Changes of Clinical Patterns of the Acute Rheumatic Fever in Korea(Compared report of 1973-1985 with that of 1986-1992)

Yoon, Hye Sun; Park, Min Young; Shin, Wan Young; Sco, Byong Soo; Cha, Sung Ho

Abstract

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992
METHODS
Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992
RESULTS
1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure.
CONCLUSIONS
The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.