الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rheumatic fever (RF) is the most common cause of acquired heart disease in children and young adults in developing countries. Although the incidence of ARF has declined in the United States and Western Europe, it has remained high in developing countries.
In Egypt, RHD is a significant health problem, with an estimated prevalence of 5.1 per 1000 school child. Annually, there are 400,000 deaths and hundreds of thousands of children die due to rheumatic fever (RF) and rheumatic heart diseases. The prevalence of rheumatic heart disease in children in Egypt is about 5 per 1000.
The impact of disease is aggravated by low public awareness, the lack of appropriate and early diagnosis and the low socioeconomic status of affected families. Poor transport facilities, overburdened clinics and overcrowding also add to the problem. The pathophysiology of RHD is thought to involve the triad of host genetic makeup, group A streptococcal virulence and environmental factors. Known suspected contributing factors include low socio-economic status, overcrowding, malnutrition, and low government health subsidy.
The Jones criteria for the diagnosis of ARF were introduced in 1944.The criteria divide the clinical features of ARF into major and minor manifestations, based on their prevalence and specificity. An expert group convened by the World Health Organization (WHO) has recently provided additional guidelines as to how the Jones criteria should be applied in primary and recurrent episodes, the diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria, are present along with evidence of preceding GAS infection.
RF and RHD have a negative impact on the society by decreasing the capacity of the most productive age groups, as well as limiting future capacity by threatening the physical development of young people. ARF and RHD lead to increased school absenteeism and work absenteeism. The patient and the family bear most of the brunt of these costs, which are shared to some extent by the society as a whole. Household crowding as a situation where one or more additional bedrooms are required to meet the sleeping needs of the household. This standard was first used in Canada so is sometimes called the Canadian National Occupancy Standard (CNOS).