Pattern of Rheumatic Fever in Egyptian Children Younger Than 5 Years

Aims: Acute rheumatic fever (ARF) is common between 5-15 years, uncommon with different presentation 25 in children below 5 years. The aim of this study is to assess the frequency and characterize the pattern of 26 presentation of rheumatic fever (RF) in Egyptian children younger than 5 years.
Study Design: Retrospective study.
Place and Duration of the Study: Pediatric department, cardiology division, Cairo University Children’s Hospital, 5 years follow up.
Methodology: We retrospectively reviewed the pre-completed data of 766 patients following up in the rheumatic fever clinic. Those with incomplete medical records were excluded. We compared between children younger than 5 years and those who are 5 years or older as regards their demographic data, clinical presentations, laboratory findings and echocardiographic findings.
Results: We enrolled 667 patients; 17 of them (2.5%) were younger than 5 years (mean age 3.82± SD 0.393 years). The group of patients younger than 5 years old; included 10 females (58.8%) and 7 males (41.2%). Positive family history was encountered in 6 patients (37.7%). The most common presentations of the younger age group of patients were arthritis in 12 patients (70.5%), followed by carditis in 5 patients (29.4%), chorea in 3 patients (17.6%), and skin manifestations in 2 patients in the form of erythema marginatum (11.7%). Subclinical carditis was more common in younger children than the older group, with more severe valve affection. None of the patients in the younger age group had recurrence of the RF during a period of 5 years follow up while recurrences were encountered in 16 patients (2.5%) of the older age group.
Conclusion: ARF can occur in children younger than 5 years. The possibility of rheumatic fever should be adequately investigated in those young children presenting with arthritis, chorea, or skin rash especially in developing countries like Egypt. Echocardiography is an essential tool to diagnose cases with5 subclinical carditis.