Acute rheumatic fever and rheumatic heart disease
Jonathan R Carapetis, Andrea Beaton, Madeleine W Cunningham, Luiza Guilherme, Ganesan Karthikeyan, Bongani M Mayosi, Craig Sable, Andrew Steer, Nigel Wilson, Rosemary Wyber, Liesl Zühlke, Jonathan R Carapetis, Andrea Beaton, Madeleine W Cunningham, Luiza Guilherme, Ganesan Karthikeyan, Bongani M Mayosi, Craig Sable, Andrew Steer, Nigel Wilson, Rosemary Wyber, Liesl Zühlke
Abstract
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.
Conflict of interest statement
Competing interests statement
G.K., L.Z., A.S., J.R.C., A.B., N.W., L.G., C.S., R.W. and B.M.M. have no conflict of interest. M.W.C. has financial interest in and is Chief Scientific Officer of Moleculera Labs, a company offering diagnostic testing for neurological disorders.
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Source: PubMed