The Initial Attack of Acute Rheumatic Fever During Childhood in North India

A prospective study was done to determine the clinical profile of first attacks of acute rheumatic fever in children in North India. Unlike other reports, the clinical profile described here closely resembles the spectrum prevalent in the West. Arthritis, the most common manifestation, was seen in 66.6% of the 102 patients, chorea in 20.7%, and carditis in 33.7%. Carditis was considered mild in 22 patients and severe in 12; a persistent elevation of sleeping pulse rate and mitral regurgitation was noted in each case. Patients with severe carditis also had significant cardiomegaly and apical mid-diastolic murmur. Two patients with severe carditis developed congestive heart failure; one of them had pericarditis as well. Murmur of aortic origin was not noted in this series. One patient with severe carditis died from the disease. Erythema marginatum was noted in two, both of whom had severe carditis. There were two instances of subcutaneous nodules, one with and one without carditis. The close similarity of these results with those in the West is attributed to the prospective design of the study, analysis of first attacks only and survey of a general pediatric population for all manifestations suggestive of the disease.