No.36, Farvardin Lane, Mohammad-Abad Street, Amadegah Avenue, Post-code: 81449, Isfahan, Iran.


Background- Rheumatic heart disease (RHD), which is one of the most common causes of cardiovascular mortality and morbidity in the world, occurs following repeated episodes of rheumatic fever (RF) recurrences. This study evaluated the RF recurrences to verify the clinical features of the disease and to determine the related risk factors in recurrences.
Methods- The medical charts of 38 cases of confirmed RF with recurrence who were admitted to our Pediatric Cardiology Unit from March 1995 to March 2001 were reviewed and evaluated. All demographic data and injection schedules were completely recorded.
Results- Of the 38 patients with recurrent RF, 25 (65.8%) were girls and 13 (34.2%) were boys. Their age at the time of their first attack ranged from 4 to 13 years with a mean (±SD) of 8.14 (±2.8) years. Carditis was the most common major manifestation (86.8%). Pure chorea was seen in 4 (10.5%) of the patients (2 boys and 2 girls) and isolated arthritis occurred only in one (2.6%) case. Major clinical manifestations were not statistically different in both sexes (p=0.38). Of the 38 patients, 37 (97.4%) cases were not on penicillin prophylaxis at the time of recurrence. In 15 (39.5%) of the patients, medical staff were responsible for the discontinuation of prevention and in 22 (57.9%) patients, secondary prophylaxis was stopped because of their own or their families’ refusal.
Conclusions- The present study supports the need to concentrate on optimizing adherence to secondary prophylactic regimens in the years immediately following an episode of ARF and to assure medical staff and patients of the long-term benefits of benzathine penicillin administration to prevent recurrent RF