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* Performing your original search, new trends and issues about rheumatic fever and rheumatic heart disease, in PMC will retrieve 219 records. Clin Epidemiol. 2011; 3: 67–84.
Published online 2011 February 22. doi: 10.2147/CLEP.S12977 PMCID: PMC3046187
The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease Michael D Seckeler and Tracey R Hoke
Author information ► Article notes ► Copyright and License information ► This article has been cited by other articles in PMC.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns around the world. Despite decreasing incidence, there is still a significant disease burden, especially in developing nations. This review provides background on the history of ARF, its pathology and treatment, and the current reported worldwide incidence of ARF and prevalence of RHD. Keywords: rheumatic fever, rheumatic heart disease, group A streptococcus, epidemiology Go to:
Acute rheumatic fever (ARF) is a postinfectious, nonsuppurative sequela of pharyngeal infection with Streptococcus pyogenes, or Group A β hemolytic Streptococcus (GABHS). Of the associated symptoms, only damage to the valve tissue within the heart, or rheumatic heart disease (RHD), can become a chronic condition leading to congestive heart failure, strokes, endocarditis, and death. While the incidence and prevalence of ARF and RHD have been decreasing in developed nations since the early 1900s, they continue to be major causes of morbidity and mortality among young people in developing nations. It is estimated that there are over 15 million cases of RHD worldwide, with 282,000 new cases and 233,000 deaths annually.1 More recent data using echocardiography to screen for RHD in developing nations have lead to a marked increase in the recognized prevalence in these regions.2–6 With these new data, there has been an increased awareness and interest in ARF and RHD, which stimulated this review of the literature to provide information on the pathogenesis, diagnosis, and treatment for ARF and RHD, and an updated estimate of the worldwide incidence and prevalence. Go to:
Although physicians in Europe had been describing clinical components of ARF since the 1500s, it was William Charles Wells’ seminal publication in 1812 that definitively linked ARF with carditis.7 The entire clinical spectrum of ARF (from tonsillitis to carditis) was first described by Cheadle in 1889.8 The infectious etiology of ARF was long suspected, especially given the seasonal variation in outbreaks, and in 1900 Poynton and Paine described a diplococcus isolated from patients with ARF, which they implicated as a causal organism for the disease.9 Micrococcus (or Streptococcus) rheumaticus was isolated from a patient with ARF in 1904, and was noted to be “indistinguishable from strains of Streptococcus pyogenes”.10 Into the 1930s, theories implicating viruses as causal agents for ARF surfaced,11 and are still being investigated today.12,13 Go to:
An extensive literature search for any articles about “acute rheumatic fever” or “rheumatic heart disease” was performed in August 2010 using PubMed. Articles reporting data of the incidence of ARF or prevalence of RHD were reviewed. In order to maximize the available information, non-English language articles were included if it was possible to obtain an English translation of either the abstract or the entire article. To generate...