We designed a multi-hospital prospective study of @entity1 less than 12 years to determine the comparative clinical profile, severity of @entity2401 , and outcome on follow up of @entity1 suffering an initial and recurrent episodes of @entity4789 . The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 @entity1 in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of @entity2401 was graded by clinical and echocardiographic means. In those suffering their first episode, @entity2401 was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). @entity625 was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). @entity4790 was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but @entity5105 was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). @entity4841 , in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of @entity2401 in the first versus recurrent episodes, at the start of study mild @entity2401 was found in 29.8% versus 10.6%, moderate @entity2401 in 26.3% versus 53.8%, and severe @entity2401 in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of @entity1 suffering their first episode were completely cured of @entity2401 , and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the @entity1 . We conclude that the clinical profile of @entity4789 , especially that of @entity2401 , is milder in those suffering their first attack compared to those with recurrent episodes.

Clinical profile of XXXX in Pakistan.

@entity1 :: ('9606', 'Species') :: ['children', 'patients'] @entity4789 :: ('MESH:D012213', 'Disease') :: ['acute rheumatic fever'] @entity625 :: ('MESH:D001168', 'Disease') :: ['Arthritis'] @entity4790 :: ('MESH:D002819', 'Disease') :: ['Chorea'] @entity5105 :: ('MESH:D004890', 'Disease') :: ['Erythema marginatum'] @entity4841 :: ('MESH:D018771', 'Disease') :: ['Arthralgia'] @entity2401 :: ('MESH:D009205', 'Disease') :: ['carditis']
@entity4789 :: (MESH:D012213,Disease) :: ['acute rheumatic fever']
