Rheumatic fever in the Nazareth area during the last decade

Background: Acute rheumatic fever is considered a relatively uncommon disea se in developed countries. Although cases are encountered in the Nazareth a rea in Israel, no systematic study of this disease has been done in the las t 20 years. Objective: To study the incidence and characteristics of acute rheumatic fe ver cases in the Nazareth area during the last decade. Methods: Cases of acute rheumatic fever diagnosed according to the modified Jones criteria were identified in two hospitals in the Nazareth area durin g the 10 years. These two hospitals receive about 75% of non-obstetric refe rrals to the emergency room. Clinical, laboratory and treatment data of the se patients were documented and the incidence of disease calculated. The po pulation census in the Nazareth area was obtained from the Central Bureau o f Statistics. Results: Forty-four patients, with a mean age of 18 years, were identified. The mean annual incidence was 5 cases/100,000 population. Arthritis was fo und in 98% of the patients (migratory in 52%) and carditis in 34%, but only one patient had a subcutaneous nodule, and none had either erythema margin atum or chorea. Only one patient with carditis developed heart failure a fe w months later due to severe mitral stenosis. Conclusion: Rheumatic fever in the Nazareth area is still manifest. The mea n age of the patients was higher than found previously. In only half of the patients was the arthritis migratory, with other major manifestations of r heumatic fever found only rarely.