Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

• Published in: Current treatment options in cardiovascular medicine Vol. 19; no. 2; p. 15
• Main Authors: Zühlke, Liesl J., Beaton, Andrea, Engel, Mark E., Hugo-Hamman, Christopher T., Karthikeyan, Ganesan, Katzenellenbogen, Judith M., Ntusi, Ntobeko, Ralph, Anna P., Saxena, Anita, Smeesters, Pierre R., Watkins, David, Zilla, Peter, Carapetis, Jonathan
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2017; Springer Nature B.V
• Subjects: Age; Antibodies; Arthritis; Cardiology; Cardiovascular disease; Collagen; Developing countries; Epidemics; Epidemiology; Granulomas; Heart; LDCs; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Pathogenesis; Pathophysiology; Proteins; Rheumatic fever; Section Editor; Streptococcus infections; Topical Collection on Valvular Heart Disease; Valvular Heart Disease (J Dal-Bianco; Valvular Heart Disease (J Dal-Bianco, Section Editor); Australia; Africa; Group A streptococcus; Benzathine penicillin; Echocardiography; Acute rheumatic fever; Pathogenesis; Global burden of disease
• ISSN: 1092-8464; 1534-3189
• DOI: 10.1007/s11936-017-0513-y

Opinion statement Early recognition of group A streptococcal pharyngitis and appropriate management with benzathine penicillin using local clinical prediction rules together with validated rapi-strep testing when available should be incorporated in primary health care. A directed approach to the differential diagnosis of acute rheumatic fever now includes the concept of low-risk versus medium-to-high risk populations. Initiation of secondary prophylaxis and the establishment of early medium to long-term care plans is a key aspect of the management of ARF. It is a requirement to identify high-risk individuals with RHD such as those with heart failure, pregnant women, and those with severe disease and multiple valve involvement. As penicillin is the mainstay of primary and secondary prevention, further research into penicillin supply chains, alternate preparations and modes of delivery is required.