Retrospective Study Assessing Compliance of Secondary Prophylaxis in Paediatric Patients at Risk of Recurrent Acute Rheumatic Fever in a Western Australian Metropolitan Hospital Setting

Background Group A streptococcal (GAS) pharyngitis has traditionally been considered the sole precursor of acute rheumatic fever (ARF). Evidence from Australia, however, suggests that GAS skin infections may contribute to the pathogenesis of ARF. A missing piece of evidence is the incidence of sore throat and GAS pharyngitis in this setting. We conducted a systematic review and meta-analysis of the incidence of sore throat and GAS pharyngitis in all children at risk of developing ARF. Methods Databases were systematically searched for studies reporting on the incidence of pharyngitis among children from low to upper-middle income countries, and Indigenous children living in high-income countries. Studies were subjected to data extraction by two independent reviewers. Following an assessment of the methodological quality of the studies, we extracted incidence rates (IRs) and conducted a meta-analysis. This systematic review is registered on PROSPERO (CRD42019113019). Results From 607 titles identified by the search, 11 articles met the predetermined inclusion criteria; ten studies reported IRs while for the remaining study, the incidence was calculated. The pooled incidence estimated for sore throat was 82.5 per 100 child-years (95% confidence interval [CI], 6.5 to 1044.4 per 100 child-years, I2 = 100%) and GAS pharyngitis was 10.8 per 100 child-years (95% CI, 2.3 to 50.0 per 100 child-years, I2 = 99.9%). Conclusions The pooled IRs for sore throat in children at risk of developing ARF were higher than rates reported in developed nations (32.70–40 per 100 child-years) and similar for GAS pharyngitis (12.8–14 per 100 years). The limited Australian data lend support to the need for further studies to inform the role of GAS pharyngitis in the development of ARF in Australian Indigenous children, so as to inform local primary prevention strategies for ARF and Rheumatic Heart Disease (RHD).

Download Full-text

Erythema marginatum: an uncommon presentation of acute rheumatic fever in a Nigerian adolescent girl—a case report

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00068-w ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Barakat Adeola Animasahun ◽

Faith O. Lawani ◽

Moriam Omolola Lamina

Keyword(s):

Case Report ◽

Rheumatic Fever ◽

Acute Rheumatic Fever ◽

Skin Lesions ◽

Secondary Prophylaxis ◽

Pulmonary Artery Hypertension ◽

Mitral Valves ◽

Reticular Pattern ◽

Uncommon Presentation ◽

The Face

Abstract Background Erythema marginatum is an uncommon presentation in children with acute rheumatic fever and it is one of the major criteria needed to make a diagnosis. It is seen in less than 10% of cases. It is also reported to be difficult to detect in black-skinned children. This is the first and only patient to present with the above since the inception of the unit about 14 years ago and also the first to be reported in Nigeria as far as the authors are aware, after a careful literature search; hence, we report this case based on the rarity of this symptom of acute rheumatic fever. Case presentation This is a case report of O.E, a 12-year-old Nigerian girl who presented with features of acute rheumatic fever, and these features included the rare manifestation of erythema marginatum. She presented with generalized skin eruptions on the trunk and extremities, sparing the face, migratory polyarthritis, features of congestive heart failure and high grade continuous fever. The skin lesions consisted of papules, patches, plaques and polycycles with a reticular pattern having serpiginous and raised borders. Diagnostic investigations revealed elevated erythrocyte sedimentation rate of 83mm/h, anti-streptolysin O titer of 2020IU/L and echocardiography which showed thickened mitral valves with grade II mitral regurgitation and a mild pulmonary artery hypertension. The patient was treated with anti-inflammatory and anti-failure drugs and commenced secondary prophylaxis with benzathine penicillin. Skin eruptions resolved within 3 weeks of management and are currently on follow up. Conclusions We present the above to increase awareness on the possibility of acute rheumatic fever presenting with erythema marginatum in our region, to encourage early diagnosis of acute rheumatic fever to reduce morbidity and mortality from its sequel, rheumatic heart disease.

Download Full-text

Adherence to Secondary Prophylaxis Among Patients with Acute Rheumatic Fever and Rheumatic Heart Disease

Current Cardiology Reviews ◽

10.2174/1573403x1503190506120953 ◽

2019 ◽

Vol 15 (3) ◽

pp. 239-241

Author(s):

John A. Woods ◽

Judith M. Katzenellenbogen

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Acute Rheumatic Fever ◽

Secondary Prophylaxis ◽

Rheumatic Heart

Download Full-text

A Biochemical Marker of Preeclampsia - Hypertriglyceridemia - and the Impact of Secondary Prevention Therapy

Revista de Chimie ◽

10.37358/rc.18.10.6616 ◽

2018 ◽

Vol 69 (10) ◽

pp. 2740-2743

Author(s):

Corina Grigoriu ◽

Florentina Furtunescu ◽

Laura Elena Gaman ◽

Alice Lavinia Balaceanu ◽

Ramona Buzatu ◽

...

Keyword(s):

At Risk ◽

Pregnant Women ◽

Secondary Prophylaxis ◽

Control Group ◽

Maternal Complications ◽

Prevention Therapy ◽

Severe Hypertriglyceridemia ◽

Patients At Risk ◽

Anticoagulant Prophylaxis ◽

The Impact

Changes in lipid metabolism from pregnancies with preeclampsia (PE) are a challenge for the obstetrician, because they contribute to the pathological chain and to some specific severe complications (severe hypertriglyceridemia of pregnancy, acute pancreatitis etc). Patients at risk for PE have higher levels of triglycerides, total and LDL cholesterol, compared to normotensive pregnant women. We searched the link between lipidic changes in pregnancies with PE and the way secondary prophylactic treatments with acetylsalicilic acid or low molecular weight heparin (LMWH) can influence the evolution of pregnancy, avoiding the severe complications of this disease. We identified patients at risk of developing PE and then applied a secondary prophylaxis with either a platelet antiaggregant (acetylsalycilic acid - a group of 36 patients) or an anticoagulant prophylaxis with LMWH � enoxaparin (a second group of 37 patients), aiming a decrease of severe complications of PIH/PE. The control group consisted of 33 pregnant women with risk factors for PE, without any secondary prophylaxis, according to actual guidelines. We periodically determined (at 14, 16-20 and 34 weeks of pregnancy) several biochemical parameters: triglycerides, uric acid, free fatty acids, total cholesterol and albuminemia. In the present paper we present the evolution of triglyceridemia in the studied groups, considering hypertriglyceridemia as an important prognostic factor for maternal complications in pregnancy. The most important result of our study is the statistically significant extremely low rate of complications in the treatment groups.

Download Full-text

Penicillin and Acute Rheumatic Fever

PEDIATRICS ◽

10.1542/peds.70.3.506 ◽

1982 ◽

Vol 70 (3) ◽

pp. 506-507

Author(s):

Bernard Boxerbaum

Keyword(s):

Heart Disease ◽

Mitral Regurgitation ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Acute Rheumatic Fever ◽

Secondary Prophylaxis ◽

Benzathine Penicillin ◽

Childrens Hospital ◽

Rheumatic Heart

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4

Download Full-text