Rheumatic fever in a developed country – is it still relevant? A retrospective, 25 years follow-up

Rotem Tal*, Mohamad Hamad Saied, Razi Zidani, Yoel Levinsky, Rachel Straussberg, Jacob Amir, Gil Amarilyo, Liora Harel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Our aims were to clinically and epidemiologically characterize rheumatic fever (RF) in the current era in Israel. Although there has been a steady decline in the incidence of RF in the western world, evidence of disease resurgence in developed countries continues to be published. The paucity of recent epidemiological data prompted our study. Methods: Medical files were retrospectively reviewed for all children with RF in our tertiary pediatric university-affiliated hospital from 1993 to 2017. Main outcome measures were patients and disease related characteristics, incidence trends, risk factors, disease course, relapse rates and secondary prophylaxis. Results: The cohort included 307 children. Sixty-four percent presented with arthritis, interestingly including hips and small joints of hands and feet at presentation, 52% presented with carditis. Severe carditis developed in 31 patients (19.5%), of whom 21 (13.2% of all carditis patients) acquired heart failure, 5 required intensive care monitoring, with one recent death. The percentage of patients with acute carditis of the overall RF patients remained relatively stable. Thirty-two patients (10% of patients with RF) relapsed, including 11 with a cardiac relapse (3.6% of all cardiac patients). The recurrence rate of RF continued to rise up to 9 years from the initial episode. One of 147 patients (< 0.7%) with a non-cardiac initial presentation had carditis at relapse. Conclusion: RF and rheumatic heart disease remain an important cause of morbidity and mortality including developed countries, with relapse rate continuing after 9 years of prophylaxis. Presentation of small joints as well as hips, although uncommon, should not exclude the diagnosis.

Original languageEnglish
Article number20
JournalPediatric Rheumatology
Issue number1
StatePublished - Dec 2022


  • Pediatric rheumatology
  • Rheumatic fever
  • Rheumatic heart disease


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