Prevalence Of Acute Rheumatic Fever Research Articles

Promising approaches to early diagnosis of chronic rheumatic heart disease

Aim to determine the prevalence of acute rheumatic fever (ARF) in children and chronic rheumatic heart disease (HRHD) in adults on the example of the Samara region and to propose measures for the early detection and prevention of valvular heart lesions.
 Material and methods. The authors cite the material of their own research, indicating a significant prevalence of rheumatic etiology of valvular lesions that required surgical treatment in 20162020 in the Samara region. We retrospectively analyzed the prevalence of acute rheumatic fever and chronic rheumatic heart disease in out-patients of a large polyclinic of Samara city.
 Results. The study demonstrates the low frequency of acute rheumatic fever in the Russian Federation along with the disproportionately high prevalence of chronic rheumatic heart disease.
 Conclusion. It is advisable to supplement the procedure for preventive medical examinations of the underage, has being in force in the territory of the Russian Federation since 2017, by ultrasound examination of the heart for the timely diagnosis of chronic rheumatic heart disease and long-term treatment with benzathine penicillin. In this case, it is also possible to identify previously undiagnosed congenital heart defects and heart diseases that manifest in adolescence.

Antibiotics for treatment of sore throat in children and adults.

Antibiotics for treatment of sore throat in children and adults.

Using community‐led development to build health communication about rheumatic heart disease in Aboriginal children: a developmental evaluation

ObjectiveA high prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Aboriginal children in northern Australia is coupled with low understanding among families. This has negative impacts on children's health, limits opportunities for prevention and suggests that better health communication is needed. MethodsDuring an RHD echocardiography screening project, Aboriginal teachers in a remote community school created lessons to teach children about RHD in their home languages, drawing on principles of community‐led development. Access to community‐level RHD data, previously unknown to teachers and families, was a catalyst for this innovative work. Careful, iterative discussions among speakers of four Aboriginal languages ensured a culturally coherent narrative and accompanying teaching resources. ResultsThe evaluation demonstrated the importance of collective work, local Indigenous Knowledge and metaphors. As a result of the lessons, some children showed new responses and attitudes to skin infections and their RHD treatment. Language teachers used natural social networks to disseminate new information. A community interagency collaboration working to prevent RHD commenced. Conclusions and implications for public healthAction to address high rates of RHD must include effective health communication strategies that value Indigenous Knowledge, language and culture, collaborative leadership and respect for Indigenous data sovereignty.

Rheumatic Fever in Large Cohort of Adolescents in Israel.

Background: Acute rheumatic fever (ARF) remains a major worldwide healthcare problem, despite its progressive decline in developed countries. The aims of our study were to estimate the prevalence of ARF among adolescents in Israel and to investigate risk factors.Methods: The study population consisted of 113,671 consecutive conscripts 16–19 years old, born during 1971–1993, who completed the medical profiling as part of the recruitment process to the IDF. ARF was diagnosed according to Jones criteria at time of illness, with confirmation relying on medical documentation and cardiologist evaluation including echocardiography.Results: The general prevalence rate of ARF was 0.12%. A downward trend was observed, from 0.19% among those born during 1971–1980 to 0.07% among those born during 1981–1993. Differences in prevalence of ARF were noted in sub-populations based on country of birth and origin—Israel, Ethiopia and the former soviet union (FUSSR). The prevalence rates of valvar disease among ARF+ and ARF– recruits were 15.7% and 0.95%, respectively. In multivariable logistic regression analyses, 4 variables were negatively associated with ARF: later birth year group, female gender, rural residence, youngest child; and 3 were positively associated with ARF: young parents, above normal BMI and valvar disease.Conclusion: Our study provides support for the documented decline in ARF prevalence and describes socio-demographic and anthropometric risk factors including the association with valvar disease and novel risk factors including above normal BMI and young parents, both warranting further investigation which might help in developing societal level prevention strategies.

P5354Echocardiographic findings in pregnant indigenous Australians: under utilised?

Abstract Background The Indigenous population of Australia has one of the highest prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) globally. RHD is more common in females and the incidence peaks in the 3rd to 4th decade of life, corresponding with child-bearing age. It is the number one cause of cardiac complications in pregnancy globally. Signs and symptoms of normal pregnancy may overlap with those of cardiac pathology. Significant valvular disease can complicate pregnancy and delivery. Current practice sees pregnant women referred for echocardiography if there are signs or symptoms of possible cardiac pathology or a history of RHD. Aim To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of rheumatic heart disease. Method A retrospective study of all echocardiograms requested for an indication relating to pregnancy over a three-year period were reviewed in the Northern Territory of Australia. Data collected included patient demographics, echocardiography indication, history of RHD, ARF or other cardiac disease, echocardiographic parameters, location of delivery, peri-partum morbidity and mortality. Results The total number of patients reviewed were 257. The 158 Indigenous Australian women had a mean age of 25 years and the 99 non-indigenous women had a mean age of 30 years. The Indigenous women had a higher rate of abnormal echocardiograms, 36.1% compared with 9.1% for non-indigenous women. Table 1 outlines echocardiography indications and outcomes. Indigenous women had extremely high rates of ARF or RHD representing 37% of echocardiography referrals, with 17.1% (27/158) having moderate or severe valve lesions. 5 cases (3.2%) had a history of prior valve surgery. 10 (6.3%) Indigenous patients required transfer to a tertiary centre with valve intervention services available for delivery. There was one maternal death, one post-partum stroke and one foetal death in utero. Echocardiogram indications and outcomes Incidental murmur Cardiac symptoms Other cardiac disease History of RHD and/or ARF Normal study Rheumatic heart disease Congenital heart disease Other heart disease Indigenous (n=158) 60 (38%) 15 (9.4%) 24 (15%) 59 (37.3%) 101 (63.9%) 47 (29.7%) 7 (4.4%) 3 (1.9%) Non-indigenous (n=99) 44 (44.4%) 24 (24.2%) 31 (31.3%) 0 90 (91%) 2 (2%) 3 (3%) 4 (4%) Conclusion In the Top End of Australia, Indigenous patients have a very high rate of abnormal echocardiograms during pregnancy compared with their non-indigenous counterparts, mainly as a result of RHD. Data suggests that pregnant Indigenous women are being under serviced by the current medical model and referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.

The effect of group A streptococcal carrier on the epidemic model of acute rheumatic fever

BackgroundGroup A streptococcus (GAS) is the most frequent cause of bacterial pharyngitis in school-aged children. The postinfection sequel as acute rheumatic fever (ARF) and rheumatic heart disease that cause morbidity and mortality among young people is public health concerns in several developing countries. Asymptomatic carriage state of GAS is not fully understood in terms of host and bacterial factors. Although the ability of transmitting GAS of the asymptomatic carriers is relatively low, they may present the reservoir of the epidemic. A fraction of GAS carriers is difficult to estimate in practice and may greatly vary between populations. Understanding the role of carriage on the transmission dynamic of GAS is important for assessing the public health impact of the ARF.MethodThis study investigates the effect of GAS carriers on both the transmission and dynamic of ARF cases by using a mathematical model.ResultWe derive the sufficient conditions for which the GAS can spread or extinct from the naive population under the variation of the fraction of symptomatic cases over the incidence of GAS. The threshold is possible to occur in general, but the last condition which is rather restrictive and involves parameter uncertainty. The increasing of carriers in the endemic state leads to the reduction in magnitude of the reproduction number and the number of ARF patients. We demonstrate that the adjustment of parameters can be carried out by the use of endemic state and some specific data.ConclusionWe show theoretically that the presence of asymptomatic carriers may induce the epidemic threshold and reduce the virulence of GAS and the prevalence of ARF.

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.

Using preceding hospital admissions to identify children at risk of developing acute rheumatic fever

New Zealand (NZ) Māori and Pacific children have high rates of acute rheumatic fever (ARF). Around 150 new cases arise each year. As part of the national ARF prevention programme, funding is available to improve housing. To obtain maximum benefit from interventions, an effective tool is needed for targeting high-risk children. This study aimed to assess the effectiveness of using hospitalisations for identifying children at risk of subsequent ARF. Three potentially avoidable hospitalisation (PAH) groups were investigated, including diseases thought to be influenced by housing. All were developed using expert opinion or systematic reviews. These were: (i) the PAH conditions associated with the housing environment (PAHHE) group; (ii) the Crowding group; and (iii) the Ministry of Health (MoH) group. We analysed NZ public hospital discharge data (2000-2014). The prevalence of ARF among patients hospitalised in each group was calculated to estimate sensitivity and potential effectiveness. The number needed to screen (NNS) to identify one ARF case was estimated as a measure of efficiency. Nearly one-third of ARF patients experienced a PAH as children (before developing ARF). Sensitivity for detecting future ARF ranged from <5% (MoH group) to 27% (PAHHE group). NNS ranged from 502.4 (PAHHE) to 707.5 (MoH). Because ARF is relatively rare, observing hospitalisations is not particularly efficient for targeting prevention activities for this condition alone. However, housing interventions are likely to improve multiple outcomes; thus, the hospital setting is still useful for identifying at-risk children who could benefit from such programmes.

Cardiovascular Disease in Bangladesh: A Review

Like elsewhere, cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality in Bangladesh. Over the past few decades, because of epidemiological transition, the prevailing disease pattern in this country changed from predominantly communicable to predominantly non- communicable disease, CVD contributes to the latter a lot. Actually, CVD particularly coronary artery disease (CAD) is getting epidemic proportion day by day. Hypertension and heart failure are on the rise, whereas the prevalence of acute rheumatic fever is declining. However, despite some efforts, reliable data concerning various aspects of CVD is inadequate at present. The current prevalence of hypertension, CAD, rheumatic fever and rheumatic heart disease and stroke may be 20-25%, 4-6%, &lt;1/1000, 0.3- 1.0% respectively. Besides conventional risk factors for different CVD, genetic predisposition and some novel issues like high salt intake, arsenicosis, hypovitaminosis D and air pollution may play important role in the aetiopathogenesis of CVD in this population. Formulation of appropriate policy and more emphasis on preventive strategy may help combat CVD in Bangladesh.Bangladesh Heart Journal 2016; 31(2) : 80-99

Clinical and epidemiological aspects of streptococcus pyogenes pharyngitis and carriage in Africa

Infection with Group A β-haemolytic Streptococcus, also known as Streptococcus pyogenes, results in various mucosal and skin diseases including pharyngitis. An exaggerated immune response to a single or repeated group A streptococcal (GAS) infection subsequently results in acute rheumatic fever (ARF) and, in the absence of intervention, repeated bouts of ARF may in turn result in progression to RHD, particularly in those ARF patients with cardiac involvement. Addressing GAS pharyngitis through appropriate primary prevention measures and treating all symptomatic GAS sore throats with a course of oral or parenteral penicillin presents an opportunity for the primary intervention of RHD. Failure to eradicate streptococci from the pharynx occurs in about one third of non-treated cases, giving rise to carrier status in those individuals harbouring intracellular GAS and thus representing a potential source of the acquisition of infections for other children and adults. Improved living conditions and access to healthcare during the last century are credited for the considerable decline in the prevalence of ARF and RHD in developed countries. However, a few studies have been reported from within Africa, and in these GAS carriage ranged around 9.0%. In South African studies GAS carriage isolation rates, which range from 1.62% to16.8%, were reported. As regards the prevalence of GAS pharyngitis, it is generally higher in developing countries and impoverished communities within industrialised nations. The most-up-to-date data from South Africa was collected more than 30 years ago with rates then ranging from 23.2% to 45.5%. There are no incidence data on GAS pharyngitis in Africa. This review found that there is a need to document the epidemiology of GAS carriage and GAS pharyngitis in school children of all ages within Africa. Molecular characterisation of strains harboured in the pharynx of carriers and of those isolated during bouts of pharyngitis, will help to identify risk factors associated with carriage in school-aged children and infl uence the planning and evaluation of management programmes in the screening of pharyngeal carriers and treatment of GAS pharyngitis.

Acute Rheumatic Fever among Primary School Students in Harari Region, Eastern Ethiopia

Background: In many developed countries, acute rheumatic fever is eradicated through strong health promotion and prevention efforts; yet, it continues to cause serious health problems in many developing countries including Ethiopia. The main aim of the study was to assess the prevalence and factors associated with acute rheumatic fever among primary school students in Harari region, Eastern Ethiopia. Methodology: A cross-sectional study was conducted among students of four primary schools from November, 2015 to April, 2016. Data were collected according to modified Jones criteria with confirmation of preceding infection by anti-streptolysin –O titre. Factors associated with the outcome were identified using logistic regression. Odds ratios and the corresponding confidence intervals were used to report the findings. Results: Out of 1739 school children with the mean age of 11.5 years (6-19 years), 21 had Acute Rheumatic Fever (ARF). The two week prevalence of acute rheumatic fever and tonsillopharyngitis were 21/1739 (1.2%) and 231/1739 (13.2%) respectively. Regarding awareness towards causes of tonsillitis, 78% perceived consumption of cold foods and drinks. Factors associated with ARF were maternal illiteracy (AOR 5.54, 95% CI 1.07, 28.662) and urban school (AOR 0.254, 95% CI 0.084, 0.769). Conclusion: The prevalence of ARF among primary school children was high. School health education program focused on acute rheumatic fever causes and consequences are needed to increase awareness among children and their parents. (Less)

An epidemiological study to assess the true incidence and prevalence of rheumatic heart disease and acute rheumatic fever in New Caledonian school children.

To provide in New Caledonian school children (i) the prevalence of rheumatic heart disease (RHD) detected by annual screening program using new World Heart Federation diagnostic criteria; (ii) the point prevalence of acute rheumatic fever (ARF); and (iii) to investigate socio-demographic risk factors associated with RHD. This study linked data from national ARF/RHD programs by combining ARF incidence data from the register with RHD prevalence data from echocardiographic screening data for a single age year of the population for overall point prevalence ARF/RHD rates. For the analysis, cases of echocardiographic detection of RHD are presumed to be synonymous with undiagnosed ARF. All results were weighted to minimise the bias introduced from absent pupils of each annual screening program. Incidence and prevalence were age-standardised to the WHO World Standard Population. Each 2013 cumulative prevalence of definite and borderline RHD was studied using a multivariate logistic regression adjusted for socio-demographic factors. The overall age-standardised incidence of clinical and undiagnosed ARF (i.e. echocardiographic-detected RHD) was combined as point prevalence and estimated to be 99/10 000 cases in 2012 and 114/10 000 cases in 2013. This included 40/10 000 prevalent cases of asymptomatic RHD detected by screening each year. Being Melanesian, OR 23.2 (95% CI: 3.4-157.3), or Polynesian, OR 21.5 (95% CI: 2.9-157.7), was associated with a higher prevalence of having definite RHD compared with being Caucasian. Being a girl was associated with a higher risk of having borderline RHD, OR 1.9 (95% CI: 1.03-3.3). Without echocardiographic screening, ARF/RHD burden is substantially underestimated.

Characteristics of Children with Acute Rheumatic Fever in Two Governorates of Upper Egypt

Abstract: While the incidence and prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) have been decreasing in developed nations since the early 1900s, they continue to be major causes of morbidity and mortality among children in developing nations. Aim of the study: The aim of the present study is to evaluate the characteristics of children with ARF in two governorates in upper Egypt. Materials and Methods: The study was conducted in pediatric cardiology clinics in pediatric departments of Assiut and Sohag University hospitals. The study included 160 children aged 5-15 years old with ARF, eighty from each pediatric department of Assuit and Sohag University Hospitals. A control group of apparently healthy children of same number for each group was included. Three tools for collecting data were used in this study: tool one is an assessment questionnaire of children and parents knowledge about rheumatic fever (RF). Tool two: Assessment of socioeconomic condition of families. Tool threeincluded anthropometric measurements of children. Results: ARF was more common among male children (62.5%) than females (37.5%) in Assiut compared with Sohag group (41.3%, 58.7% respectively) (P=0.002). Children with RF were more prevalent among families living in rural areas in Assiut and Sohag (78.8% and 60% respectively) than urban (21.25% and 40% respectively) (P=0.008). High percentages of illiteracy of the fathers of children with RF in Assiut (58.8%) and Sohag (62.5%) and similarly were the mothers in Assiut and Sohag (87.5% and 77.5% respectively). There was a significant difference between low socio-economic class (200-400 L.E) of families in Assiut and Sohag and RF (P=0.009).. The Majority of fathers of the two study groups in Assiut and Sohag were workers and farmers (85.0% and 71.25% respectively). Also the majority of mothers in both groups were housewives (95.0% and 82.5% respectively). About one quarter in Sohag group (23.75%) had a family history of RF compared to 21.25% in Assiut. There was a lack of parents' knowledge about RF including definition, causes, signs and symptoms, treatment, persons at risk of RF, its complications and caring of child with RF. Conclusion: RF occurs equally in both sexes to some extent, more common among rural, crowded, low socioeconomic families with high percentage of illiteracy, unemployment, and lack of knowledge about RF among parents.

English

INTRODUCTION: Acute rheumatic fever is an auto-immune response to bacterial infection with group A streptococcus (GAS). Despite the dramatic nature of the acute episode, acute rheumatic fever leaves no lasting damage to the brain, joints or skin. Recurrences of acute rheumatic fever may cause further valve damage, leading to steady worsening of rheumatic heart disease. AIMS AND OBJECTIVE: To study prevalence of acute rheumatic fever and rheumatic heart disease as detected by 2D ECHOCARDIOGRAPHY in patients 05 years to 40 years of age attending OPD and IPD of medicine and pediatrics department Rama Medical College, Kanpur. MATERIAL AND METHODS: The present study was conducted on patients of 05 to 40 years of age. All patients were examined clinically and relevant investigations including 2D ECHOCARDIOGRAPHY was done in all patients. RESULTS: A total of 734 patients belonging to age group 05 to 40 years & attending the OPD & IPD of Medicine & pediatrics Department of Rama Medical College, Kanpur, were studied, Out of 734 patients, 42 patients (5.72%) had findings of RF & RHD on 2D ECHO. RF were present in 10 patients (1.36%), RHD in 28 patients (3.81%), and 04 patients (0.54%) had evidence of both RF & RHD, 38.09% had findings of RF & RHD, were >25 years of age, Out of 42 patients 61.90% were females & 38.09% were males, RF & RHD occurred more frequently (57.14%) in rural population as compared to urban population (42.86%). Among the Jones Minor Criteria, the most common manifestation (57.14%) was Arthralgia followed by Fever (50%). ESR was raised in 28.57%, CRP was elevated in 28.57% and PR-interval prolongation was seen in 14.28%.Clinically 04 patients had evidence of carditis. All these patients also had ECHO findings suggesting carditis. Other than that ECHO also identified 10 more patients with carditis. Mitral valve was most commonly involved. Isolated mitral stenosis was present in 25% of patients, isolated mitral regurgitation in 18.75% of patients, while combined mitral valve stenosis & regurgitation was present in 37.50% of patients. Multi valvular lesions were present in 18.25% of patients. CONCLUSION: Our study shows prevalence of RF to be 19.07 per 1000 patients and prevalence of RHD to be 43.59 per 1000 patients, there is higher sensitivity and positive predictive value of 2D ECHO in detecting RF and RHD. Maximum number of patients of RF and RHD belong to the >25 years age group, followed by 20-25 years, 15-20 years and 05-10 years with prevalence is higher in females than male, Polyarthritis was the most common manifestation among the Jones major criteria seen in 35.71% patients.2D ECHO had a sensitivity and positive predictive value of 100% in identifying carditis as compared to clinical methods of detecting carditis with sensitivity of 28.57%.

Health education interventions to raise awareness of rheumatic fever: a systematic review protocol

BackgroundThere is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF.Methods and designThis article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before–after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops.DiscussionThis review will provide evidence for the effectiveness of educational components in health promotion interventions in raising public awareness in regard to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide guidance in the development of future intervention studies and programs.

Region Specific and Worldwide Distribution of Collagen-Binding M Proteins with PARF Motifs among Human Pathogenic Streptococcal Isolates

Some of the variety of Streptococcus pyogenes and Streptococcus dysgalactiae ssp. equisimilis (SDSE) M proteins act as collagen-binding adhesins that facilitate acute infection. Moreover, their potential to trigger collagen autoimmunity has been implicated in the pathogenesis of acute rheumatic fever and attributed to a collagen-binding motif called PARF (peptide associated with rheumatic fever). For the first time we determine the rate of clinical isolates with collagen-binding M proteins that use a PARF motif (A/T/E)XYLXX(L/F)N in a defined geographic region, Vellore in South India. In this region both, incidence of streptococcal infections and prevalence of acute rheumatic fever are high. M proteins with PARF motif conferred collagen-binding activity to 3.9% of 153 S. pyogenes and 10.6% of 255 SDSE clinical isolates from Vellore. The PARF motif occurred in three S. pyogenes and 22 SDSE M protein types. In one of the S. pyogenes and five of the SDSE M proteins that contained the motif, collagen-binding was impaired, due to influences of other parts of the M protein molecule. The accumulated data on the collagen binding activity of certain M protein types allowed a reanalysis of published worldwide emm-typing data with the aim to estimate the rates of isolates that bind collagen via PARF. The results indicate that M proteins, which bind collagen via a PARF motif, are epidemiologically relevant in human infections, not only in Vellore. It is imperative to include the most relevant collagen-binding M types in vaccines. But when designing M protein based vaccines it should be considered that collagen binding motifs within the vaccine antigen remain potential risk factors.

THE CLINICAL-DIAGNOSTIC ROLE OF ANTISTREPTOLYSIN O ANTIBODIES

The antistreptolysin O antibody (ASLO) test is often requested in a clinical setting with limited evidence for its usefulness. For this reason, the diagnostic scenario in which ASLO plays an evidence-based role and the analytical performance of the test are critically appraised, taking into account the clinical need and the direct medical cost. Little or no scientific evidence was found for the use of ASLO in patients with pharyngitis, post-streptococcal glomerulonephritis and in adults with rheumatoid arthritis. The clinical relevance of ASLO is restricted to paediatrics, where it contributes to fulfil the diagnosis of acute rheumatic fever (ARF) as per Jones criteria. The standardization of current automated ASLO-latex assays is limited. Attention should be paid to inaccurate reference values and many circumstances causing false positive and false negative results. Because of a low prevalence of ARF in the Western world, a high negative predictive value is obtained for the ASLO test (> 99%). In clinical practice, the result of the test is not urgent. To reduce overconsumption, the clinical laboratory should drive the request behaviour of physicians by a strategic lay-out of the application form. The health insurance/government also contributed by introducing a diagnostic rule for reimbursement.

Too much and too little? Prevalence and extent of antibiotic use in a New Zealand region

Although antibiotic use in the community is a significant contributor to resistance, little is known about social patterns of use. This study aimed to explore the use of antibiotics by age, gender, ethnicity, socio-economic status and rurality. Data were obtained on all medicines dispensed to ambulatory patients in one isolated town for a year, and data on antibiotics are presented in this paper. Demographic details were obtained from pharmacy records or by matching to a national patient dataset. During the study year, 51% of the population received a prescription for one or more antibiotics, and on average people in the region received 10.15 defined daily doses (DDDs). Prevalence of use was higher for females (ratio, 1.18), and for young people (under 25) and the elderly (75 and over), and the amount in DDDs/person/year broadly followed this pattern. Māori (indigenous New Zealanders) were less likely to receive a prescription (48% of the population) than non-Māori (55%) and received smaller quantities on average. Rural Māori, including rural Māori children, received few prescriptions and low quantities of antibiotics compared with other population groups. The level of antibiotic use in the general population is high, despite campaigns to try to reduce unnecessary use. The prevalence of acute rheumatic fever is high amongst rural Māori, and consequently treatment guidelines recommend prophylactic use of antibiotics for sore throat in this population. This makes the comparatively very low level of use of antibiotics amongst rural Māori children very concerning.

Clinical and Microbial Characteristics of Invasive Streptococcus pyogenes Disease in New Caledonia, a Region in Oceania with a High Incidence of Acute Rheumatic Fever

New Caledonia is an archipelago in the South Pacific with a high prevalence of acute rheumatic fever and rheumatic heart disease. Conducted in 2006, this study aimed at characterizing clinical manifestations and microbial features of isolates obtained from invasive Streptococcus pyogenes disease. Clinical and demographic data were collected prospectively. Isolates were biotyped, T typed, emm sequenced, and tested for antibiotic susceptibility. Detection of the speA, speB, speC, and ssa genes was also carried out. The estimated annual incidence of invasive S. pyogenes disease in 2006 was high at 38 cases/100,000 inhabitants in New Caledonia. Invasive isolates were obtained from 90 patients with necrotizing fasciitis (41 cases), bacteremia with no identified focus (12 cases), myositis (10 cases), septic arthritis (9 cases), erysipelas (8 cases), postpartum infection (4 cases), myelitis and osteomyelitis (3 cases), severe pneumonia (2 cases), and endocarditis (1 case). The most frequent associated comorbidities were skin lesions (71%) and obesity (29%). Thirty-one different emm types were identified, and the following six accounted for 54% of the isolates: emm15 (15.5%), emm92 (12.2%), emm106 (8.9%), emm74 (6.7%), emm89 (5.6%), and emm109 (5.6%). The speA, speC, and ssa genes were expressed at different frequencies in the various emm types. The first epidemiological study of invasive S. pyogenes disease in New Caledonia highlights that emm type distribution is particular and should be taken into account in the development of an appropriate vaccine. These findings support the prevention of pyoderma and other cutaneous lesions in order to limit the development of both invasive disease and poststreptococcal sequelae in the South Pacific.

The pattern of acute rheumatic fever in children: Experience at the children’s hospital, Riyadh, Saudi Arabia

Background The study was carried out in Riyadh City Hospital to determine the hospital prevalence of acute rheumatic fever (ARF), its characteristics and to determine the proportion of the ARF population that have recurrent attacks. Methods The study was an analysis of 83 children with ARF, admitted to the Children’s Hospital, Riyadh, over a 10-year period (1994–2003). The diagnosis of ARF was based on clinical features as defined in the modified Jones criteria with evidence of recent streptococcal infection. The diagnosis of recurrence of rheumatic fever in children with rheumatic heart disease was based on the presence of one major criterion apart from carditis or two minor criteria, in addition to evidence of preceding streptococcal infection. Results The mean age at presentation was 9 years. In 31 (37%) cases, arthritis was the only major Jones criterion. In 30 (36%) others, arthritis was associated with carditis and in 3 (4%), with chorea. Cardiac involvement was documented in 44 (53%) cases; it occurred alone in 5 (6%), with arthritis in 30 (36%), and with chorea in 9 (11%) others. Among the 44 with carditis, the pattern of cardiac involvement was valvular only (mild carditis) in 30 (68%), while it was severe in the remaining 14 (32%) cases who also had heart failure. The involvement of the mitral valve alone occurred in 26 (59%) cases in the form mitral regurgitation, while both aortic and mitral valve regurgitation were present in 11 (25%) cases, and aortic valve regurgitation alone in four (9%) others. Chorea was the only major criterion of ARF in 5 children (6%), while it occurred in association with other major criteria in 12 (15%) others. Nineteen (23%) children had recurrent attacks of ARF. Conclusion ARF continues to occur in Saudi Arabia in the period (1994–2003), despite the progress made in the socio-economic development of the country , and this is often associated with severe cardiac involvement.