Pakinam Abdel Aty MARZOUK, Hala HAMZA, Naglaa MOSAAD, Soha EMAM, Aya M. FATTOUH, Lamiaa HAMİD

New guidelines for diagnosis of rheumatic fever; do they apply to all populations?

Background and objectives. To evaluate the efficacy of recently updated Jones criteria for diagnosis of rheumatic fever in high incidence populations like Egypt. Methods. Clinical data of 891 Egyptian patients with rheumatic fever, aged 5-15 years in a highly specialized rheumatic fever clinic were reviewed retrospectively from March 2014 to March 2016. Discriminant analysis was used to detect the most effective predictors for diagnosis of rheumatic fever in our patients incorporating echocardiographic criteria. We compared our results to the most recent update by the American Heart Association. Results. The most effective predictors of rheumatic fever included arthritis, carditis, chorea, aortic regurgitation, grades of mitral regurgitation ≥10mm length and velocity ≥2.5 m/s, thick anterior mitral valve leaflets, elevated acute phase reactants, positive family history and prolonged PR interval. Our predictors showed a high sensitivity of 93%, a specificity of 62% and an overall prediction accuracy of 81.4%. Conclusion. We concluded that strict application of updated Jones criteria may lead to under diagnosis of rheumatic fever in highly endemic countries. We recommend further studies to examine the sensitivity of the most recent update of Jones criteria on other highly endemic populations.

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1. Abdel-Moula AM, Sherif AA, Sallam SA, Mandil AM, Kassem AS, Zaher SR. Prevalence of rheumatic heart disease among school children in Alexandria, Egypt: a prospective epidemiological study. J Egypt Public Health Assoc 1998; 73: 233-254.

2. Carapetis JR. Rheumatic heart disease in developing countries. N Engl J Med 2007; 357: 439-441.

3. Bryant PA, Robins-Browne R, Carapetis JR, Curtis N. Some of the people, some of the time: susceptibility to acute rheumatic fever. Circulation 2009; 119: 742- 753.

4. Jones TD. The diagnosis of rheumatic fever. JAMA 1944; 126: 481-484.

5. Guidelines for the Diagnosis of Rheumatic Fever. Jones Criteria 1992 Update. Special Writing Group of the Committee on Rheumatic fever, Endocarditis and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992; 268: 2069-2073.

6. Ferrieri P, for the Jones Criteria Working Group. Proceedings of the Jones Criteria Workshop. Circulation 2002; 106: 2521-2523.

7. WHO Study Group. Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation; 20 October-1 November 2001, Geneva, Switzerland. Technical Report Series No. 923. Geneva: World Health Organization, 2004.

8. Carapetis J, Brown A, Walsh W, et al; National Heart Foundation of Australia (RF/RHD Guidelines Development Working Group) and the Cardiac Society of Australia and New Zealand. Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australian - An evidencebased review. 2006.

9. RHD Australia (ARF/RHD Writing Group), National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. The Australian Guideline for Prevention, Diagnosis, and Management of Acute Rheumatic Fever and Rheumatic Heart Disease (2nd ed). Casuarina, Australia: RHD Australia; 2012.

10. Remenyi B, Wilson N, Steer A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence – based guideline. Nat Rev Cardiol 2012; 9: 297-309.

11. Gewitz MH, Baltimore RS, Tani LY, et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler Echocardiography: a Scientific Statement from the American Heart Association. Circulation 2015; 131: 1806-1818.

12. Lancellotti P, Moura L, Picrard LA, et al; European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010; 11: 307-332.

13. Zoghbi WA, Enriquez-Sarano M, Foster E, et al; A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and Task Force on Valvular Regurgitation. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16: 777-802.

14. Lancelotti P, Tribouilloy C, Hagendorff A, et al; European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part I: aortic and pulmonary regurgitation (native valve disease) Eur J Echocardiogr 2010; 11 : 223-244.

15. Melka A. Rheumatic heart disease in Gondar College of Medical Sciences Teaching Hospital: Socio-demographic and clinical profile. Ethiop Med J 1996; 34: 207-216.

16. Bhardwaj R, Kandoria A, Marwah R, et al. Prevalence of rheumatic fever and rheumatic heart disease in rural population of Himachal- a population based study. J Assoc Physicians India 2012; 60: 13-14.

17. Sabri M, Kadivar MR. Correlation between the severity of carditis and the level of acute phase reactants and anti-streptolysin O titre in acute rheumatic fever. A retrospective study in Shiraz. Med J Islam Repub Iran 1999; 13: 11-14.

18. Carapetis JR, Wolff DR, Currie BJ. Acute rheumatic fever and rheumatic heart disease in the top end of Australia’s northern territory. Med J Aust 1996; 164: 146-149.

19. Tani LY, Veasy LG, Minich LL, Shaddy RE. Rheumatic fever in children younger than 5 years: is the presentation different? Pediatrics 2003; 112: 1065-1068.

20. Kumar V, Abbas AK, Fausto N, Mitchell RN. Robbins Basic Pathology (8th ed). Philadelphia: Saunders Elsevier, 2007: 403-406.

21. Miyake CY, Gauvreau K, Tani LY, Sundel RP, Newburger JW. Characteristics of children discharged from hospitals in the United States in 2000 with the diagnosis of acute rheumatic fever. Pediatrics 2007; 120: 503-508.

22. Olgunturk R, Canter B, Tunaoglu FS, Kula S. Review of 609 patients with acute rheumatic fever in terms of revised and updated Jones criteria. Int J Cardiol 2006; 112: 91-98.

23. Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis 2003; 12: 577-581.

24. Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. Lancet 2009; 374: 1271-1283.

25. Alkhalifa MS, Ibrahim SA, Osman SH. Pattern and severity of rheumatic valvular lesions in children in Khartoum, Sudan. East Mediterr Health J 2008; 14: 1015-1021.

26. Beg A, Sadiq M. Subclinical valvulitis in children with acute rheumatic fever. Pediatr Cardiol 2008; 29: 619-623.

27. Caldas AM, Terreri MTR, Moises VA, et al. What is the true frequency of carditis in acute rheumatic fever? A prospective clinical and Doppler blind study of 56 children with up to 60 months of follow up evaluation. Pediatr Cardiol 2008; 29: 1048-1053.

28. Figueroa FE, Fernandez MS, Valdes P, et al. Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow-up of patients with subclinical disease. Heart 2001; 85: 407-410.

29. Lanna CCD, Tonelli E, Barros MVL, Goulart EMA, Mota CCC. Subclinical rheumatic valvulitis: a longterm follow-up. Cardiol Young 2003; 13: 431-438.

30. Ozdemir O, Isik S, Abaci A, ve ark. Akut romatizmal ateşte sessiz düşman: subklinik kardit. Türk Kardiyoloji Derneği Arşivi 2011; 39: 41-46.

31. Cann MP, Sive AA, Norton RE, McBride WJH, Ketheesan N. Clinical presentation of rheumatic fever in an endemic area. Arch Dis Child 2010; 95: 455-457.

32. Vijayalakshmi IB, Vishnuprabhu RO, Chitra N, Rajasri R, Anuradha TV. The efficacy of echocardiographic criterions for the diagnosis of carditis in acute rheumatic fever. Cardiol Young 2008; 18: 586-592.

33. Caldas AM, Terreri MTRA, Moises VA, Silva CMC, Carvalho AC, Hilário MOE. The case for utilizing more strict quantitative Doppler echocardiographic criterions for diagnosis of subclinical rheumatic carditis. Cardiol Young 2007; 17: 42-47.

34. Rayamajhi A, Sharma D, Shakya U. Clinical, laboratory and echocardiographic profile of acute rheumatic fever in Nepali children. Ann Trop Paediatr 2007; 27: 169-177.

35. Ozer S, Hallioğlu O, Ozkutlu S, Celiker A, Alehan D, Karagöz T. Childhood acute rheumatic fever in Ankara, Turkey. Turk J Pediatr 2005; 47: 120-124.

36. Khriesat I, Najada A, Al-Hakim F, Abu-Haweleh A. Acute rheumatic fever in Jordanian children. East Mediterr Health J 2003; 9: 981-987.

37. Ozkutlu S, Hallioglu O, Ayabakan C. Evaluation of subclinical valvar disease in patients with rheumatic fever. Cardiol Young 2003; 13: 495-499.

38. Turbridy-Clark M, Carapetis JR. Subclinical carditis in rheumatic fever: a systematic review. Int J Cardiol 2007; 119: 54-58.

39. Vasan RS, Shrivastava S, Vijayakumar M, Narang R, Lister BC, Narula J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996; 94: 73-82.

40. Abernethy M, Bass N, Sharpe N, et al. Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever. Aust N Z J Med 1994; 24: 530-535.

41. Hilario MO, Andrade JL, Gasparian AB, Carvalho AC, Andrade CT, Len CA. The value of echocardiography in the diagnosis and follow up of rheumatic carditis in children and adolescents: a 2 year prospective study. J Rheumatol 2000; 27: 1082- 1086.

42. Ralph A, Jacups S, McGough K, McDonald M, Currie BJ. The challenge of acute rheumatic fever diagnosis in a high-incidence population: a prospective study and proposed Guidelines for Diagnosis in Australia’s Northern Territory. Heart Lung Circ 2006; 15: 113- 118.

43. Folger Jr GM, Hajar R, Robida A, Hajar HA. Occurrence of valvular heart disease in acute rheumatic fever without evident carditis: colour flow Doppler identification. Br Heart J 1992; 67: 434- 438.

44. Panamonta M, Chaikitpinyo A, Kaplan EL, Pantongwiriyakul A, Tassniyom S, Sutra S. The relationship of carditis to the initial attack of Sydenham’s chorea. Int J Cardiol 2004; 94: 241-248.

45. Vijayalakshmi IB, Mithravinda J, Deva ANP. The role of echocardiography in diagnosing carditis in the setting of acute rheumatic fever. Cardiol Young 2005; 15: 583-588.

46. Parks T, Kado J, Colquhoun S, Carapetis J, Steer A. Under diagnosis of acute rheumatic fever in primary care settings in a developing country..Trop Med Int Health 2009; 14: 1407–1413. Erratum in: Trop Med Int Health 2010; 15: 384.

47. Carapetis JR, Currie BJ. Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Arch Dis Child 2001; 85: 223-227.

48. Al-Eissa YA. Acute rheumatic fever during childhood in Saudi Arabia. Ann Trop Pediatr 1991; 11: 225-231.

49. Guilherme L, Köhler KF, Postol E, Kalil J. Genes, autoimmunity and pathogenesis of rheumatic heart disease. Ann Pediatr Cardiol 2011; 4: 13-21.

50. Engel ME, Stander R, Vogel J, Adeyemo AA, Mayosi BM. Genetic susceptibility to acute rheumatic fever: a systematic review and meta-analysis of twin studies. PLoS One 2011; 6: e25326.