Modern features of rheumatic chorea in children

Chorea is the nervous system lesions with rheumatic fever (RF) as a result of the phenomenon of antigenic mimicry with antibodies cross-reactivity to BGSA antigens with similar antigen epitopes of brain tissue. Objective of the research - to determine frequency of nervous system lesion by RF, chorea clinical symptoms structure and prognosis of the disease in children. The study included 56 children 4-17 years old, hospitalized in the Morozov Children’s Clinical Hospital in 2001-2015 with RF. Clinical and medical history, laboratory and instrumental methods (ECG, ECHOCG, CT and/or MRI of the brain, EEG, ENMG) were used. The main clinical manifestation of RF was carditis (89,3%) with a high frequency (76,8%) of extracardiac manifestations: arthritis (46,4%), annular erythema (10,7%), in one child (1,8%) - rheumatoid nodules. Noteworthy is high frequency of chorea development (42,9%) mainly in patients with neurological history (p<0,05). 12,5% of children had isolated chorea. Most (30,4%) had combined form of neurorheumatism. The study revealed frequent errors (66%) in RF diagnosis in the prehospital stage. Medical history (45,8%) and streptococcal infection laboratory markers (p=0,02) are rarely detected among patients with chorea compared with patients without chorea symptoms (69%). Hemichorea (78%) with subacute onset (75%) predominated. RF issue requires attention from the medical community. Chorea is the most challenging for the differential diagnosis, especially isolated (29%). Even with isolated chorea chronic rheumatic heart disease (12,5%) may develop. In rheumatic chorea treatment, in addition to antibacterial drugs and drugs that affect dopamine and GABA metabolism, glucocorticosteroids (prednisolone) are needed. © 2016, Pediatria Ltd. All rights reserved.