Skip to main content
SpringerLink
Log in

Rheumatic Fever and Rheumatic Heart Disease in Children

  • Review Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Acute rheumatic fever (ARF) and its sequelae, Rheumatic heart disease (RHD), contribute significantly to the cardiovascular morbidity and mortality in developing countries. Generally considered a disease of poverty and poor socio-economic conditions, RHD affects the population at the most productive phase of their life. The diagnostic criteria for ARF have been constantly updated to improve the sensitivity. The diagnosis of ARF was entirely clinical however, recently echocardiographic evidence has been added as a major criterion. The disease seems to be on the decline in India, but recent studies using echocardiography have shown high prevalence of RHD among school children. The focus of management has been on prompt recognition and treatment of streptococcal pharyngitis and preventing recurrences of ARF with long-term antibiotic prophylaxis. However, emphasis should be placed on the appropriate management of patients with established RHD, in order to limit the RHD related mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Box 1

Similar content being viewed by others

References

  1. Watkins DA, Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017;377:713–22.

    Article  Google Scholar 

  2. Ramakrishnan S, Kothari SS, Juneja R, Bhargava B, Saxena A, Bahl VK. Prevalence of rheumatic heart disease: has it declined in India? Natl Med J India. 2009;22:72–4.

    CAS  PubMed  Google Scholar 

  3. Saxena A, Desai A, Narvencar K, et al. Echocardiographic prevalence of rheumatic heart disease in Indian school children using world heart federation criteria – a multi site extension of RHEUMATIC study (the e-RHEUMATIC study). Int J Cardiol. 2017;249:438–42.

    Article  Google Scholar 

  4. Jose VJ, Gomathi M. Declining prevalence of rheumatic heart disease in rural school children in India: 2001-2002. Indian Heart J. 2003;55:158–60.

    PubMed  Google Scholar 

  5. Jai Vigyan Mission Mode Project. Community Control of Rheumatic Fever/ Rheumatic Heart Disease in India. Comprehensive Project Report. 2000–2010. Available at: https://www.icmr.nic.in/sites/default/files/reports/Jai Vigyan Mission Mode project.

  6. Misra M, Mittal M, Singh R, et al. Prevalence of rheumatic heart disease in school-going children of eastern Uttar Pradesh. Indian Heart J. 2007;59:42–3.

    PubMed  Google Scholar 

  7. Periwal K, Gupta B, Panwar R, Khatri P, Raja S, Gupta R. Prevalence of rheumatic heart disease in school children in Bikaner: an echocardiographic study. J Assoc Physicians India. 2006;54:279–82.

    CAS  PubMed  Google Scholar 

  8. Negi PC, Kanwar A, Chauhan R, Asotra S, Thakur JS, Bhardwaj AK. Epidemiological trends of RF/RHD in school children of Shimla in North India. Indian J Med Res. 2013;137:1121–7.

    PubMed  PubMed Central  Google Scholar 

  9. Rama Kumari N, Bhaskara Raju I, Patnaik AN, et al. Prevalence of rheumatic and congenital heart disease in school children of Andhra Pradesh, South India. J Cardiovasc Dis Res 2013;4:11–4.

    Article  CAS  Google Scholar 

  10. Saxena A, Ramakrishnan S, Roy A, et al. Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study. Heart. 2011;97:2018–22.

    Article  Google Scholar 

  11. Bhaya M, Panwar S, Beniwal R, Panwar RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography. 2010;27:448–53.

    Article  Google Scholar 

  12. Nair B, Viswanathan S, Koshy AG, Gupta PN, Nair N, Thakkar A. Rheumatic heart disease in Kerala: a vanishing entity? An echo doppler study in 5–15-years-old school children. Int J Rheumatol. 2015. https://doi.org/10.1155/2015/930790.

    Article  Google Scholar 

  13. Azevedo PM, Pereira RR, Guilherme L. Understanding rheumatic fever. Rheumatol Int. 2012;32:1113–20.

    Article  Google Scholar 

  14. Guilherme L, Kalil J. Rheumatic fever and rheumatic heart disease: cellular mechanisms leading autoimmune reactivity and disease. J Clin Immunol. 2010;30:17–23.

    Article  Google Scholar 

  15. Bryant PA, Robins-Browne R, Carapetis JR, Curtis N. Some of the people, some of the time: susceptibility to acute rheumatic fever. Circulation. 2009;119:742–53.

    Article  Google Scholar 

  16. Gewitz MH, Baltimore RS, Tani LY, et al. 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;131:1806–18.

    Article  Google Scholar 

  17. Veasy LG, Tani LY, Hill HR. Persistence of acute rheumatic fever in the intermountain area of the United States. J Pediatr. 1994;124:9–16.

    Article  CAS  Google Scholar 

  18. Arora R, Subramanyam G, Khalilullah M, Gupta MP. Clinical profile of rheumatic fever and rheumatic heart disease: a study of 2,500 cases. Indian Heart J. 1981;33:264–9.

    CAS  PubMed  Google Scholar 

  19. Tubridy-Clark M, Carapetis JR. Subclinical carditis in rheumatic fever: a systematic review. Int J Cardiol. 2007;119:54–8.

    Article  Google Scholar 

  20. Sethi S, Kaushik K, Mohandas K, Sengupta C, Singh S, Sharma M. Anti-streptolysin O titers in normal healthy children of 5-15 years. Indian Pediatr. 2003;40:1068–71.

    PubMed  Google Scholar 

  21. Saini N, Kumar D, Swarnim S, Bhatt D, Kishore S. Comparison of antistreptolysin O and anti-deoxyribonucleic B titers in healthy children to those with acute pharyngitis, acute rheumatic fever, and rheumatic heart disease aged 5-15 years. Ann Pediatr Cardiol. 2019;12:195–200.

    Article  Google Scholar 

  22. Pichichero ME, Marsocci SM, Murphy ML, Hoeger W, Green JL, Sorrento A. Incidence of streptococcal carriers in private pediatric practice. Arch Pediatr Adolesc Med. 1999;153:624–8.

    Article  CAS  Google Scholar 

  23. Ramakrishnan S. Echocardiography in acute rheumatic fever. Ann Pediatr Card. 2009;2:61–4.

    Article  CAS  Google Scholar 

  24. Reményi 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.

    Article  Google Scholar 

  25. Karthikeyan G, Guilherme L. Acute rheumatic fever. Lancet. 2018;392:161–74.

    Article  Google Scholar 

  26. Van Asselt GJ, Mouton RP. Detection of penicillin tolerance in Streptococcus pyogenes. J Med Microbiol. 1993;38:197–202.

    Article  Google Scholar 

  27. Hashkes PJ, Tauber T, Somekh E, et al. Naproxen as an alternative to aspirin for the treatment of arthritis of rheumatic fever: a randomized trial. J Pediatr. 2003;143:399–401.

    Article  CAS  Google Scholar 

  28. Treatement of acute rheumatic fever in children a co-operative clinical trial of A.C.T.H., cortisone, and aspirin; a joint report by the Rheumatic Fever Working Party of the Medical Research Council of Great Britain and the Subcommittee of Principal Investigators of the American Council on Rheumatic Fever and Congenital Heart Disease, American Heart Association. Br Med J. 1955; 1:555–74.

  29. Mehta A, Saxena A, Juneja R, Ramakrishnan S, Gupta S, Kothari SS. Characteristics and outcomes of Indian children enrolled in a rheumatic heart disease registry. Int J Cardiol. 2016;222:1136–40.

    Article  Google Scholar 

  30. Enriquez-Sarano M, Basmadjian AJ, Rossi A, Bailey KR, Seward JB, Tajik AJ. Progression of mitral regurgitation: a prospective Doppler echocardiographic study. J Am Coll Cardiol. 1999;34:1137–44.

    Article  CAS  Google Scholar 

  31. Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the global rheumatic heart disease registry (the REMEDY study). Eur Heart J. 2015;36:1115–22a.

    Article  Google Scholar 

  32. Roy SB, Bhatia ML, Lazaro EJ, Ramalingaswami V. Juvenile mitral stenosis in India. Lancet. 1963;282:1193–6.

    Article  Google Scholar 

  33. Goswami KC, Rao MB, Dev V, Shrivastava S. Juvenile tricuspid stenosis and rheumatic tricuspid valve disease: an echocardiographic study. Int J Cardiol. 1999;72:83–6.

    Article  CAS  Google Scholar 

  34. International Rheumatic Fever Study Group. Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever. Lancet. 1991;337:1308–10.

    Google Scholar 

  35. Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129:2440–92.

    Article  Google Scholar 

  36. Kumar AS, Talwar S, Saxena A, Singh R, Velayoudam D. Results of mitral valve repair in rheumatic mitral regurgitation. Interact Cardiovasc Thorac Surg. 2006;5:356–61.

    Article  Google Scholar 

  37. Skoularigis J, Sinovich V, Joubert G, Sareli P. Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation. Circulation. 1994;90:(II)167–74.

    Google Scholar 

  38. Gometza B. al-Halees Z, Shahid M, Hatle LK, Duran CM. Surgery for rheumatic mitral regurgitation in patients below twenty years of age. An analysis of failures. J Heart Valve Dis. 1996;5:294–301.

    CAS  PubMed  Google Scholar 

  39. Kothari SS, Ramakrishnan S, Kumar CK, Juneja R, Yadav R. Intermediate-term results of percutaneous transvenous mitral commissurotomy in children less than 12 years of age. Catheter Cardiovasc Interv. 2005;64:487–90.

    Article  Google Scholar 

  40. Kothari SS, Ramakrishnan S, Juneja R, Yadav R. Percutaneous transvenous mitral commissurotomy in patients with severe mitral stenosis and acute rheumatic fever. Pediatr Cardiol. 2006;27:347–50.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Balaji Arvind & Sivasubramanian Ramakrishnan

Authors
  1. Balaji Arvind
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sivasubramanian Ramakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BA did literature search and wrote the draft manuscript. SR guided BA and finalised the manuscript. SR is the guarantor for this paper.

Corresponding author

Correspondence to Sivasubramanian Ramakrishnan.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arvind, B., Ramakrishnan, S. Rheumatic Fever and Rheumatic Heart Disease in Children. Indian J Pediatr 87, 305–311 (2020). https://doi.org/10.1007/s12098-019-03128-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-019-03128-7

Keywords

Search

Navigation