054 Association of S. Pyogenes Dna from Throat Swabs of Asymptomatic Children and Very High Prevalence of Rheumatic Heart Disease in Rural South America

Abstract

BackgroundValvular lesions compatible with rheumatic heart disease (RHD) are common in developing countries. Their association with S. pyogenes (SP) infection has not been previously demonstrated nor has echo Doppler (ED) been used to assess prevalence of RHD in South American children.MethodsDuring 2-week annual visits from 2008-2010 a medical team visited 12 remote Amerindian villages and 1 mixed race town in Guyana. Randomly selected asymptomatic children underwent ED assessment. 2 cardiologists reviewed each study. RHD was defined as mitral valvular thickening AND a 1 cm regurgitant jet in at least two views. Affected children were given penicillin secondary prophylaxis. In 2009/2010, a subgroup of 13 RHD cases and 104 ED negative age- and sex-matched controls, had throat swabs for PCR for SP (Spy-1258). 8 cases and 24 controls had Streptococcal serology (ASOT) tested; 13 children had rapid antigen testing for SP on throat swabs.Results341 children ages 8-18 were reviewed; 23 had ED-defined RHD [6.7% (95% CI 3.2-10.2)]. 4/8(50%) cases and 13/24 (54%) controls had a positive ASOT (P = NS). 5/18 (38%) cases and 13/104 (8%) controls were PCR + for SP (P < 0.01). All rapid antigen tests were negative including 8/8 simultaneously sampled PCR positive children. 14 cases of incidental congenital heart disease were identified (3.8%). In one village where medics routinely gave penicillin for all cases of sore throat >5days, there was a trend towards a lower prevalence of RHD (P = 0.06).ConclusionsThis study demonstrates one of the highest prevalences of RHD worldwide. It is also the first to confirm the relationship between SP and valvular lesions in the developing world. Aggressive proactive SP treatment strategies are needed and may be effective. BackgroundValvular lesions compatible with rheumatic heart disease (RHD) are common in developing countries. Their association with S. pyogenes (SP) infection has not been previously demonstrated nor has echo Doppler (ED) been used to assess prevalence of RHD in South American children. Valvular lesions compatible with rheumatic heart disease (RHD) are common in developing countries. Their association with S. pyogenes (SP) infection has not been previously demonstrated nor has echo Doppler (ED) been used to assess prevalence of RHD in South American children. MethodsDuring 2-week annual visits from 2008-2010 a medical team visited 12 remote Amerindian villages and 1 mixed race town in Guyana. Randomly selected asymptomatic children underwent ED assessment. 2 cardiologists reviewed each study. RHD was defined as mitral valvular thickening AND a 1 cm regurgitant jet in at least two views. Affected children were given penicillin secondary prophylaxis. In 2009/2010, a subgroup of 13 RHD cases and 104 ED negative age- and sex-matched controls, had throat swabs for PCR for SP (Spy-1258). 8 cases and 24 controls had Streptococcal serology (ASOT) tested; 13 children had rapid antigen testing for SP on throat swabs. During 2-week annual visits from 2008-2010 a medical team visited 12 remote Amerindian villages and 1 mixed race town in Guyana. Randomly selected asymptomatic children underwent ED assessment. 2 cardiologists reviewed each study. RHD was defined as mitral valvular thickening AND a 1 cm regurgitant jet in at least two views. Affected children were given penicillin secondary prophylaxis. In 2009/2010, a subgroup of 13 RHD cases and 104 ED negative age- and sex-matched controls, had throat swabs for PCR for SP (Spy-1258). 8 cases and 24 controls had Streptococcal serology (ASOT) tested; 13 children had rapid antigen testing for SP on throat swabs. Results341 children ages 8-18 were reviewed; 23 had ED-defined RHD [6.7% (95% CI 3.2-10.2)]. 4/8(50%) cases and 13/24 (54%) controls had a positive ASOT (P = NS). 5/18 (38%) cases and 13/104 (8%) controls were PCR + for SP (P < 0.01). All rapid antigen tests were negative including 8/8 simultaneously sampled PCR positive children. 14 cases of incidental congenital heart disease were identified (3.8%). In one village where medics routinely gave penicillin for all cases of sore throat >5days, there was a trend towards a lower prevalence of RHD (P = 0.06). 341 children ages 8-18 were reviewed; 23 had ED-defined RHD [6.7% (95% CI 3.2-10.2)]. 4/8(50%) cases and 13/24 (54%) controls had a positive ASOT (P = NS). 5/18 (38%) cases and 13/104 (8%) controls were PCR + for SP (P < 0.01). All rapid antigen tests were negative including 8/8 simultaneously sampled PCR positive children. 14 cases of incidental congenital heart disease were identified (3.8%). In one village where medics routinely gave penicillin for all cases of sore throat >5days, there was a trend towards a lower prevalence of RHD (P = 0.06). ConclusionsThis study demonstrates one of the highest prevalences of RHD worldwide. It is also the first to confirm the relationship between SP and valvular lesions in the developing world. Aggressive proactive SP treatment strategies are needed and may be effective. This study demonstrates one of the highest prevalences of RHD worldwide. It is also the first to confirm the relationship between SP and valvular lesions in the developing world. Aggressive proactive SP treatment strategies are needed and may be effective.