History Of Acute Rheumatic Fever Research Articles

Risk Factors of Rheumatic Heart Disease in a Children's Hospital in Khartoum: A Case-Control Study.

Rheumatic heart disease (RHD) is the most prevalent acquired cardiac illness in Sudan, arising as a complication of acute rheumatic fever (ARF). Additionally, Sudan exhibited a wide diversity in the distribution of RHD. The echocardiographic screening revealed 3/1000 cases in one region (Khartoum), while in another region (Nort Kordofan), it revealed 61/1000 cases. Consequently, further research is warranted to shed light on this disease, particularly its risk factors. There is a lack of research on the risk factors in Sudan. The objective of this study is to evaluate Sudan's RHD risk factors. This case-control study was conducted at Jafar Ibn Auf Children's Hospitalfrom August to December 2016. A questionnaire was used to study RHD risk factors, including socioeconomic status, maternal education and employment, housing conditions, residence, and history of sore throat and ARF. Comparison between cases and controls was estimated using conditional logistic regression with 95% confidence intervals (CI). A total of 78 participants, including 39 established RHD cases and 39 age- and sex-matched normal controls, were recruited. The age in years for cases and controls was 11.1 +/- 2.9 and 11+/- 2.9, respectively. In the univariate analysis, only the history of ARF was significantly associated with RHD (odds ratio (OR) 60.8, 95% CI10.3-356). There was a trend toward increased risk of RHD in association with a history of sore throat in 69.2% of the patients and origin from western states in 41% of the patients, but this did not reach statistical significance. ARF history and a six-month history of throat infections are linked to RHD. Mothers do not have a correlation with RHD, buta correlation exists when there is a connection between a history of ARF and a recent throat infection (effect modification). Furthermore, an association was found between throat infections and living in a western state. Consequently, it is imperative to adopt RHD prevention, particularly the prevention and treatment of both ARF and throat infections.

Subtle myocardial effects of rheumatic heart disease in children are revealed earlier with two-dimensional speckle tracking echocardiography.

Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in developing countries and remains a serious public health problem. In the subclinical course of carditis, the absence of typical symptoms and the normal range of classical echocardiographic measurements used to evaluate cardiac functions have required new echocardiographic methods and parameters. Previous studies regarding rheumatic heart disease in children and adults have shown that strain patterns obtained by speckle tracking echocardiography, are in fact affected although left ventricular systolic functions are preserved, yet some studies have suggested otherwise. The aim of our study is to compare the use of speckle tracking echocardiography with conventional methods in the evaluation of cardiac functions and myocardial involvement in children with subclinical RHD. The study group consisted of 24 patients with asymptomatic cardiovascular who had no history of acute rheumatic fever, but had definite or probable rheumatic valve disease. This study group was determined according to the World Heart Federation guidelines by an echocardiographic examination performed for different reasons, as well as the control group of 22 healthy children. In order to evaluate the left ventricular regional myocardial functions of the patients, tissue Doppler echocardiography (TDE) and speckle tracking echocardiographic parameters were compared with the control group. The mean ages of the patient and control groups were 14.1±2.7 years and 13.9±2.3 years, respectively. There was no statistically significant difference between the two groups in terms of conventional methods (p>0.05) but global longitudinal strain and strain rate values were found to be significantly lower in the patient group (p<0.01). These changes appeared to be relevant throughout the duration of the illness. In patients with subclinical rheumatic heart disease, conventional echocardiographic evaluations are likely negative, whereas two-dimensional speckle tracking echocardiography reveal systolic and diastolic dysfunctions of the disease.

Assessing the Role of Echocardiography in Pregnancy in First Nations Australian Women: Is it an Underutilised Resource?

Rheumatic heart disease (RHD) remains prevalent within First Nations Australian communities. RHD is more common in females and peak prevalence corresponds with childbearing age. Significant valvular disease can complicate pregnancy. Current practice in Northern Australia is to refer pregnant women for echocardiography if there are signs or symptoms of possible cardiac pathology or a history of acute rheumatic fever (ARF) or RHD. It is not currently routine practice to offer echocardiographic screening for all pregnant women at high risk of RHD. This study aimed to assess the current referral practices for echocardiography and disease patterns in pregnant women in the Northern Territory, Australia-a region with a known high prevalence of RHD in the First Nations population. A retrospective analysis of all echocardiography referrals of pregnant women over a 4-year period was performed. Data included indication for echocardiography, clinical history, echocardiographic findings, and location of delivery. Comparisons were made using Fisher's exact and Mann-Whitney U tests. A total of 322 women underwent echocardiography during pregnancy: 195 First Nations and 127 non-Indigenous women (median age, 25 vs 30 years, respectively; p<0.01). Indications for echocardiography differed by ethnicity, with history of ARF or RHD being the most common indication in First Nations women, and incidental murmur the most common in non-Indigenous women. First Nations women were more likely to have abnormal echocardiograms (35.9% vs 11.0% in non-Indigenous women; p<0.01) or a history of ARF or RHD (39.5% vs 0.8%; p<0.01), but less likely to have documented cardiac symptoms as an indication for echocardiography (8.2% vs 20.5%; p<0.01). New cardiac diagnoses were made during pregnancy in 11 (5.6%) First Nations and two (1.6%) non-Indigenous women (p=0.02). Moderate or severe valve lesions were detected in 26 (13.3%) First Nations women (all previously diagnosed), and 11 (5.6%) had previous cardiac surgery. No severe valve lesions were identified in the non-Indigenous group. Interstate transfer to a tertiary centre with valve intervention services was required during pregnancy or the puerperium for 12 (6.2%) First Nations women and no non-Indigenous women. Amongst pregnant women in the Northern Territory who had an indication for echocardiography, First Nations women were more likely to have abnormal echocardiograms. This was mainly due to valvular disease secondary to RHD. Cardiac symptoms were infrequently recorded as an indication for echocardiography in First Nations women, suggesting possible underappreciation of symptoms. Having a low threshold for echocardiographic investigation, including consideration of universal screening during pregnancy, is important in a high RHD-burden setting such as ours. A better understanding of the true prevalence and spectrum of disease severity in this population would enable health services to invest in appropriate resources.

Clinical and demographic profile of patients of rheumatic valvular heart disease

Background: Rheumatic heart disease (RHD) is a preventable structural heart disease involving cardiac valves affecting the young population of productive age-group having considerable morbidity and mortality due to associated complications. Aims and Objectives: To evaluate the clinic-demographical characteristics and complications of RHD patients and thus to build up a RHD valvular registry. Materials and Methods: In this study, we enrolled 570 consecutive patients diagnosed with rheumatic valvular affection as defined by echocardiographic criteria, and studied their demographic, valvular pathology, symptomatology, prophylaxis and complication profile. Results: Female patients dominated the population in number, mitral being the most affected valve, mitral stenosis the commonest lesion. Newly diagnosed patients constituting 20% of study population. One-fourth of the patients gave a proper history of acute rheumatic fever and oral prophylaxis was noted to be more compliant than parenteral. Case proportionality ratio for atrial fibrillation was highest with severe MS with AR and for pulmonary hypertension with severe MR with or without MS. Conclusion: RHD is a preventable disease and health professionals and policy making institutions at all levels should strive in unison to mitigate its incidence, disease severity and complications.

Standardization of Epidemiological Surveillance of Rheumatic Heart Disease.

Rheumatic heart disease (RHD) is a long-term sequela of acute rheumatic fever (ARF), which classically begins after an untreated or undertreated infection caused by Streptococcus pyogenes (Strep A). RHD develops after the heart valves are permanently damaged due to ARF. RHD remains a leading cause of morbidity and mortality in young adults in resource-limited and low- and middle-income countries. This article presents case definitions for latent, suspected, and clinical RHD for persons with and without a history of ARF, and details case classifications, including differentiating between definite or borderline according to the 2012 World Heart Federation echocardiographic diagnostic criteria. This article also covers considerations specific to RHD surveillance methodology, including discussions on echocardiographic screening, where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare), participant eligibility, and the surveillance population. Additional considerations for RHD surveillance, including implications for secondary prophylaxis and follow-up, RHD registers, community engagement, and the negative impact of surveillance, are addressed. Finally, the core elements of case report forms for RHD, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.

Transcatheter aortic valve implantation in patients with rheumatic aortic stenosis

BackgroundRheumatic heart disease (RHD) accounts for the highest number of deaths from valvular heart disease globally. Yet, rheumatic aortic stenosis (AS) was excluded from landmark studies investigating the safety and...

Long-term outcomes following rheumatic heart disease diagnosis in Australia.

Aims Rheumatic heart disease (RHD) is a major contributor to cardiac morbidity and mortality globally. This study aims to estimate the probability and predictors of progressing to non-fatal cardiovascular complications and death in young Australians after their first RHD diagnosis.Methods and results This retrospective cohort study used linked RHD register, hospital, and death data from five Australian states and territories (covering 70% of the whole population and 86% of the Indigenous population). Progression from uncomplicated RHD to all-cause death and non-fatal cardiovascular complications (surgical intervention, heart failure, atrial fibrillation, infective endocarditis, and stroke) was estimated for people aged <35 years with first-ever RHD diagnosis between 2010 and 2018, identified from register and hospital data. The study cohort comprised 1718 initially uncomplicated RHD cases (84.6% Indigenous; 10.9% migrant; 63.2% women; 40.3% aged 5–14 years; 76.4% non-metropolitan). The composite outcome of death/cardiovascular complication was experienced by 23.3% (95% confidence interval: 19.5–26.9) within 8 years. Older age and metropolitan residence were independent positive predictors of the composite outcome; history of acute rheumatic fever was a negative predictor. Population group (Indigenous/migrant/other Australian) and sex were not predictive of outcome after multivariable adjustment.Conclusion This study provides the most definitive and contemporary estimates of progression to major cardiovascular complication or death in young Australians with RHD. Despite access to the publically funded universal Australian healthcare system, one-fifth of initially uncomplicated RHD cases will experience one of the major complications of RHD within 8 years supporting the need for programmes to eradicate RHD.

Problems of chronic rheumatic heart disease diagnosis at the present stage

The review refl ects modern data on the epidemiology of acute rheumatic fever and chronic rheumatic heart disease in Russia and the world at present, as well as the dynamics of the prevalence of these diseases over the past decades. Much attention is paid to the issues of modern diagnostics of these conditions by physical, laboratory and instrumental methods. The focus is on the Jones criteria in the diagnosis of acute rheumatic fever in accordance with their revision by the American Heart Association experts in 2015. Taking into account the fact that damage to the valvular apparatus of the heart in acute rheumatic fever is the main disabling outcome of carditis at the present stage, a special place in the article is devoted to the discussion of echocardiographic criteria for valvulitis. The recommendations of the International Expert Council of the World Heart Federation aimed at detecting chronic rheumatic heart disease in patients without a history of acute rheumatic fever diagnosed by ultrasound imaging are also given. Criteria for pathological aortic and mitral regurgitation are presented. The authors believe that extrapolation of modern principles of ultrasound diagnostics of chronic rheumatic heart disease in Russia and their use as screening programs in young people and adolescents will contribute to its early detection and timely selection of patients for secondary prevention of benzathine with benzylpenicillin.

Modelling rheumatic heart disease progression in australia using disease register data linked to administrative records

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Australian Government National Health and Medical Research Council OnBehalf ERASE project Background Rheumatic Heart Disease (RHD) is a major contributor to morbidity and mortality globally, and is endemic among Indigenous Australians. The RHD Endgame strategy was recently launched, outlining comprehensive methods for eliminating RHD in Australia by 2031. However, there is currently limited information on national rates of RHD and progression to severe or complicated RHD. Purpose This study provides current estimates of RHD progression prior to RHD Endgame Strategy implementation. We estimate the probability and predictors of progressing from RHD diagnosis to cardiovascular complications, death, or need for surgical intervention in the Australian population from expanded data sources, addressing methodological shortcomings in existing evidence by using cross-jurisdictional administrative datasets and a competing risks approach. Methods This retrospective cohort study used linked RHD register, hospital and death data from five Australian jurisdictions (&amp;gt;70% Australians). Progression from RHD diagnosis to all-cause mortality, non-fatal cardiovascular complications (heart failure, stroke, endocarditis, atrial fibrillation), or need for surgical intervention were estimated for people aged &amp;lt;35years diagnosed with first-ever RHD between 2010 and 2018. A minimum 8.5-year look-back excluded prevalent cases; maximum follow-up was 8 years. Proportional cause-specific hazard regression modelling investigated independent predictors of outcomes, with death treated as a competing risk. Sensitivity analyses compared results between all-sources and register-only cohorts. Results We identified 1714 first-ever RHD cases aged &amp;lt;35years in the all-sources cohort (84% Indigenous, 11% migrant, 63% women, 40% age 5-14years, 85% non-metropolitan). Six months after diagnosis, 8.1% (95%CI:6.9-9.5%) had experienced heart failure, other cardiovascular complications or surgical intervention and 23.6% (95%CI:20.2-27.5%) progressed to these outcomes within 8 years. The register-only cohort experienced less disease progression with estimated composite event rates of 5.6% (95%CI:4.7-6.6%) and 18.4% (95%CI:16.6-20.5%) at 6 month and 8 years respectively. Death rate in the all-sources cohort was 0.5% at 6 months and 3.2% at 8 years. Older age, Metropolitan residence, and history of acute rheumatic fever, but not sex or Indigenous status, were independent predictors of major cardiovascular outcomes. Conclusions This study provides the most definitive and contemporary estimates of RHD disease progression in young Australians. Despite Australia"s excellent healthcare system infrastructure, RHD complication rates remain high. Improvements in healthcare systems for diagnosis, monitoring, and management of RHD cases will need to be implemented in both Metropolitan and remote settings as Australia implements its Endgame strategy against RHD. However, primordial and primary prevention provides the best potential to reduce the burden of RHD in Australia and beyond.

Optical Coherence Tomography Findings in Nodular Anterior Scleritis due to Post-Streptococcal Syndrome.

PurposeTo report a case of nodular anterior scleritis due to poststreptococcal syndrome using optical coherence tomography imaging.Case ReportA 41-year-old woman with a history of acute rheumatic fever presented with a nodular anterior scleritis. Common causes were excluded. Optical coherence tomography of sclera showed enlarged vessels, inflammatory infiltrates, separated fibers, and a serous detachment. Laboratory investigations showed an elevated erythrocyte sedimentation rate, raised anti-streptolysin O titer, and the presence of group A streptococcus in the throat. The scleritis rapidly improved with penicillin treatment.ConclusionPoststreptococcal syndrome should be considered in the etiology of non-necrotizing anterior scleritis.

How is juvenile rheumatic heart disease different: baseline results from a prospective north Indian registry

Abstract Introduction Juvenile rheumatic heart disease (RHD) refers to RHD in patients &amp;lt;20 years of age. There are no contemporary data highlighting the differences between juvenile and older RHD patients. Purpose We aim to report the age related differences in the pattern, and consequencies of valvular dysfunction in patients of RHD. Methods The 2475 consecutive patients of RHD diagnosed using clinical and echocardiographic criteria were registered prospectively from 2011 till December 2019. Patients were divided into 3 groups according to their age: Group 1 (Juvenile RHD), Group 2 (21–50 years), and Group 2 (&amp;gt;51 years).The data concerning the socio-demographic and clinical profile were recorded systematically, and the nature and severity of valvular dysfunction was assessed by echocardiography. The data were analyzed using the Epi-InfoTM Software. Results Out of 2475 RHD patients, Juvenile RHD comprised of 211 (8.5%) patients. Group 2 and 3 comprised of 1691 (68.3%) and 573 (23.2%) patients respectively. Overall, 1767 (71.4%) patients were females, however this female predilection was less pronounced in juvenile RHD (55.5% females vs 44.5% males) as compared to older groups. Past history of acute rheumatic fever was more commonly recorded in Juvenile RHD group (37.9% vs 18.8% in group 2 and 10% in group 3, p=0.0001). At the time of registration, the presence of advanced heart failure symptoms (dyspnea class III and IV) (11.4% group 1 vs 13.9% group 2 vs 20.6% group 3, p&amp;lt;0.0001), right heart failure symptoms (0.9% group 1 vs 2.5% group 2 vs 7.3% group 3, p&amp;lt;0.01), thromboembolic events (0% group 1 vs 4.1% group 2 vs 3.3% group 3, p&amp;lt;0.01), atrial fibrillation (2.8% group 1 vs 24.5% group 2 vs 45.9% group 3, p&amp;lt;0.0001), and pulmonary hypertension (27.1% group 1 vs 40.3% group 2 vs 51.9% group 3, p&amp;lt;0.01), were all more commonly recorded in non-juvenile older RHD groups. Multivalvular involvement was also less common in juvenile RHD (34.6% vs 42.4% and 44.5%, p=0.04). Mitral regurgitation was the most common lesion in Juvenile RHD followed by aortic regurgitation (68.7% and 40.2% respectively). Stenotic lesions (both mitral and aortic) were present more commonly in older age groups. Conclusion RHD is predominantly a disease of females, however the predilection is less common in juvenile patients. Juvenile RHD predominantly affects the mitral valve and mainly leads to regurgitant lesions. As the age advances, the complications of RHD, mainly heart failure symptoms, thromboembolic events, pulmonary hypertension, and atrial fibrillation, become more common. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Self sponsored registry

Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening.

Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town. Prospective, cross-sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register. People aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018. Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer. Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF. The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8-14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5-20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF. Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.

Arthralgia in Egyptian children

Abstract Background Children presenting with joint pains are a very common occurrence in any general pediatric outpatient department. About 15% of general pediatric consultations are for myriad pains of the musculoskeletal system. Aim of the work To screen Egyptian children presenting to a tertiary center for different causes of arthralgia. Subjects and Methods This is a descriptive study that was conducted on 200 pediatric patients (86 males and 114 females) presenting with arthralgia at the Children’s hospital Ain shams University from August 2017 till April 2018. Patients with chronic illness, skeletal deformity, past history of acute rheumatic fever, and any patient with acute febrile illness were excluded. All patients were subjected to full medical history, examination, laboratory investigation as complete blood picture, erythrocyte sedimentation rate, c reactive protein, electrocardiography and echocardiography. Results Around 18% of patients with arthralgia were proved to have post streptococcal arthralgia, 35% had collagen diseases, 10% with malignant conditions. no identifiable cause could be found in 36% of the patients and two patients diagnosed as acute rheumatic fever. Conclusion Arthralgia is a common symptom in the pediatric age group. Although it is a benign condition, sometimes it accurs due to serious illness like malignancy or collagen diseases.

Features of heritable disorders of connective tissue in children with acute rheumatic fever and rheumatic heart disease.

ObjectivesHeritable disorders of connective tissue (HDCT) are associated with morphological and functional disorders of different organs and systems. The aim of our study was to determine the clinical signs of heritable disorders of connective tissue and oxyproline levels in children with acute rheumatic fever (ARF) and rheumatic heart disease (RHD).Material and methodsA total of 155 patients aged 4 to 17 years participated in the study: 23 with ARF, 78 with RHD, and 54 healthy patients with a history of ARF. All patients underwent a standardized examination protocol, which consisted of a detailed medical history recorded by the physician, general and special laboratory tests, electrocardiogram, echocardiography, and Doppler echocardiography. Special attention was paid to the clinical signs of HDCT. The intensity of the metabolic processes in the connective tissue was evaluated by serum oxyproline levels.ResultsThe signs of HDCT were revealed in 121 (78.1%) of the patients with ARF and RHD. Among cardiovascular manifestations, we observed mitral valve prolapse most often – in 91 (58.7%) patients. Musculoskeletal anomalies were observed in 94 (60.7%) patients. Both groups of patients with ARF and RHD had elevated mean serum oxyproline levels.ConclusionsChildren with acute rheumatic fever and rheumatic heart disease presented with a number of signs characteristic of heritable connective tissue disorders. The cardiovascular and musculoskeletal system changes are the most frequent among all features of HDCT. Elevated levels of serum oxyproline in patients with ARF and RHD confirm connective tissue disorders. Children with manifestations of HDCT are at the risk of ARF and RHD development.

Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease.

Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease.

Echocardiographic Screening Detects Extremely High Prevalence of RHD in Australia

Introduction: Globally, most patients with rheumatic heart disease (RHD) do not have a history of acute rheumatic fever (ARF). The Indigenous people of the Northern Territory (NT) of Australia have some of the highest rates of ARF and RHD in the world. Coordinated register-based delivery of secondary prophylaxis has been active for two decades. This study aimed to better define the burden of RHD using active case finding for RHD in school-aged children in a remote community in the NT. Methods: A community-driven approach to engagement and education on ARF/RHD was implemented on the invitation of the Maningrida community. For active case finding, participants aged 5–20y had echocardiography performed by cardiologists. Diagnoses of RHD were made according to World Heart Federation criteria. Echo data were combined with register data to describe the burden of ARF/RHD. Results: Estimated target population (aged 5–20y) was 849 people. Of these, 615 (72.4%) underwent echocardiography (median age 11y). An existing diagnosis of probable/definite ARF and/or RHD was recorded in 44/615 (7.2%). At screening, 13 known cases and 19 new cases were found to have definite RHD (32/615, 5.2%); 6/615 (1.0%) have had cardiac surgery for severe RHD, including 3 new cases. Conclusion: The burden of ARF/RHD in Maningrida is extremely high. Active case finding using echocardiography facilitates detection and access to treatment, even in settings with effective primary health care and ongoing disease surveillance. Community engagement and education are key to early detection and treatment, as well as primordial and primary prevention of ARF/RHD.

Clinical features of rheumatic heart disease in children and adults in Western Ukraine

Background: Rheumatic heart disease (RHD) is still a big problem affecting children and adults in many countries all over the world.&#x0D; Objectives: The aim of our study was to determine the clinical course of RHD in children and adults of Western Ukraine, to ascertain the reasons for development and progression of the disease, and outline prospects for its prevention.&#x0D; Material and methods: The study included 32 children aged 11 to17 years and 35 adults aged 20 to 42 years with RHD. All patients underwent a standardized examination protocol, which consisted of detailed medical history, laboratory tests, ECG, Doppler echocardiography.&#x0D; Results: The mean age in the children group was 15.8±1.5 years and in adults group - 35.4±7.3 years. Rural areas residents were the majority in both children and adults groups, 71.9% and 77.1% respectively. Recurrent acute rheumatic fever (ARF) was observed in 35.0% of children and in 54.3% adults with history of ARF. Long-term secondary prevention of streptococcal infections was satisfactory in 40.0% of child cases and in 31.6% of adult cases. The lack of compliance and poor health awareness among patients and their parents were most common reasons for inadequate prophylaxis. Subclinical RHD was diagnosed in 37.5% of child cases and in 45.7% of adult cases. Isolated mitral regurgitation (MR) was common in child cases (43.8%) while mitral stenosis (MS) (isolated or combined) was the most common in adult cases (88.6%). Clinical signs of heart failure were absent in half of child cases, but were present in all adult cases at functional class II and III (42.3% and 57.7% respectively). Atrial fibrillation occurred in 34.3% of adult cases.&#x0D; Conclusion: MR is the predominant cardiac valvular lesion in children with RHD. Inadequate secondary prevention was identified as one of the main causes of development and progression of the disease, leading in adults to MS, combined valvular lesions, arrhythmic and infectious complications. Education of patients and their parents is very important for improving compliance with long-term prophylaxis. Special attention should be given to patients from rural areas and those with difficulties in adhering to antibiotic prevention regimes.&#x0D; Bangladesh Journal of Medical Science Vol.18(1) 2019 p.87-93

A Cost-Effectiveness Tool to Guide the Prioritization of Interventions for Rheumatic Fever and Rheumatic Heart Disease Control in African Nations.

BackgroundRheumatic heart disease (RHD) prevalence and mortality rates remain especially high in many parts of Africa. While effective prevention and treatment exist, coverage rates of the various interventions are low. Little is known about the comparative cost-effectiveness of different RHD interventions in limited resource settings. We developed an economic evaluation tool to assist ministries of health in allocating resources and planning RHD control programs.Methodology/Principal FindingsWe constructed a Markov model of the natural history of acute rheumatic fever (ARF) and RHD, taking transition probabilities and intervention effectiveness data from previously published studies and expert opinion. Our model estimates the incremental cost-effectiveness of scaling up coverage of primary prevention (PP), secondary prevention (SP) and heart valve surgery (VS) interventions for RHD. We take a healthcare system perspective on costs and measure outcomes as disability-adjusted life-years (DALYs), discounting both at 3%. Univariate and probabilistic sensitivity analyses are also built into the modeling tool. We illustrate the use of this model in a hypothetical low-income African country, drawing on available disease burden and cost data. We found that, in our hypothetical country, PP would be cost saving and SP would be very cost-effective. International referral for VS (e.g., to a country like India that has existing surgical capacity) would be cost-effective, but building in-country VS services would not be cost-effective at typical low-income country thresholds.Conclusions/SignificanceOur cost-effectiveness analysis tool is designed to inform priorities for ARF/RHD control programs in Africa at the national or subnational level. In contrast to previous literature, our preliminary findings suggest PP could be the most efficient and cheapest approach in poor countries. We provide our model for public use in the form of a Supplementary File. Our research has immediate policy relevance and calls for renewed efforts to scale up RHD prevention.

School and Community Screening Shows Malawi, Africa, to Have a High Prevalence of Latent Rheumatic Heart Disease.

Determine the prevalence of latent RHD among children ages 5-16 in Lilongwe, Malawi. This is a cross-sectional study in which children ages 5 through 16 were screened for RHD using echocardiography. Screening was conducted in 3 schools and surrounding communities in the Lilongwe district of Malawi between February and April 2014. Children were diagnosed as having no, borderline, or definite RHD as defined by World Heart Federation criteria. The primary reader completed offline reads of all studies. A second reader reviewed all of the studies diagnosed as RHD, plus a selection of normal studies. A third reader served as tiebreaker for discordant diagnoses. The distribution of results was compared between gender, location, and age categories using Fisher's exact test. The prevalence of latent RHD was 3.4% (95% CI = 2.45, 4.31), with 0.7% definite RHD and 2.7% borderline RHD. There was no significant differences in prevalence between gender (P = .44), site (P = .6), urban vs. peri-urban (P = .75), or age (P = .79). Of those with definite RHD, all were diagnosed because of pathologic mitral regurgitation (MR) and 2 morphologic features of the mitral valve. Of those with borderline RHD, most met the criteria by having pathological MR (92.3%). Malawi has a high rate of latent RHD, which is consistent with other results from sub-Saharan Africa. This study strongly supports the need for a RHD prevention and control program in Malawi.

The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study.

BackgroundLatent rheumatic heart disease (RHD) occurs in asymptomatic individuals with echocardiographic evidence of RHD and no history of acute rheumatic fever. The natural history of latent RHD is unclear but has important clinical and economic implications about whether these children should receive penicillin prophylaxis or not. We performed a 5-year prospective study of this question.MethodsIn August 2013 through September 2014, we conducted a follow-up study of latent RHD among school pupils using the World Heart Federation (WHF) echocardiographic criteria. Contingency tables were used to assess progression, persistence or regression of latent RHD.ResultsForty two borderline and 13 definite cases of RHD (n 55) were identified, 44 (80 %; mean age 13.8 ± 4.0 years; 29 (65.9 %) female) of whom were available for echocardiographic examination at a median follow-up of 60.8 months (interquartile range 51.3-63.5). Over the follow-up period, half the participants (n = 23; 52.3 %) improved to normal or better WHF category (regressors), a third (n = 14, 31.8 %) remained in the same category (persistors), while seven others (15.9 %) progressed from borderline to definite RHD (progressors). In total, 21 subjects (47.7 %) reverted to a normal status, nine (20.4 %) either improved from definite to borderline or remained in the borderline category, and 14 (31.8 %) either remained definite or progressed from borderline to a definite status. Two cases (20 %) progressed to symptomatic disease.ConclusionsLatent RHD has a variable natural history that ranges from regression to normal in nearly half of cases, to persistence, progression or development of symptoms in the remainder of subjects.