title: Sydenham Chorea and PANDAS in South Africa: Review of Evidence and Recommendations for Management in Resource-Poor Countries.
abstract: In South Africa, and worldwide, rheumatic fever represents a public health problem. Improved diagnosis and management of Sydenham chorea, a major manifestation of acute rheumatic fever is key to prevention of rheumatic heart disease. This article reviews Sydenham chorea from its original description to current opinions. Recommendations are founded on expert opinion as class 1 data is lacking. This South African perspective is relevant to resource-poor settings globally insofar as it provides diagnosis and management recommendations for primary- and secondary-level healthcare professionals who care for patients in such environments. Four basic tenets of care are recommended, namely, elimination of the streptococcal infection, symptomatic treatment, immunological treatment, and nonpharmacologic interventions. A user-friendly outcome measurement tool, viable for use in low-resource settings is presented. Introduction of this tool may lead to increased awareness of the neuropsychiatric manifestations of poststreptococcal movement disorders in Africa, where reports are limited.
authors.affiliation: Department of Pediatric Neurology, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa Rheumatic Fever Clinic, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa buley@iafrica.com.
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Walker
authors.affiliation: Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
authors.forename: Petrus J
authors.initials: PJ
authors.lastname: de Vries
authors.affiliation: MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Department of Pediatric Neurology, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Jo M
authors.initials: JM
authors.lastname: Wilmshurst
mesh_terms: D020274:Autoimmune Diseases of the Nervous System / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D002819:Chorea / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D012213:Rheumatic Fever / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D013019:South Africa
keywords: PANDAS; Sydenham chorea; heart; management