Published online September 1, 2004
PEDIATRICS Vol. 114 No. 3 September 2004, pp. 906 (doi:10.1542/peds.2004-0787)
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Rheumatic Fever in Children Under 5 Years

Lloyd Y. Tani, MD
L. George Veasy, MD
L. LuAnn Minich, MD
Robert E. Shaddy, MD
Department of Pediatrics,
University of Utah School of Medicine,
Salt Lake City, UT 84113

To the Editor.—

We appreciate the comments made by Canter et al1 comparing their 20-year experience with rheumatic fever (RF) in patients <5 years of age. We acknowledged the variable reported incidence of RF in children <5 years of age in our article,2 citing references reporting incidences from 1 to 6.8%. We agree that this variability is at least partly related to whether primary care physicians consider RF in the differential diagnosis of young children presenting with inflamed joints, a new murmur, or neurologic abnormalities consistent with chorea.

Although Canter et al did not find isolated arthritis to be more common in their series, other series3,4 have reported joint involvement to be more common in these younger children, as we reported in our series. Similarly, although Canter et al did not find the severity of carditis to vary with age, others have reported findings similar to ours, with younger age at presentation to be associated with greater carditis severity.3–5

The differences between the experience of Canter et al and our series emphasize the wide variability in presentations between populations. Clearly, our understanding of RF is incomplete. Nonetheless, the important message from our combined experience is that RF can and does occur in children <5 years of age. Recognition of clinical features and diagnosis are imperative so that recurrences and the associated increased risk of significant chronic rheumatic heart disease can be prevented.

REFERENCES

  1. Canter B, Olguntürk R, Tunaoglu FS. Rheumatic fever in children under 5 years old [letter]. Pediatrics. 2004;114 :329 –330[Free Full Text]
  2. Tani LY, Veasy LG, Minich LL, Shaddy RE. Rheumatic fever in children younger than 5 years: is the presentation different? Pediatrics. 2003;112 :1065 –1068[Abstract/Free Full Text]
  3. Rosenthal, Czoniczer G, Massell BF. Rheumatic fever under 3 years of age: a report of 10 cases. Pediatrics. 1968;41 :612 –619[Abstract/Free Full Text]
  4. Majeed HA, Yousof AM, Shaltout A, Khuffash FA. Acute rheumatic fever below the age of five years: a prospective study of the clinical profile. Ann Trop Paediatr. 1984;4 :37 –40[Medline]
  5. Vazquez-Antona C, Calderon-Colmenero J, Attie F, et al. Rheumatic cardiopathy in children younger than 6 years of age [in Spanish]. Arch Inst Cardiol Mex. 1991;61 :143 –147[Medline]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
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Right arrow E-mail this article to a friend
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Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
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Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (4)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tani, L. Y.
Right arrow Articles by Shaddy, R. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tani, L. Y.
Right arrow Articles by Shaddy, R. E.
Related Collections
Right arrowRelated AAP Red Book topics:
Group A Streptococcal Infections
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