CHANGING CLINICAL PATTERN OF RHEUMATIC FEVER AT PESHAWAR,(PAKISTAN)

Objective: Rheumatic fever (RF) still remains a common problem and an important cause of morbidity and mortality in our children. The purpose of this study was to know the change in clinical profile and presentation of RF, determine its hospital prevalence and assess the magnitude of problem at Peshawar.Material and Methods: We did a study on RF from 1986-987 in Lady Reading Hospital, Peshawar. Significant data on prevalence, clinical profile, recurrence rate and the types of valvular lesions in carditis was collected (Unpublished). During 1999-2000, after 12 years and in same city, we conducted another prospective study on RF in one of the two units of Khyber teaching hospital. 35 children were documented and studied.Results: The recent study showed a marked decline in hospital admission rate of RF. Maximum prevalence was noted in 6-10 years age in both the studies. Maximum numbers of children (51% and 40%) were admitted during January to April. The prevalence of carditis has declined from 67% to 51% while Sydenhamʹs chorea from 38% to 28%. However, polyarthritis has increased from 39% to 62%. Mitral regurgitation was the commonest valvular lesion in both the studies (83% in the first and 100% in the second study), followed by aortic regurgitation. Mitral stenosis was not documented in the second study.Conclusion: Rheumatic fever has shown a decline in at least hospital prevalence in our setup. Polyarthritis was more common than carditis in the latest study, a trend more often seen in developed world.