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18THE COURSE OF ACUTE RHEUMATIC FEVER IN CHILDREN IN SAMARKAND REGION AND PREVENTION OF THE DISEASE Umarova S.S.1, Safoeva Z.F.2, Khusainova Sh.K.3
Umarova Saodat Sulaymonovna — Assistant; 2Safoeva Zebo Farkhodovna — Assistant; 3Khusainova Shirin Kamildjanovna — Assistant, DEPARTMENT OF 3 - PEDIATRICS AND MEDICAL GENETICS, FACULTY OF PEDIATRICS, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the problem of acute tonsillitis caused by Group A Beta-Hemolytic Streptococcus (GABHS) still remains relevant. Adequate primary prevention of rheumatic fever is still based on timely diagnosis and rational antimicrobial therapy of GABHS -tonsillitis/pharyngitis. Objective of the study: to determine the frequency of complications and to evaluate the effectiveness of various penicillin treatment regimens. For the survey, a retrospective analysis of the medical history of 130 children 5-16 years old, hospitalized in the 1st clinic of SamMl in 2018, was carried out. with rheumatic fever, anamnestic, clinical, laboratory and instrumental methods were used.
Keywords: group A streptococcal tonsillitis, antibiotic therapy, penicillins, treatment, prevention.
Abstract. Acute rheumatic fever (ARF) and its consequences cause significant morbidity and mortality in developing countries, but it is not recognised as a global health problem [1]. Although the incidence of rheumatism appears to have declined in recent decades, the challenge of effectively controlling it remains. The clinical picture of rheumatic fever has changed in economically developed countries. The disease has lost the classic features of OPJI: acute onset, high fever, acute polyarthritis, and pancarditis [2]. Currently, prevention of recurrent episodes of group A b-haemolytic streptococcal pharyngitis is the most effective method of preventing the development of severe rheumatic heart disease. However, the evidence for these recommendations is weak and comes from studies carried out over 50 years ago [3]. Recent studies have confirmed the importance of studying the complications of this disease in children and its prevention to prevent complications.
The aim of the work is to identify the incidence of complications associated with acute rheumatic fever found at follow-up and to evaluate the effectiveness of different penicillin treatment regimens in patients with acute rheumatic fever..
Materials and Methods. We retrospectively reviewed 130 case reports of children with ARL and PRL, aged 6 to 16 years, hospitalized in the paediatric department of the 1st clinic of SamMI in 2018.
Results. In the acute period of the disease, streptococci from a pharyngeal swab was detected in 72% (93 patients) of those examined. It should be emphasized that the highest
incidence was noted in the winter-spring period, which coincides with the data in the literature [4,5]. [4,5].
65% (85 patients) had catarrhal symptoms (hyperemia of the pharynx and pharyngeal wall). In 76% of patients, a fever of between 3 (71%) and 5-6 (18%) days was detected. The remaining children had no fever. The diagnosis of ARL has also been based for many years on the Kissel-Jones criteria, which are a unique diagnostic tool (Table 1).
Table 1. Kissel-Jones criterias used for the diagnosis of acute rheumatic fever
Major criterias Minor criteria Evidence of previous A-streptococcal infection
carditis polyarthritis chorea annular erythema subcutaneous rheumatoid nodules clinical arthralgia fever Positive A-streptococcal culture isolated from the pharynx or a positive A-streptococcal antigen rapid test. Increased or rising titres of anti-streptococcal antibodies (ASLOs, anti-DNAase B)
laboratory Increased acute phase reactants: sedimentation, C-reactive protein
instrumental prolongation of PR interval on ECG, signs of mitral and/or aortic regurgitation on Doppler-EchoCG
The first "big" diagnostic criterion and the leading syndrome of ARF is rheumocarditis, which determines the severity of the course and outcome of the disease. In our study, rheumocarditis was found in 30% of children with recurrent rheumatic fever.
Rheumatic polyarthritis remains one of the leading clinical syndromes of the first attack of ARF. In 60% of children, the lesion is found to be short-lived, benign and volatile, with predominantly involvement of the large and medium-sized joints within 2 to 3 weeks. Under the influence of modern anti-inflammatory therapy, this period is shortened to a few hours or days [6].
Rheumatic lesions of the nervous system, minor chorea, occurred in 23% of cases, predominantly in children, less frequently in adolescents.
We did not find ring-shaped (anular) erythema and rheumatic nodules.
Laboratory tests showed C-reactive protein positivity in all patients, fibrinogen values ranging from 232 to 463. At the same time, an increase in anti-streptolysin-O titres was observed in 80 % of the paediatric patients.
An examination of the instrumental methods showed bilateral pyelonephritis in 12 patients with ultrasound. Abdominal pain, tachycardia unrelated to fever, malaise, anaemia and sore throat have also been observed in children and adolescents with ARF. As these symptoms are common in many diseases, they are not part of the diagnostic criteria, but may provide additional support for the diagnosis of ARF (4,7)..
All children received comprehensive pathogenetic therapy, including antibacterial (benzylpenicillin), nosteroid anti-inflammatory therapy and glucocorticoid therapy. The use of prolonged penicillins, especially bicillin-5, has played a huge role in the prevention of recurrent attacks of ARF. Although patients received bicillin after discharge from hospital, recurrent attacks of the disease were observed in patients, indicating a lack of efficacy in 33% of patients. According to the literature, one of the reasons for ineffectiveness is the low concentration of penicillin in the serum of patients on the long-term after intramuscular administration of common prophylactic doses of bicillin-5 (1,500,000 units) [11]. Thus, the results indicate the need for further evaluation of children with rheumatic fever in order to develop and improve treatment and prophylactic interventions.
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