Epidemiological Investigation of Rheumatic Heart Disease in the Emergency Department in Dakar: A Descriptive Analysis

Abstract

Background: Rheumatic Heart Disease (RHD), also known as "Bouillaud's disease", is a post-streptococcal non-suppurative inflammatory disease complicating an upper airway infection with group A β-hemolytic streptococcus. Although RHD has almost disappeared in developed countries, it is still a major public health problem in low- and middle-income countries, as it remains the most frequent cause of cardiovascular mortality and morbidity in children. The objective was to describe the epidemiological and evolutionary aspects of rheumatic heart disease admitted to the emergency room of the Albert Royer National Children's Hospital in Dakar. Methods: We conducted a retrospective, descriptive study over a 12-month period (January 1 to December 31, 2021) of children aged 3 to 18 years hospitalized for rheumatic heart disease in the emergency department during the study period. Results: The prevalence was 3.73% (37/993) with a mean age of 11.35 +/- 3 years and a majority between 10 and 15 years. Males predominated - sex ratio 1.3. The majority came from disadvantaged areas (91.9%) with low incomes for the most part (83.8%). The reasons for consultation were dominated by dyspnea (86.5%), fever (75.7%) and poly-arthralgia (35.1%).  General and physical signs were tachycardia (86.5%), orthopnea (24.3%), hypoxia (40.5%), congestive heart failure (83.7%). Cardiac involvement was dominated by mitral and aortic polyvalvular disease in more than half (57%). Management included diuretics (97.3%), oxygen therapy (90%), corticosteroids (31%) and antibiotics (81%). Three cases of death were noted. Conclusion: RHD is still frequent in our countries with an often poor prognosis due to delayed management.  Prevention policies are necessary to eradicate this scourge.