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KMID : 0367419890320121621
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Journal of Korean Pediatric Society
1989 Volume.32 No. 12 p.1621 ~ p.1631
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The Collaborative Clinical Analysis of 985 Cases of Rheumatic Fever and Rheumatic carditis in Children for 10 Years (1978-1987) in KOREA
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차성호
정상영/이두봉/이경수/이상범/권태찬/독고영창/손창성 손근찬/홍영진
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Abstract
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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%).
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KEYWORD
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Acute rheumatic fever, Rheumatic carditis
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