Clinical Spectrum of Rheumatic Fever in Balochistan

Objective: To describe the clinical spectrum of Rheumatic fever patients in Baluchistan. Patients and Methods: This study was carried out in the Department of Paediatric Medicine Bolan Medical Complex Hospital from September 2010 to December 2011. 52 children between 4-14 years of age with positive modified Jones criteria for Rheumatic fever were included in this study. Patients with other rheumatic conditions and without supporting evidence of antecedent infection were excluded. Data was collected using a proforma which included detailed history, examination and lab tests. Auscultation findings and Doppler echocardiography were used to diagnose carditis. Results: Thirty patients out of total 52 i.e., 56.769% patients presented with initial presentation whereas 22(42.305%) with complaint of recurrent episode. 37 (71.51%) presented with carditis. 18 (60%) and 19(86.36%) had carditis in initial presenting group and recurrent presentation respectively with (RR 0.6947 (95% CI 0.4964-0.9722) P 0.038112. Overall 23.08% had pericarditis. 48.08%, 19.23% and 5.77% had Mitral regurgitation, combination of Mitral regurgitation with aortic regurgitation and aortic regurgitation respectively. Mitral regurgitation was statistically significant in the initial presenting group RR 3.85 (1.5391-9.6306) P= 0.00022. rthritis (65.38%) and chorea (9.62%) was seen slightly higher in the initial presenting group. Subcutaneous nodules and erythema marginatum was present in 7.69% and 3.85% respectively. Minor manifestation's i.e. fever (86.54%) arthralgia (21.15%), prolongs PR interval (5.77%) and sore throat (51.92%) all were higher in initial presenting group. Conclusion: Rheumatic heart disease remains a main cause of morbidity in the patients diagnosed in recurrent and initial episodes Rheumatic fever.