All issues > Volume 32(12); 1989

Original Article

J Korean Pediatr Soc. 1989;32(12):1621-1631. Published online December 31, 1989.

The Collaborative Clinical Analysis of 985 Cases of Rheumatic Fever and Rheumatic Carditis in Children for 10 Years(1978~1987) in Korea.

Sung Ho Cha¹, Sang Young Jeong¹, Du Bong Lee², Kyong Su Lee², Sang Bum Lee³, Tae Chan Kwon⁴, Young Chang Tockgo⁵, Chang Sung Sohn⁵, Keun Chan Sohn⁶, Young Jin Hong⁶, Chan Young Kim⁷, Chang Yee Hong⁸, Yong Soo Yun⁸, Jung Yun Choi⁸, Chang Hwi Kim⁹, Chul Ho Kim¹⁰, Tae Ju Hwang¹¹, Jae Suk Ma¹¹, Chan Uhul Joo¹², Kyoo Hwan Rhee¹³, Hahng Lee¹³

¹Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
²Department of Pediatrics, Catholic University Medical College, Seoul, Korea
³Department of Pediatrics, College of Medicine, Kyung Buk National University Taegu, Korea
⁴Department of Pediatrics, College of Medicine, Kei Myung University, Taegu, 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 National University, Pusan, Korea
⁸Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
⁹Department of Pediatrics, College of Medicine, Soon Chun Hyang University, Seoul, Korea
¹⁰Department of Pediatrics, In Je Medical College, Pusan Paik Hospital, Pusan, Korea
¹¹Department of Pediatrics, College of Medicine, Chon Nam National University, Kwangju, Korea
¹²Department of Pediatrics, College of Medicine, Chung Buk National University, Jeonju, Korea
¹³Department of Pediatrics, College of Medicine, Han Yang University, Seoul, Korea

Abstract

Acute rheumatic fever and rheumatic carditis were still important disease of the acquired heart disease in children and adults, in spite of improving socioeconomic status in Korea. Recently, many outbreaks of acute rheumatic fever have been reported in the papers from developed countries. We should be aware of such outbreaks of acute rheumatic fever and should pay attention to their treatment of the patients with Streptococcal pharyngitis and their secondary prophylaxis. A retrospective chart review was carried out about incidence, clinical manifestations and labora- tory findings of rheumatic fever and rheumatic carditis. Between 1978 and 1987, 985 cases of rheu- matic fever and rheumatic carditis were seen at 12 university hospitals and one general hospital in Korea. The following results were obtained: 1) The average incidence of rheumatic fever and rheumatic carditis for 10-year period was 4.7 per 1,000 annual pediatric in-ward patients. There was no increased or decreased incidence of rheumatic fever and rheumatic heart disease during study period. 2) There were 558 boys and 427 girls, and 96.3% of total patients were 6 to 15 years old. The most prevalent months of year of outbreaks were January and December. 3) 352 out of 985 patients (35.7%) had no history of preceding infection, and 460 out of 985 patients (46.7%) had preceding tonsillitis and pharyngitis. 4) The incidence of major manifestations were as follows; carditis (69.4%), polyarthritis (41.0%), erythema marginatum (8.5%), chorea (4.5%) and subcutaneous nodule (3.6%). 5) Sites of joint involvement in 404 patients were knee joint (66.1%), ankle joint (45.8%), hip joint (25.0%) and wrist joint (19.3%). 6) Clinical findings of carditis in 683 patients were cardiac murmur (88.9%)，cardiomegaly in chest PA (54.9%), congestive heart failure (37.9%)，and pericardial effusion and pericarditis (22.0%). 7) The electrocardiographic findings of 616 patients were PR interval prolongation (50.8%)，right and left ventricular hypertrophy (27.8%), and prolonged P wave duration (26.1%). 8) Doppler echocardiographic valvular lesions of 233 patients were mitral insufficiency (72.1%), aortic insufficiency (21.9%), and mitral stenoinsufficiency (21.5%). 9) Minor and other clinical manifestations in 968 patients were fever, arthralgia, dyspnea, coughing, palpitation, weakness, sore throat and chest pain in order of frequency. 10) Laboratory findings of 912 patients on admission were increased ASO titer, Todd unit above 251 (68.4%), positive CRP (76.6%), and increased ESR (73.0%). 11) 308 out of 985 patients (31.3%) were recurred more than one times. 12) The most common family size was 4—6 persons in a family (73.0%).

Keywords :Acute rheumatic fever, Rheumatic carditis