P054 Acute articular rheumatism at the Hassan II hospital center, Fez, Morocco (prospective study: about 152 cases)

Background Acute Articular Rheumatism (AAR) is a major public health problem in developing countries, due to the high prevalence of its main complication, which is rheumatic heart disease. The objective of this study is to determine the clinical and biological manifestations of rheumatic fever in children at CHU Hassan II in Fez, Morocco. Methods This is a prospective study carried out from January 2016 to July 2019 in the cardiopediatric unit of CHU Hassan II in Fez. Included were patients below 18 years of age. 152 children with RAA are diagnosed according to the modified Jones criteria. The patients are classified into 2 groups: group 1: RAA with carditis and group 2: RAA without carditis. Patient data is collected on operating sheets. Statistical analysis was performed using SPSS v 21 software. Results The average age of the patients was 12 years and 10 months. The male/female sex ratio was 0.7. The most represented age group was between 5 and 15 years (76.16%). Patients of urban origin presented 78.8%. The majority of children who are diagnosed with AAR with and without cardiac involvement are admitted in winter and fall respectively. A family history of RAA was found in 1 patient and recurrent tonsillitis were mentioned in 68.42%. Cardiac involvement is found in 78.3% of patients. Arthritis was the most common major end point in patients with and without carditis (24.4% and 12.1% respectively). Arthralgia was the most common minor outcome in these patients (67.2% and 78.8% respectively). Penicillin A was the most prescribed antibiotic in the two groups (80.83% and 79.31% respectively). The predominant valve disease in children with cardiac involvement is mitral leakage (69%). Serological proof of a streptococcal infection (ASLO> 300U/ml) was found in 37.2% of cases. A high biological inflammatory syndrome (ESR> 20) was noted in 29.4%. Corticosteroid therapy was used in 42.8% of patients with carditis and in 30.3% of patients without carditis. There was a recurrence in surveillance, this is an aggravation of the mitral leakage with in an 11-year-old boy. 6 patients (3.9%) underwent valve replacement: 4 valve replacements (mitral or aortic) and two double valve replacements (mitral and aortic). One death is noted, a form of acute carditis. Conclusion Cardiac involvement was very common in our series, which shows that AAR still remains a public health problem in our country. Keywords RAA, child, cardiac involvement