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Acute rheumatic fever outbreak in southern central European country

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Abstract

A decline in the incidence of acute rheumatic fever (ARF) in developed countries over the past century can be attributed to the improved public hygiene and to widespread use of antibiotics. ARF seemed to be a rare disease in southern central European country, Slovenia, up to 2010 when we noticed an increase in the number of patients with ARF. In order to assess the current incidence of ARF, we performed a retrospective study of all patients with ARF treated at the University Children’s Hospital Ljubljana from January 2008 until the end of December 2014. In a period of 7 years, 19 patients with ARF were identified. The estimated annual incidence of ARF during the study period was 1.25 cases per 100,000 children. Carditis was present in all patients, arthritis in 37 % and Sydenham chorea in 32 %.

Conclusion: Recent ARF outbreak in Slovenia revealed that this disease is still present in southern central Europe with an estimated annual incidence of 1.25 cases per 100,000 children. Unrecognized or inadequately treated ARF could be the cause of acquired heart disease and must be even nowadays included among the differential diagnoses in a febrile child with arthritis, heart murmur or movement disorder.

What is Known:

• Acute rheumatic fever (ARF) is diagnosed based on the major and minor Jones Criteria.

• A decline in the incidence of ARF in developed countries over the past century can be attributed to the improved public hygiene and to widespread use of antibiotics.

What is New:

• In the last decade, an increase in the incidence of ARF was observed in Slovenia which has a central European geographic position.

• Our paper highlights the importance of including ARF in the differential diagnosis of a febrile child with arthritis/arthralgia and/or heart murmur and/or acute chorea.

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Abbreviations

ALT:

Alanine aminotrasferase

ARF:

Acute rheumatic fever

ASA:

Acetylsalicylic acid

ASLO:

Antistreptolysin O titer

AST:

Aspartate aminotransferase

AV:

Aortic valve

CRP:

C-reactive protein

ECG:

Electrocardiography

ELISA:

Enzyme-linked immunosorbent assay

ESR:

Erythrocyte sedimentation rate

GGT:

Gamma-glutamyl transferase

MV:

Mitral valve

NSAID:

Nonsteroidal anti-inflammatory drug

SD:

standard deviation

UCHL:

University Children’s Hospital Ljubljana

WHO:

World Health Organization

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Authors’ contributions

UK, NT and TA participated in the design of the study and drafted the manuscript. UK preformed statistical analysis. NT, BK, SV, LK, NK, MH and RR preformed clinical evaluation of children included in the study. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Bohoričeva 20, 1000, Ljubljana, Slovenia

    Urška Kočevar, Nataša Toplak & Tadej Avčin

  2. Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia

    Nataša Toplak, Matjaž Homan & Tadej Avčin

  3. Department of Cardiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia

    Blaž Kosmač & Samo Vesel

  4. Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia

    Luka Kopač & Natalija Krajnc

  5. Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, Ljubljana, Slovenia

    Matjaž Homan

  6. Department of Nephrology, University Children’s Hospital, University Medical Center, Ljubljana, Slovenia

    Rina Rus

Authors
  1. Urška Kočevar
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  2. Nataša Toplak
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  3. Blaž Kosmač
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  4. Luka Kopač
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  5. Samo Vesel
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  6. Natalija Krajnc
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  7. Matjaž Homan
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  8. Rina Rus
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  9. Tadej Avčin
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Corresponding author

Correspondence to Urška Kočevar.

Ethics declarations

This study was not funded. Authors declare that they have no conflict of interest. The study was approved by the Slovenian national medical ethics committee and was done in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments.

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Kočevar, U., Toplak, N., Kosmač, B. et al. Acute rheumatic fever outbreak in southern central European country. Eur J Pediatr 176, 23–29 (2017). https://doi.org/10.1007/s00431-016-2801-z

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  • DOI: https://doi.org/10.1007/s00431-016-2801-z

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