الفهرس 
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Abstract
Abstract
Rheumatic fever and more serious rheumatic heart disease have great impact on child health in the developing countries than industrial countries, it is the major cause of cardiovascular death in pediatric age group. About 40-80% of all rheumatic fever show carditis which is the major cause of death during the first five decade of life in developing countries. Our study aims to determine the incidence of acute rheumatic fever (ARF), pattern of clinical presentation and its long term complications particularly rheumatic heart disease (RHD) at Zagazig University Pediatric Hospitals (ZUPH ) during the period between (June 2010- June 2011). Total number of children who were admitted to ZUPH were (8145) children. Out of them, (410) children were admitted to Cardiology Unit. Complete history taking, full clinical examination with careful cardiovascular examination and laboratory investigations such as (ESR, CRP, CBC, ASOT), chest X ray, ECG, and echocardiography were performed to the twelve cases with rheumatic fever. Diagnosis of acute rheumatic fever was based on the 1992 update of Jone′s criteria. Twelve cases were diagnosed with ARF (8 girls and 4 boys). Seven cases were presented in the first attack and five cases were presented in recurrence with incidence rate 1.47 per 1000. Age of cases ranged between (3 to 15) years with mean age of 10.5 years. There was statistically significant difference regarding the incidence of ARF and RHD among different age groups , the highest incidence was found among the age group > 10 years (1.8 per 1000) and the lowest at the age group ≤ 10 years (1 per 1000). As regarding sex distribution in the present study, rheumatic fever was more common in females but there was insignificant statistically difference in the incidence of rheumatic cases between males (0.11%) and females (0.17%) . There was no sex difference in the clinical presentation of rheumatic fever except with rheumatic chorea which was more common in females.
Rheumatic fever was more common in low socioeconomic class, also more common in rural than urban. Arthritis and carditis were the most common manifestations (66.7%), arthralgia presented in one case (8.3%), chorea was common manifestation of ARF in females (16.7%). None had subcutaneous nodules or erythema marginatum in our study. Laboratory investigations as an evidence of streptococcal infection is still very important. Echocardiography is the most recent and most helpful in confirming the diagnosis and follow up of carditis and RHD. Rheumatic fever had a great impact on children health due its complications as RHD (75%) of cases, infective endocarditis (16.7%) and hear failure (16.7%) of cases. The valve lesion in our studied cases was mitral incompetence in 9 cases (75%), aortic incompetence in 7 cases (58.3%), tricuspid incompetence in 2 cases (16.7%) and no pulmonary valve lesion.