Acute Rheumatic Fever: Where Do We Stand? An Epidemiological Study in Northern Italy

Frontiers in Medicine

Rolando Cimaz¹  Patrizia Calzi²  Tiziana Varisco³  Massimo Andreotti³  Achille Marino³  Anna Cogliardi⁴  Roberto Bellù⁴  Claudia Addis⁴  Giulia Tattesi⁵  Maria Antonietta Pelagatti⁵  Andrea Biondi⁵  Francesco Morandi⁶  Francesca Cortinovis⁶  Laura Menni⁷  Marco Sala⁷ 

[1] Azienda Socio Sanitaria Territoriale G.Pini-Centro Traumatologico Ortopedico, Milan, Italy;Department of Clinical Sciences and Community Health, and Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy;Department of Pediatrics, Carate Hospital, Carate Brianza, Italy;Department of Pediatrics, Desio Hospital, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy;Department of Pediatrics, Lecco Hospital, ASST Lecco, Lecco, Italy;Department of Pediatrics, Milano-Bicocca University Monza e Brianza per il Bambino e la sua Mamma Foundation, Monza, Italy;Department of Pediatrics, San Leopoldo Mandic Hospital, ASST Lecco, Lecco, Italy;Department of Pediatrics, Vimercate Hospital, Vimercate, Italy;

关键词: acute rheumatic fever;    group A β-hemolytic streptococcus;    carditis;    Jones criteria;    penicillin;   

DOI  :  10.3389/fmed.2021.621668

来源: Frontiers

【 摘 要 】

Acute rheumatic fever (ARF) is a non-septic complication of group A β-hemolytic streptococcal (GAS) throat infection. Since 1944, ARF diagnosis relies on the Jones criteria, which were periodically revised. The 2015 revision of Jones criteria underlines the importance of knowing the epidemiological status of its own region with updated data. This study aims to describe ARF features in a retrospective cohort retrieved over a 10-year timespan (2009–2018) and to report the annual incidence of ARF among children in the Province of Monza-Brianza, Lombardy, Italy during the same period. This is a multicentric cross-sectional/retrospective study; 70 patients (39 boys) were diagnosed with ARF. The median age at diagnosis was 8.5 years (range, 4–14.2 years). Overall, carditis represented the most reported major Jones criteria followed by arthritis and chorea (40, 27, and 20 cases, respectively). In order to calculate the annual incidence of ARF, only children resident in the Province of Monza-Brianza were included in this part of the analysis. Therefore, 47 patients aged between 5 and 14 years were identified. The median incidence during the study time was 5.7/100,000 (range, 2.8–8.3/100,000). In the Province of Monza-Brianza, we found an incidence rate of ARF among children aged 5–14 years constantly above the threshold of low-risk area as defined in the 2015 revision of Jones criteria. Therefore, the diagnosis of ARF should be based on the moderate–high-risk set of Jones criteria. However, given the burden of secondary prophylaxis, expert opinion is advisable when the diagnosis of ARF is uncertain.

【 授权许可】

CC BY