title: Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations.
abstract: 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.
authors.affiliation: Department of Paediatric Cardiology, Faculty of Health Sciences, Red Cross War Memorial Childrens Hospital, University of Cape Town, Cape Town, South Africa. liesl.zuhlke@uct.ac.za.|Institute of Child Health, Red Cross War Memorial Childrens Hospital, Room 2.17 2nd floor, Klipfontein Road, Mowbray, Cape Town, 7700, South Africa. liesl.zuhlke@uct.ac.za.|Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. liesl.zuhlke@uct.ac.za.
authors.forename: Liesl J
authors.initials: LJ
authors.lastname: Zühlke
authors.affiliation: Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Beaton
authors.affiliation: Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Engel
authors.affiliation: Department of Paediatric Cardiology, Faculty of Health Sciences, Red Cross War Memorial Childrens Hospital, University of Cape Town, Cape Town, South Africa.|Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Hugo-Hamman
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ganesan
authors.initials: G
authors.lastname: Karthikeyan
authors.affiliation: Telethon Kids Institute, Roberts Road, Subiaco, Perth, Australia.|University of Western Australia, Crawley, Australia.|School of Population Health, University of Western Australia, Crawley, Perth, WA, Australia.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.affiliation: Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Ntobeko
authors.initials: N
authors.lastname: Ntusi
authors.affiliation: Global and Tropical Health, Menzies School of Health Research, Darwin, NT, Australia.|Department of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Ralph
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.|Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium.|Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.|Group A Streptococcus research group, Murdoch Children's Research Institute, Parkville, VIC, Australia.
authors.forename: Pierre R
authors.initials: PR
authors.lastname: Smeesters
authors.affiliation: Department of Paediatric Cardiology, Faculty of Health Sciences, Red Cross War Memorial Childrens Hospital, University of Cape Town, Cape Town, South Africa.|Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Watkins
authors.affiliation: Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, 7925 Obsrvatory, Cape Town, South Africa.|Cardiovasular Research Unit, University of Cape Town, Anzio Road, 7925, Cape Town, South Africa.
authors.forename: Peter
authors.initials: P
authors.lastname: Zilla
authors.affiliation: Telethon Kids Institute, Roberts Road, Subiaco, Perth, Australia.|University of Western Australia, Crawley, Australia.|Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carapetis
keywords: Acute rheumatic fever; Benzathine penicillin; Echocardiography; Global burden of disease; Group A streptococcus; Pathogenesis