대학교 의과대학 소아과
6국립의료원
7부산대학교 의과대학 소아과학교실
8서울대학교 의과대학 소아과학교실
9순천향대학교 의과대학 소아과학교실
10인제의대 부산백병원 소아과학교실
11전남대학교 의과대학 소아과학교실
12전북대학교 의과대학 소아과학교실
13한양대학교 의과대학 소아과학교실
Correspondence: 
Sung-Ho Cha, Email: 1
Abstract
Purpose
: The purpose of this study was to assess the frequency of acute rheumatic fever(ARF) among children in Korea and to describe trends in its clinical characteristics compared to data from a previous study(1978-1987).
Methods
: A mailed questionnaire survey sent to the pediatric departments of 13 general hospitals in Korea requested the total number of patients with ARF and its clinical manifestations from Jan. 1988 to Dec. 1997. These data were compared with the data from a previous study (1978-1987) to evaluate the clinical trends in occurrence and clinical manifestations of ARF during the last 20 years in Korea.
Results
: The average number of patients with ARF for the 10-year period(1988-1997) was 0.74 per 1,000 annual pediatric inward patients. There was a significant decrease in incidence during the study period. There were 115 male and 85 female patients with ARF, and 97.5% of total patients were 6 to 15 years old. 126 out of 200 patients(63.0%) had a history of preceding upper respiratory infection(URI). The percentage of major manifestations were as follows; carditis(66.5%), polyarthritis(54.0%), erythema marginatum(12.0%), chorea(7.5%) and subcutaneous nodule (6.0%). Clinical findings of carditiswere cardiac murmur(91.0%), cardiomegaly in chest PA(34.6%), congestive heart failure(15.8%). The electrocardiographic findings were PR interval prolongation (37.6%), right ventricular hypertrophy (RVH) and left ventricular hypertrophy(LVH)(15.8%), QT interval prolongation(13.5%). Doppler echocardiographic valvular lesions were mitral insufficiency(96.2 %), aortic insufficiency(39.8%). Minor and other clinical manifestations were fever(69.0%), arthralgia (56.5%), sore throat(28.5%).
Conclusion
: There was a steady decrease in the number of patients with ARF during the study period from 1988 to 1997. A sudden decrease in number of patients with ARF between the two study periods is likely due to patients with valvular heart disease, possibility of double registration, and wide spread use of echocardiography for accurate diagnosis.
Key Words: Acute rheumatic fever, Group A streptococci, Korea


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