This is a cross-sectional study conducted on 447
patients chosen consecutively from the pediatric
cardiology ward and the pediatric Traumatology ward of the
hospital Hassan II center, and the
Healthcare center of Narjiss in Fez city in Morocco from January 2016 to December 2018.
Subjects were classified into five groups.
Group 1(control) consisted of 155
children: 131 were healthy children
with no history of acute rheumatic fever, recent tonsillitis or sore throat
and 24 had non rheumatic heart disease.
Group 2 (ARF): 26 patients
with ARF without
carditis, diagnosed
according to updated modified Jones criteria.
Group 3 (RHD): 94 patients with RHD, all of whom had mitral regurge with or without aortic regurge confirmed
by echocardiography and on long-acting penicillin (LAP) prophylaxis every 3rd week for >1 year. These
patients had no history of acute
follicular tonsillitis or rheumatic activity within three months prior to enrollment in the study. These three
groups were recruited during the
consultation in the pediatric cardiology ward
of the hospital Hassan II center
in Fez city.
Group 4 (acute
follicular tonsillitis): 101 children included in this group are those coming to the ANNRJISS health
center in Fez and diagnosed with acute follicular
tonsillitis by the attending physician. These children presented
with erythematous or erythematous-pultaceous
sore throat, fever and headache. Throat samples
were collected from these children for identification of group A Streptoccocus.
Group 5 (history of recurrent follicular tonsillitis): 71 apparently healthy
children with past history of repeated follicular tonsillitis more than three times of year for
the past 3 years. Children
recruitment was carried
out in the pediatric Traumatology ward of the hospital Hassan II center. Children with proven attack of acute follicular
tonsillitis within the three months before
enrollment in the study were excluded.
The steadied groups were classified according to
gender (male/ female). Each group was sub-classified into three subgroups
according to age: ?5, 5-15 and ?15 years. They were also classified
according to the season of enrollment into the study: winter, spring, summer, and autumn. A full history was taken of all study subjects and they all underwent clinical examination with a particular emphasis on the presence of acute tonsillar
inflammation, the number of attacks of acute follicular tonsillitis per year, criteria
of rheumatic activity
and RHD. Written
information about the nature of the experimental procedures was given to parents of children, who asked
for their consent. Blood specimens
were collected by venipuncture in clean, sterile and small test tube from all subjects and conserved at 4 degrees.
The samples were forwarding of the
department of biochemistry of the Laboratory
of medical analysis on the hospital Hassan II on the same day. On arrival at the laboratory, the specimens were centrifuged
and the serum was used for ASO measurement. The measurement of ASO levels was performed on architect c8000 systems
(Abbott, France) and reagents were obtained from Masterlab
(Quantia ASO kit). It is a quantitative measurement of ASO concentration carried
out by measuring the turbidity
of reagents, considering the
peak agglutination rate and using known concentration patterns
for comparison. The results are automatically calculated through logarithmic function
and expressed in international
units - IU/mL. The measurement of ASOT
is carried out just one time for the control group and every three months for the groups 2, 3 and 5 for
one year. Concerning group 4, the
measurement of ASOT is done at the moment of the pharyngitis, after one month and after 3 months of the episode
of the tonsillitis. All patients
performed the analysis in the same laboratory.