Clinical and echocardiographic features of children with rheumatic heart disease and their serum cytokine profile.

[acute rheumatic fever]

Acute rheumatic fever (ARF ) and rheumatic heart disease (RHD ) constitute important public health problems in developing countries . Children with ARF and RHD seen at Children 's Hospital -Sudan from May 2008 -2009 were examined clinically and by echocardiography . Blood cytokines (interleukin 10 (IL 10 ), Tumor necrosis factor alpha (TNF - alpha ) and interferon gamma (IFN-gamma ) were done . Thirty six children were enrolled ; 63 % had established RHD , and 37 % ARF . Mitral regurgitation (MR ) was the most common lesion (94 %).Ninety five percent of the valve lesions were severe . The serum interleukin IL 10 level ranged between 3 -6 pg /ml . TNF alpha levels were 9 - 100 pg /ml in 12 patients (40 %), 101 -1000 pg /ml in 10 patients (33 %), more than 1000 in 8 patients (26 %). The level of IFN gamma ranged between 2 -7 pg /m in all patients except 2 (84 and 135 pg /ml ). RHD is manifested with severe valvular lesions and a high TNF alpha indicating and ongoing inflammation .