Presentación de fiebre reumática y artritis post-estreptocócica en un hospital de tercer nivel
Resumen
Introducción: La Fiebre Reumática (FR) y la Artritis Post-Estreptocócica (ARPE), se caracterizan por auto-anticuerpos secundarios a infección por Estreptococo beta hemolítico del grupo A. En nuestro país, la cardiopatía adquirida por la FR genera cuantiosos gastos para el Estado y la familia, tornándose en un problema de salud pública. Objetivos: Valorar las características clínico-epidemiológicas y la evolución de pacientes con Fiebre Reumática y ARPE, en la Cátedra y Servicio de Pediatría del Hospital de Clínicas. Metodología: estudio retrospectivo, observacional, transversal, de pacientes con diagnostic de FR y ARPE, durante el periodo comprendido entre enero del 2009 y junio del 2014. Resultados: Se encontraron 22 casos de FR y 4 de ARPE. Edad de diagnóstico: 4 a 16 años. La válvula cardiaca más afectada fue la mitral con 8/22 pacientes. Criterios mayores: artritis migratoria en 13/22, Carditis 4/22, Corea 3/22. Criterios menores: Artralgias 10/22, Fiebre 8/22, VSG elevada 14/22, PCR + 11/22, ECG alterado 6/22. En 24/26 pacientes no se realizó cultivo faríngeo. ASTO + 15/26 de los casos. Tratamiento: todos recibieron penicilina G benzatínica, 9/26 salicilatos, 5/26 corticoides, 2/26 haloperidol. El 33% de los niños con FR presentó falla cardiaca; 10/26 pacientes abandonaron tratamiento. Conclusiones: La FR, sigue siendo una causa importante de cardiopatía adquirida, quizás por el manejo inadecuado de las infecciones estreptocócicas y el diagnóstico tardío de la enfermedad. Llama la atención la falta de búsqueda de la infección (cultivo), el alto porcentaje de abandono del tratamiento, y el diagnóstico inadecuado (ARPE vs FR).
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