Rheumatic Heart Disease
Is Continuum of Care Achievable in Africa?
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Rheumatic heart disease (RHD) is a chronic disease that starts with an infectious episode caused by group A streptococcus (GAS) and progresses to chronic heart valve lesions in 3 stages that markedly differ in terms of presentation, diagnosis, and management. The initial pharingytis is an autolimited infection difficult to differentiate from viral pharyngitis clinically. In susceptible individuals, GAS pharyngitis (or pyodermitis) may progress to rheumatic fever (RF), a systemic autoimmune inflammation affecting the connective tissue with manifestations in the heart, brain, joints, and skin. This is a serious condition that may lead to death because of pancarditis and requires complex management by trained health professionals. Chronic rheumatic valve disease is a complication of RF that is more frequent and aggressive in its mode of progression if the susceptible individual is frequently exposed to GAS infections, thus having repetitive episodes of RF.
See Article by Longenecker et al
The initial decline in RHD incidence began at least partly as a result of improved socioeconomic conditions, with further acceleration in the rate of decline of RF seen after the advent of penicillin.1 However, RHD is a leading cause of premature death and disability in low-income countries, particularly in sub-Saharan Africa,2 because of poverty, overcrowding, and lack of adequate healthcare. Because of the complex pathogenesis and natural history of the disease, effective decrease in the burden of RF and RHD in endemic areas requires multiple interventions; diverse approaches to prevention of RHD should be in place, and interventions need to be available at different stages of the disease. Primary prevention is achievable through adequate treatment of GAS pharingytis with antibiotics at dosages that ensure eradication of GAS from the throat or skin and reduces the transmission of this agent among those susceptible. Once …