Study finds rheumatic fever link

Michael Baker
Michael Baker
University of Otago researchers have made a major breakthrough in further understanding acute rheumatic fever, showing that skin infections are likely to be a significant cause of the disease.

Acute rheumatic fever is an important cause of serious heart disease, particularly for Maori and Pacific children and young people in New Zealand, and for many children and young people in low and middle-income countries.

University department of public health professor Michael Baker said it had long been recognised that rheumatic fever was a complication of group A streptococcus (GAS) pharyngitis, commonly known as strep throat.

However, new research just published in the scientific journal BMJ Global Health indicated that streptococcus skin infections could also trigger the disease.

Prof Baker said the study was a major breakthrough.

"It is the world’s first study to confirm that the risk of rheumatic fever rises after a GAS skin infection in a similar way to how it does after a GAS sore throat.

"Because acute rheumatic fever is an uncommon disease and few countries have comprehensive linked health data, no previous study has been able to quantify the rheumatic fever risk following a laboratory-confirmed infection."

New Zealand has one of the highest rates of rheumatic fever seen in a high-income country, with more than half of all rheumatic fever cases in the Auckland region.

The study used data on almost 1.9million throat and skin swabs processed in the Auckland region over an eight-year period, which were linked to hospitalisation data to identify rheumatic fever cases, as well as prescribing data to identify if cases were dispensed antibiotics.

The risk of rheumatic fever increased five-fold in the eight to 90-day period following collection of both a GAS positive strep throat swab and a GAS positive skin swab (compared with negative swabs).

The focus of rheumatic fever prevention in New Zealand has been largely on diagnosing and treating GAS throat infections.

The study’s findings had huge implications for the prevention of acute rheumatic fever, Prof Baker said.

"While treating GAS sore throats should remain a key strategy in the prevention of rheumatic fever, a new focus should also be placed on addressing GAS skin infections to help reduce the risk of rheumatic fever in New Zealand and internationally."

Dr Julie Bennett, who also worked on the research, said the study team was planning research to build on the findings.

The study also revealed that dispensing a course of oral antibiotics, which was the routine treatment for children following a strep throat diagnosis, was not associated with a reduced risk of developing rheumatic fever.

"This is a worrying finding. It suggests that we need to find more effective ways of treating these infections than the course of oral antibiotics that is currently prescribed,” Dr Bennett said.

 

 

 

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