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Murray R, Mowat R, Foster MJ, Blamires J. Nursing practices to optimise rheumatic fever prevention in a high-risk country: An integrative review. J Clin Nurs 2024; 33:2905-2921. [PMID: 38549261 DOI: 10.1111/jocn.17141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND New Zealand is one of the last high-income countries in the world experiencing significant rates of rheumatic fever. Nurses play a crucial role in rheumatic fever prevention; however, little is understood as to how nurses can best achieve this. AIM To explore nursing practices that optimise rheumatic fever prevention. DESIGN An integrative review. METHODS Four electronic databases (CINAHL, SCOPUS, Medline via, and Ovid) were searched for peer-reviewed empirical articles published from 2013 to 2023. Grey literature (guidelines/reports) was also sourced. Critical appraisal was applied using the Mixed-Methods Appraisal Tools and the Joanna Briggs Critical Appraisal checklist. Qualitative Research in Psychology, 3(2), 77-101, thematic analysis method was used to generate themes. RESULTS Seven research articles and three national reports were included. Four themes-in-depth nursing knowledge and improving prophylaxis adherence, cultural competency, and therapeutic nurse-patient relationships-were found. CONCLUSION While nursing knowledge and ways to improve injection adherence are essential, being culturally receptive and developing therapeutic relationships are equally important. Without strong and trusting relationships, it is difficult to deliver care required for prevention success. IMPLICATIONS TO CARE When working with vulnerable populations it is important to be culturally receptive in all interactions with patients and their families. IMPACT New Zealand has high rates of rheumatic fever, especially among vulnerable populations such as Pacific Islanders and Māori. Nurses are often frontline primary care providers who, when skilled with the right tools, can help reduce the prevalence of this disease. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow chart. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution was required for this research.
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Affiliation(s)
- Ruby Murray
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Mowat
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Mandie Jane Foster
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Julie Blamires
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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2
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Asif M, Yousuf MH, Farooqui US, Nashwan AJ, Ullah I. Cutaneous signs of selected cardiovascular disorders: A narrative review. Open Med (Wars) 2024; 19:20240897. [PMID: 38463529 PMCID: PMC10921438 DOI: 10.1515/med-2024-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 03/12/2024] Open
Abstract
Cardiovascular diseases are the leading cause of mortality and morbidity globally. Clinicians must know cutaneous signs of cardiovascular disease, including petechiae, macules, purpura, lentigines, and rashes. Although cutaneous manifestations of diseases like infectious endocarditis and acute rheumatic fever are well established, there is an indispensable need to evaluate other important cardiovascular diseases accompanied by cutaneous signs. Moreover, discussing the latest management strategies in this regard is equally imperative. This review discusses distinctive skin findings that help narrow the diagnosis of cardiovascular diseases and recommendations on appropriate treatment.
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Affiliation(s)
- Marium Asif
- Faculty of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Irfan Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Kabir Medical College, Gandhara University, Peshawar, Pakistan
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3
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Maaloul I, Bouzidi N, Kolsi R, Ameur SB, Abid L, Aloulou H, Kamoun T. [Rheumatic cardiopathies and its risk factors: about 50 cases]. Ann Cardiol Angeiol (Paris) 2024; 73:101676. [PMID: 37988890 DOI: 10.1016/j.ancard.2023.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/07/2023] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Acute rheumatic fever (ARF) is a multi-systemic disease, in which cardiac involvement is the most serious major manifestation of disease. The aim of this study was to analyse cardiac involvement in children with ARF and his risk factors. MATERIALS AND METHODS It were a retrospective study including all children under the age of 14 years who were hospitalized for ARF in the pediatric department of the CHU Hédi Chaker of Sfax, during a period of twelve years (2010-2022). RESULTS We collected 50 cases (31 boys and 19 girls). Twenty-two patients (44%) developed cardiac lesions. The mean age at diagnosis was 9.6 years [5-14 years]. A pathological heart murmur was detected in 14 cases (n = 14/22) was classified as mild carditis in 15 cases, moderate carditis in 5 cases and severe in 2 cases. The median follow-up time was 3,3 years. Nineteen patients developed valvular sequelae Risk factors of cardiac lesions was: age more than 8 years, heart murmur, allonged PR, CRP > 100 mg/l and VS > 100 mm. CONCLUSION CR is still a public health problem in Tunisia. It is a serious pathology that can cause serious increases in morbidity rates. Thus, we must strengthen preventive strategies.
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Affiliation(s)
- Ines Maaloul
- Service de pédiatrie, CHU Hédi Chaker. Sfax. Tunisie.
| | - Nihed Bouzidi
- Service de pédiatrie, CHU Hédi Chaker. Sfax. Tunisie
| | - Roeya Kolsi
- Service de pédiatrie, CHU Hédi Chaker. Sfax. Tunisie
| | | | - Leila Abid
- Service de cardiologie.CHU Hédi Chaker. Sfax. Tunisie
| | - Hajer Aloulou
- Service de pédiatrie, CHU Hédi Chaker. Sfax. Tunisie
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Baker MG, Masterson MY, Shung-King M, Beaton A, Bowen AC, Bansal GP, Carapetis JR. Research priorities for the primordial prevention of acute rheumatic fever and rheumatic heart disease by modifying the social determinants of health. BMJ Glob Health 2023; 8:e012467. [PMID: 37914185 PMCID: PMC10619085 DOI: 10.1136/bmjgh-2023-012467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/09/2023] [Indexed: 11/03/2023] Open
Abstract
The social determinants of health (SDH), such as access to income, education, housing and healthcare, strongly shape the occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) at the household, community and national levels. The SDH are systemic factors that privilege some more than others and result in poverty and inequitable access to resources to support health and well-being. Primordial prevention is the modification of SDH to improve health and reduce the risk of disease acquisition and the subsequent progression to RHD. Modifying these determinants using primordial prevention strategies can reduce the risk of exposure to Group A Streptococcus, a causative agent of throat and skin infections, thereby lowering the risk of initiating ARF and its subsequent progression to RHD.This report summarises the findings of the Primordial Prevention Working Group-SDH, which was convened in November 2021 by the National Heart, Lung, and Blood Institute to assess how SDH influence the risk of developing RHD. Working group members identified a series of knowledge gaps and proposed research priorities, while recognising that community engagement and partnerships with those with lived experience will be integral to the success of these activities. Specifically, members emphasised the need for: (1) global analysis of disease incidence, prevalence and SDH characteristics concurrently to inform policy and interventions, (2) global assessment of legacy primordial prevention programmes to help inform the co-design of interventions alongside affected communities, (3) research to develop, implement and evaluate scalable primordial prevention interventions in diverse settings and (4) research to improve access to and equity of services across the RHD continuum. Addressing SDH, through the implementation of primordial prevention strategies, could have broader implications, not only improving RHD-related health outcomes but also impacting other neglected diseases in low-resource settings.
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Affiliation(s)
- Michael G Baker
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Mary Y Masterson
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Maylene Shung-King
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Andrea Beaton
- Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Geetha P Bansal
- HIV Research and Training Program, John E Fogarty International Center, Bethesda, Maryland, USA
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
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5
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de Loizaga SR, Pulle J, Rwebembera J, Abrams J, Atala J, Chesnut E, Danforth K, Fall N, Felicelli N, Lapthorn K, Longenecker CT, Minja NW, Moore RA, Morrison R, Mwangi J, Nakagaayi D, Nakitto M, Sable C, Sanyahumbi A, Sarnacki R, Thembo J, Vincente SL, Watkins D, Zühlke L, Okello E, Beaton A, Dexheimer JW. Development and User Testing of a Dynamic Tool for Rheumatic Heart Disease Management. Appl Clin Inform 2023; 14:866-877. [PMID: 37914157 PMCID: PMC10620041 DOI: 10.1055/s-0043-1774812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/08/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Most rheumatic heart disease (RHD) registries are static and centralized, collecting epidemiological and clinical data without providing tools to improve care. We developed a dynamic cloud-based RHD case management application with the goal of improving care for patients with RHD in Uganda. METHODS The Active Community Case Management Tool (ACT) was designed to improve community-based case management for chronic disease, with RHD as the first test case. Global and local partner consultation informed selection of critical data fields and prioritization of application functionality. Multiple stages of review and revision culminated in user testing of the application at the Uganda Heart Institute. RESULTS Global and local partners provided feedback of the application via survey and interview. The application was well received, and top considerations included avenues to import existing patient data, considering a minimum data entry form, and performing a situation assessment to tailor ACT to the health system setup for each new country. Test users completed a postuse survey. Responses were favorable regarding ease of use, desire to use the application in regular practice, and ability of the application to improve RHD care in Uganda. Concerns included appropriate technical skills and supports and potential disruption of workflow. CONCLUSION Creating the ACT application was a dynamic process, incorporating iterative feedback from local and global partners. Results of the user testing will help refine and optimize the application. The ACT application showed potential for utility and integration into existing care models in Uganda.
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Affiliation(s)
- Sarah R. de Loizaga
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Jafesi Pulle
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | - Jessica Abrams
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Reach, Cape Town, South Africa
| | - Jenifer Atala
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Emily Chesnut
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Kristen Danforth
- Department of Global Health & Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Ndate Fall
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Nicholas Felicelli
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Karen Lapthorn
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Chris T. Longenecker
- Department of Global Health & Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Neema W. Minja
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Ryan A. Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Riley Morrison
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | | | - Miriam Nakitto
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Craig Sable
- Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, United States
| | - Amy Sanyahumbi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, United States
| | - Rachel Sarnacki
- Department of Cardiology, Children's National Medical Center, Washington, District of Columbia, United States
| | | | | | - David Watkins
- Department of Global Health & Division of Cardiology, University of Washington, Seattle, Washington, United States
| | - Liesl Zühlke
- Division of Cardiology and Paediatric Cardiology, Department of Medicine/Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | - Andrea Beaton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
| | - Judith W. Dexheimer
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
- Division of Emergency Medicine and Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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Karageorgos S, Hibberd O, Mullally PJW, Segura-Retana R, Soyer S, Hall D. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Antibiotics (Basel) 2023; 12:1092. [PMID: 37508188 PMCID: PMC10376281 DOI: 10.3390/antibiotics12071092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Antibiotics are one of the most prescribed medications in pediatric emergency departments. Antimicrobial stewardship programs assist in the reduction of antibiotic use in pediatric patients. However, the establishment of antimicrobial stewardship programs in pediatric EDs remains challenging. Recent studies provide evidence that common infectious diseases treated in the pediatric ED, including acute otitis media, tonsillitis, community-acquired pneumonia, preseptal cellulitis, and urinary-tract infections, can be treated with shorter antibiotic courses. Moreover, there is still controversy regarding the actual need for antibiotic treatment and the optimal dosing scheme for each infection.
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Affiliation(s)
- Spyridon Karageorgos
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- First Department of Pediatrics, Aghia Sophia Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Owen Hibberd
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Patrick Joseph William Mullally
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Department of Medicine, Cardiff University, Cardiff CF10 3AT, UK
| | - Roberto Segura-Retana
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Pediatric Emergency Department, Hospital Nacional de Niños, San José 0221, Costa Rica
| | - Shenelle Soyer
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
| | - Dani Hall
- Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London E1 2AT, UK; (S.K.)
- Department of Emergency Medicine, Children’s Health Ireland at Crumlin, D12 N512 Dublin, Ireland
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7
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Nisa S, Vallee E, Marshall J, Collins-Emerson J, Yeung P, Prinsen G, Douwes J, Baker MG, Wright J, Quin T, Holdaway M, Wilkinson DA, Fayaz A, Littlejohn S, Benschop J. Leptospirosis in Aotearoa New Zealand: Protocol for a Nationwide Case-Control Study. JMIR Res Protoc 2023; 12:e47900. [PMID: 37289491 DOI: 10.2196/47900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND In Aotearoa New Zealand, 90% of patients with notified leptospirosis (a zoonotic bacterial disease) have been men working in agricultural industries. However, since 2008, the epidemiology of notified cases has been gradually changing, that is, more women are affected; there are more cases associated with occupations traditionally not considered high risk in New Zealand; infecting serovars have changed; and many patients experience symptoms long after infection. We hypothesized that there is a shift in leptospirosis transmission patterns with substantial burden on affected patients and their families. OBJECTIVE In this paper, we aimed to describe the protocols used to conduct a nationwide case-control study to update leptospirosis risk factors and follow-up studies to assess the burden and sources of leptospirosis in New Zealand. METHODS This study used a mixed methods approach, comprising a case-control study and 4 substudies that involved cases only. Cases were recruited nationwide, and controls were frequency matched by sex and rurality. All participants were administered a case-control questionnaire (study 1), with cases being interviewed again at least 6 months after the initial survey (study 2). A subset of cases from two high-risk populations, that is, farmers and abattoir workers, were further engaged in a semistructured interview (study 3). Some cases with regular animal exposure had their in-contact animals (livestock for blood and urine and wildlife for kidney) and environment (soil, mud, and water) sampled (study 4). Patients from selected health clinics suspected of leptospirosis also had blood and urine samples collected (study 5). In studies 4 and 5, blood samples were tested using the microscopic agglutination test to test for antibody titers against Leptospira serovars Hardjo type bovis, Ballum, Tarassovi, Pomona, and Copenhageni. Blood, urine, and environmental samples were also tested for pathogenic Leptospira DNA using polymerase chain reaction. RESULTS Participants were recruited between July 22, 2019, and January 31, 2022, and data collection for the study has concluded. In total, 95 cases (July 25, 2019, to April 13, 2022) and 300 controls (October 19, 2019, to January 26, 2022) were interviewed for the case-control study; 91 cases participated in the follow-up interviews (July 9, 2020, to October 25, 2022); 13 cases participated in the semistructured interviews (January 26, 2021, to January 19, 2022); and 4 cases had their in-contact animals and environments sampled (October 28, 2020, and July 29, 2021). Data analysis for study 3 has concluded and 2 manuscripts have been drafted for review. Results of the other studies are being analyzed and the specific results of each study will be published as individual manuscripts.. CONCLUSIONS The methods used in this study may provide a basis for future epidemiological studies of infectious diseases. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47900.
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Affiliation(s)
- Shahista Nisa
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Emilie Vallee
- EpiCentre, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Jonathan Marshall
- School of Mathematical and Computational Sciences, Massey University, Palmerston North, New Zealand
| | - Julie Collins-Emerson
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Polly Yeung
- School of Social Work, Massey University, Palmerston North, New Zealand
| | - Gerard Prinsen
- School of People, Environment and Planning, Massey University, Palmerston North, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jackie Wright
- Enteric and Leptospira Reference Laboratory, Institute of Environmental Science and Research, Christchurch, New Zealand
| | - Tanya Quin
- Goodfellow Unit, University of Auckland, Auckland, New Zealand
| | - Maureen Holdaway
- College of Health, Massey University, Palmerston North, New Zealand
| | - David A Wilkinson
- Unité Mixte de Recherche, Animal, Santé, Territoires, Risques et Ecosystèmes, Centre de coopération internationale en recherche agronomique pour le développement, Institut national de la recherche agronomique, University of Montpellier, Plateforme Technologique Cyclotron Réunion Océan Indien, Sainte-Clotilde, La Réunion, France
| | - Ahmed Fayaz
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Stuart Littlejohn
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Jackie Benschop
- Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
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8
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Humayun MB, Khalid S, Khalid H, Zahoor W, Malik WT. Post-COVID-19 Encephalitis With Claustrum Sign Responsive to Immunomodulation. Cureus 2023; 15:e35363. [PMID: 36974244 PMCID: PMC10039761 DOI: 10.7759/cureus.35363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
We describe a case of encephalitis following coronavirus disease 2019 (COVID-19) in a six-and-a-half-year-old girl who presented with acute onset confusion and jerky movements of the limbs. The patient was unvaccinated for COVID-19. Subsequent magnetic resonance imaging revealed a bilateral "claustrum sign" on T2 and fluid-attenuated inversion recovery (FLAIR) images and electroencephalogram reported moderate diffuse encephalopathy. The patient tested negative for COVID-19 by polymerase chain reaction, had positive serology for COVID-19 indicating past infection, and had a negative autoimmune panel and infectious workup. She was treated on the lines of post-infectious encephalitis with immunomodulatory therapies such as high-dose intravenous steroids and intravenous immunoglobulins. She responded significantly and had complete resolution of her symptoms; therefore, further supporting the suspicion of an immune-mediated etiology. Cases of post-COVID-19 encephalitis have been reported all over the world; however, most cases are based on speculation and temporal associations and therefore more research is required to optimize treatment guidelines.
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Hu Y, Tong Z, Huang X, Qin JJ, Lin L, Lei F, Wang W, Liu W, Sun T, Cai J, She ZG, Li H. The projections of global and regional rheumatic heart disease burden from 2020 to 2030. Front Cardiovasc Med 2022; 9:941917. [PMID: 36330016 PMCID: PMC9622772 DOI: 10.3389/fcvm.2022.941917] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Rheumatic heart disease (RHD) remains the leading cause of preventable death and disability in children and young adults, killing an estimated 320,000 individuals worldwide yearly. Materials and methods We utilized the Bayesian age-period cohort (BAPC) model to project the change in disease burden from 2020 to 2030 using the data from the Global Burden of Disease (GBD) Study 2019. Then we described the projected epidemiological characteristics of RHD by region, sex, and age. Results The global age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) of RHD increased from 1990 to 2019, and ASPR will increase to 559.88 per 100,000 population by 2030. The global age-standardized mortality rate (ASMR) of RHD will continue declining, while the projected death cases will increase. Furthermore, ASPR and cases of RHD-associated HF will continue rising, and there will be 2,922,840 heart failure (HF) cases in 2030 globally. Female subjects will still be the dominant population compared to male subjects, and the ASPR of RHD and the ASPR of RHD-associated HF in female subjects will continue to increase from 2020 to 2030. Young people will have the highest ASPR of RHD among all age groups globally, while the elderly will bear a greater death and HF burden. Conclusion In the following decade, the RHD burden will remain severe. There are large variations in the trend of RHD burden by region, sex, and age. Targeted and effective strategies are needed for the management of RHD, particularly in female subjects and young people in developing regions.
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Affiliation(s)
- Yingying Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Zijia Tong
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- Huanggang Institute of Translational Medicine, Huanggang, China
| | - Xuewei Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Fang Lei
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Wenxin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Weifang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
- *Correspondence: Hongliang Li,
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
- Zhi-Gang She,
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Zhi Y, Chen X, Cao G, Chen F, Seo HS, Li F. The effects of air pollutants exposure on the transmission and severity of invasive infection caused by an opportunistic pathogen Streptococcus pyogenes. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 310:119826. [PMID: 35932897 DOI: 10.1016/j.envpol.2022.119826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Currently, urbanization is associated with an increase in air pollutants that contribute to invasive pathogen infections by altering the host's innate immunity and antimicrobial resistance capability. Streptococcus pyogenes, also known as Group A Streptococcus (GAS), is a gram-positive opportunistic pathogen that causes a wide range of diseases, especially in children and immunosuppressed individuals. Diesel exhaust particle (DEP), a significant constituent of particulate matter (PM), are considered a prominent risk factor for respiratory illness and circulatory diseases worldwide. Several clinical and epidemiological studies have identified a close association between PM and the prevalence of viral and bacterial infections. This study investigated the role of DEP exposure in increasing pulmonary and blood bacterial counts and mortality during GAS M1 strain infection in mice. Thus, we characterized the upregulation of reactive oxygen species production and disruption of tight junctions in the A549 lung epithelial cell line due to DEP exposure, leading to the upregulation of GAS adhesion and invasion. Furthermore, DEP exposure altered the leukocyte components of infiltrated cells in bronchoalveolar lavage fluid, as determined by Diff-Quik staining. The results highlighted the DEP-related macrophage dysfunction, neutrophil impairment, and imbalance in pro-inflammatory cytokine production via the toll-like receptor 4/mitogen-activated protein kinase signaling axis. Notably, the tolerance of the GAS biofilms toward potent antibiotics and bacterial resistance against environmental stresses was also significantly enhanced by DEP. This study aimed to provide a better understanding of the physiological and molecular interactions between exposure to invasive air pollutants and susceptibility to invasive GAS infections.
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Affiliation(s)
- Yong Zhi
- Department of Obstetrics and Gynecology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xinyu Chen
- Inhalation Toxicology Center for Airborne Risk Factor, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup, Jeollabuk-do, 56212, Republic of Korea; Department of Human and Environmental Toxicology, University of Science & Technology, Daejeon, 34113, Republic of Korea
| | - Guangxu Cao
- Department of Obstetrics and Gynecology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Fengjia Chen
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, 56212, Jeollabuk-do, Republic of Korea
| | - Ho Seong Seo
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, 56212, Jeollabuk-do, Republic of Korea; Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon, Republic of Korea
| | - Fang Li
- Department of Obstetrics and Gynecology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Baker MG, Gurney J, Moreland NJ, Bennett J, Oliver J, Williamson DA, Pierse N, Wilson N, Merriman TR, Percival T, Jackson C, Edwards R, Mow FC, Thomson WM, Zhang J, Lennon D. Risk factors for acute rheumatic fever: A case-control study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100508. [PMID: 36213134 PMCID: PMC9535428 DOI: 10.1016/j.lanwpc.2022.100508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain an inequitable cause of avoidable suffering and early death in many countries, including among Indigenous Māori and Pacific populations in New Zealand. There is a lack of robust evidence on interventions to prevent ARF. This study aimed to identify modifiable risk factors, with the goal of producing evidence to support policies and programs to decrease rates of ARF. METHODS A case-control study was undertaken in New Zealand using hospitalised, first episode ARF cases meeting a standard case-definition. Population controls (ratio of 3:1) were matched by age, ethnicity, socioeconomic deprivation, location, sex, and recruitment month. A comprehensive, pre-tested questionnaire was administered face-to-face by trained interviewers. FINDINGS The study included 124 cases and 372 controls. Multivariable analysis identified strong associations between ARF and household crowding (OR 3·88; 95%CI 1·68-8·98) and barriers to accessing primary health care (OR 2·07; 95% CI 1·08-4·00), as well as a high intake of sugar-sweetened beverages (OR 2·00; 1·13-3·54). There was a marked five-fold higher ARF risk for those with a family history of ARF (OR 4·97; 95% CI 2·53-9·77). ARF risk was elevated following self-reported skin infection (aOR 2·53; 1·44-4·42) and sore throat (aOR 2·33; 1·49-3·62). INTERPRETATION These globally relevant findings direct attention to the critical importance of household crowding and access to primary health care as strong modifiable causal factors in the development of ARF. They also support a greater focus on the role of managing skin infections in ARF prevention. FUNDING This research was funded by the Health Research Council of New Zealand (HRC) Rheumatic Fever Research Partnership (supported by the New Zealand Ministry of Health, Te Puni Kōkiri, Cure Kids, Heart Foundation, and HRC) award number 13/959.
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Affiliation(s)
- Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J. Moreland
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jane Oliver
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Victoria, Australia
| | - Deborah A. Williamson
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nigel Wilson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland, New Zealand
- Green Lane Paediatric and Congenital Cardiac Services, Auckland, New Zealand
| | - Tony R. Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, United States of America
| | - Teuila Percival
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | | | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | | | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Lennon
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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12
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Bennett J, Moreland NJ, Zhang J, Crane J, Sika-Paotonu D, Carapetis J, Williamson DA, Baker MG. Risk factors for group A streptococcal pharyngitis and skin infections: A case control study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100507. [PMID: 35789826 PMCID: PMC9250036 DOI: 10.1016/j.lanwpc.2022.100507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Group A streptococcal (GAS) infections can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). The role of social and environmental risk factors for GAS pharyngitis and skin infections are not well understood. This study aimed to identify factors associated with GAS pharyngitis and skin infections, and to determine if these are the same as those for ARF. Methods A case-control study, including 733 children aged 5-14 years, was undertaken between March 2018 and October 2019 in Auckland, New Zealand. Healthy controls (n = 190) and symptomatic cases including GAS pharyngitis (n = 210), GAS seronegative carriers (n = 182), and GAS skin infections (n = 151) were recruited. Trained interviewers administered a comprehensive, pre-tested, face-to-face questionnaire. Findings Multivariable analysis identified strong associations between barriers to accessing primary healthcare and having GAS pharyngitis (adjusted OR 3·3; 95% CI 1·8-6·0), GAS carriage (aOR 2·9; 95% CI 1·5-6·0) or a GAS skin infection (aOR 3·5; 95% CI 1·6-7·6). Children who had GAS skin infections were more likely than all other groups to report living in a crowded home (aOR 1·9; 95% CI 1·0-3·4), have Māori or Pacific grandparents (aOR 3·0; 95% CI 1·2-7·6), a family history of ARF (aOR 2·2; 95% CI 1·1-4·3), or having a previous diagnosis of eczema (aOR 3·9; 95% CI 2·2-6·9). Interpretation Reducing barriers to accessing primary healthcare (including financial restrictions, the inability to book an appointment, lack of transport, and lack of childcare for other children) to treat GAS pharyngitis and skin infections could potentially reduce these infections and lead to a reduction in their sequelae, including ARF. These strategies should be co-designed and culturally appropriate for the communities being served and carefully evaluated. Funding This work was supported by the Health Research Council of New Zealand (HRC), award number 16/005.
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Affiliation(s)
- Julie Bennett
- Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand
| | - Nicole J. Moreland
- School of Medical Sciences, the University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- Maurice Wilkins Centre, the University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Jane Zhang
- Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology and Molecular Medicine, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand
| | - Jonathan Carapetis
- Telethon Kids Institute, 15 Hospital Ave, Nedlands, Perth, 6009, Western Australia
- Centre for Child Health and Research, University of Western Australia, 35 Stirling Hwy, Crawley, Perth 6009, Western Australia
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, Perth, 6009, Western Australia
| | - Deborah A. Williamson
- Department of Infectious Disease, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3004, Australia
| | - Michael G. Baker
- Department of Public Health, University of Otago, 23A Mein Street, Newtown, Wellington 6021, New Zealand
- Maurice Wilkins Centre, the University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Williams AN, Tyrrell GJ. ARF risk factors: Beyond a sore throat. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100545. [PMID: 35875692 PMCID: PMC9301566 DOI: 10.1016/j.lanwpc.2022.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ashley N. Williams
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Gregory J. Tyrrell
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories, Public Health-Alberta Health Services, Edmonton, AB, Canada
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada
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14
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Rentta NN, Bennett J, Leung W, Webb R, Jack S, Harwood M, Baker MG, Lund M, Wilson N. Medical Treatment for Rheumatic Heart Disease: A Narrative Review. Heart Lung Circ 2022; 31:1463-1470. [PMID: 35987720 DOI: 10.1016/j.hlc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD. METHODS Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards. RESULTS Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis. CONCLUSION As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD.
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Affiliation(s)
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - William Leung
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Rachel Webb
- Auckland District Health Board, Auckland, New Zealand; University of Auckland, Department of Paediatrics: Child and Youth Health, Auckland, New Zealand
| | - Susan Jack
- Public Health South, Southern District Health Board, Dunedin, New Zealand
| | - Matire Harwood
- General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mayanna Lund
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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15
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Ricciardo BM, Kessaris HL, Kumarasinghe SP, Carapetis JR, Bowen AC. The burden of bacterial skin infection, scabies and atopic dermatitis among urban-living Indigenous children in high-income countries: a protocol for a systematic review. Syst Rev 2022; 11:159. [PMID: 35945624 PMCID: PMC9361683 DOI: 10.1186/s13643-022-02038-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Bacterial skin infections and scabies disproportionately affect children in resource-poor countries as well as underprivileged children in high-income countries. Atopic dermatitis is a common childhood dermatosis that predisposes to bacterial skin infection. In Australia, at any one time, almost half of all Aboriginal and Torres Strait Islander children living remotely will have impetigo, and up to one-third will also have scabies. Yet, there is a gap in knowledge of the skin infection burden for urban-living Australian Aboriginal and Torres Strait Islander children, as well as atopic dermatitis which may be a contributing factor. The objective of this study is to provide a global background on the burden of these disorders in Indigenous urban-living children in high-income countries. These countries share a similar history of colonisation, dispossession and subsequent ongoing negative impacts on Indigenous people. METHODS This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols statement. Observational studies reporting incidence and/or prevalence data on bacterial skin infection, scabies and/or atopic dermatitis in urban-living Indigenous children in high-income countries will be included. Literature searches will be conducted in several international electronic databases (from 1990 onwards), including MEDLINE, Embase, EmCare, Web of Science and PubMed. Reference lists and citation records of all included articles will be scanned for additional relevant manuscripts. Two investigators will independently perform eligibility assessment of titles, abstract and full-text manuscripts, following which both investigators will independently extract data. Where there is disagreement, the senior author will determine eligibility. The methodological quality of selected studies will be appraised using an appropriate tool. Data will be tabulated and narratively synthesised. We expect there will be insufficient data to perform meta-analysis. DISCUSSION This study will identify and evaluate epidemiological data on bacterial skin infection, scabies and atopic dermatitis in urban-living Indigenous children in high-income countries. Where available, the clinical features, risk factors, comorbidities and complications of these common childhood skin disorders will be described. The evidence will highlight the burden of disease in this population, to contribute to global burden of disease estimates and identify gaps in the current literature to provide direction for future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021277288.
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Affiliation(s)
- Bernadette M Ricciardo
- University of Western Australia, Crawley, Western Australia, Australia. .,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia. .,Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
| | | | | | - Jonathan R Carapetis
- University of Western Australia, Crawley, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Asha C Bowen
- University of Western Australia, Crawley, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
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16
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Tu'akoi S, Ofanoa M, Ofanoa S, Lutui H, Heather M, Jansen RM, van der Werf B, Goodyear-Smith F. Co-designing an intervention to prevent rheumatic fever in Pacific People in South Auckland: a study protocol. Int J Equity Health 2022; 21:101. [PMID: 35864550 PMCID: PMC9302560 DOI: 10.1186/s12939-022-01701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Rheumatic fever is an autoimmune condition that occurs in response to an untreated Group A Streptococcus throat or skin infection. Recurrent episodes of rheumatic fever can cause permanent damage to heart valves, heart failure and even death. Māori and Pacific people in Aotearoa New Zealand experience some of the highest rates globally, with Pacific children 80 times more likely to be hospitalised for rheumatic fever and Māori children 36 times more likely than non-Māori, non-Pacific children. Community members from the Pacific People’s Health Advisory Group, research officers from the Pacific Practice-Based Research Network and University of Auckland researchers identified key health priorities within the South Auckland community that needed to be addressed, one of which was rheumatic fever. The study outlined in this protocol aims to co-design, implement, and evaluate a novel intervention to reduce rheumatic fever rates for Pacific communities in South Auckland. Methods This participatory mixed-methods study utilises the Fa’afaletui method and follows a three-phase approach. Phase 1 comprises a quantitative analysis of the rheumatic fever burden within Auckland and across New Zealand over the last five years, including sub-analyses by ethnicity. Phase 2 will include co-design workshops with Pacific community members, families affected by rheumatic fever, health professionals, and other stakeholders in order to develop a novel intervention to reduce rheumatic fever in South Auckland. Phase 3 comprises the implementation and evaluation of the intervention. Discussion This study aims to reduce the inequitable rheumatic fever burden faced by Pacific communities in South Auckland via a community-based participatory research approach. The final intervention may guide approaches in other settings or regions that also experience high rates of rheumatic fever. Additionally, Māori have the second-highest incidence rates of rheumatic fever of all ethnic groups, thus community-led approaches ‘by Māori for Māori’ are also necessary. Trial registration The Australian New Zealand Clinical Trial Registry has approved the proposed study: ACTRN12622000565741 and ACTRN12622000572763. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01701-9.
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Affiliation(s)
- Siobhan Tu'akoi
- Pacific Health Section, Faculty of Medical and Health Sciences, University of Auckland, PB 92019, Auckland, 1142, New Zealand.
| | - Malakai Ofanoa
- Pacific Health Section, Faculty of Medical and Health Sciences, University of Auckland, PB 92019, Auckland, 1142, New Zealand
| | - Samuela Ofanoa
- Pacific Health Section, Faculty of Medical and Health Sciences, University of Auckland, PB 92019, Auckland, 1142, New Zealand
| | - Hinamaha Lutui
- Alliance Health Plus, Mount Wellington, Auckland, New Zealand
| | - Maryann Heather
- Pacific Health Section, Faculty of Medical and Health Sciences, University of Auckland, PB 92019, Auckland, 1142, New Zealand
| | | | - Bert van der Werf
- Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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Acute Rheumatic Fever and Rheumatic Heart Disease: Highlighting the Role of Group A Streptococcus in the Global Burden of Cardiovascular Disease. Pathogens 2022; 11:pathogens11050496. [PMID: 35631018 PMCID: PMC9145486 DOI: 10.3390/pathogens11050496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Group A Streptococcus (GAS) causes superficial and invasive infections and immune mediated post-infectious sequalae (including acute rheumatic fever/rheumatic heart disease). Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are important determinants of global cardiovascular morbidity and mortality. ARF is a multiorgan inflammatory disease that is triggered by GAS infection that activates the innate immune system. In susceptible hosts the response against GAS elicits autoimmune reactions targeting the heart, joints, brain, skin, and subcutaneous tissue. Repeated episodes of ARF—undetected, subclinical, or diagnosed—may progressively lead to RHD, unless prevented by periodic administration of penicillin. The recently modified Duckett Jones criteria with stratification by population risk remains relevant for the diagnosis of ARF and includes subclinical carditis detected by echocardiography as a major criterion. Chronic RHD is defined by valve regurgitation and/or stenosis that presents with complications such as arrhythmias, systemic embolism, infective endocarditis, pulmonary hypertension, heart failure, and death. RHD predominantly affects children, adolescents, and young adults in LMICs. National programs with compulsory notification of ARF/RHD are needed to highlight the role of GAS in the global burden of cardiovascular disease and to allow prioritisation of these diseases aimed at reducing health inequalities and to achieve universal health coverage.
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Rwebembera J, Nascimento BR, Minja NW, de Loizaga S, Aliku T, dos Santos LPA, Galdino BF, Corte LS, Silva VR, Chang AY, Dutra WO, Nunes MCP, Beaton AZ. Recent Advances in the Rheumatic Fever and Rheumatic Heart Disease Continuum. Pathogens 2022; 11:179. [PMID: 35215123 PMCID: PMC8878614 DOI: 10.3390/pathogens11020179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from the developed world, the disease remains endemic in many low- and middle-income countries (LMICs), with grim health and socioeconomic impacts. The neglect of RHD which persisted for a semi-centennial was further driven by competing infectious diseases, particularly the human immunodeficiency virus (HIV) pandemic. However, over the last two-decades, slowly at first but with building momentum, there has been a resurgence of interest in RF/RHD. In this narrative review, we present the advances that have been made in the RF/RHD continuum over the past two decades since the re-awakening of interest, with a more concise focus on the last decade's achievements. Such primary advances include understanding the genetic predisposition to RHD, group A Streptococcus (GAS) vaccine development, and improved diagnostic strategies for GAS pharyngitis. Echocardiographic screening for RHD has been a major advance which has unearthed the prevailing high burden of RHD and the recent demonstration of benefit of secondary antibiotic prophylaxis on halting progression of latent RHD is a major step forward. Multiple befitting advances in tertiary management of RHD have also been realized. Finally, we summarize the research gaps and provide illumination on profitable future directions towards global eradication of RHD.
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Affiliation(s)
- Joselyn Rwebembera
- Department of Adult Cardiology (JR), Uganda Heart Institute, Kampala 37392, Uganda
| | - Bruno Ramos Nascimento
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
- Servico de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaude, Hospital das Clinicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, 1st Floor, Belo Horizonte 30130-100, MG, Brazil
| | - Neema W. Minja
- Rheumatic Heart Disease Research Collaborative in Uganda, Uganda Heart Institute, Kampala 37392, Uganda;
| | - Sarah de Loizaga
- School of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA; (S.d.L.); (A.Z.B.)
| | - Twalib Aliku
- Department of Paediatric Cardiology (TA), Uganda Heart Institute, Kampala 37392, Uganda;
| | - Luiza Pereira Afonso dos Santos
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Bruno Fernandes Galdino
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Luiza Silame Corte
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Vicente Rezende Silva
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
| | - Andrew Young Chang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Walderez Ornelas Dutra
- Laboratory of Cell-Cell Interactions, Institute of Biological Sciences, Department of Morphology, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- National Institute of Science and Technology in Tropical Diseases (INCT-DT), Salvador 40170-970, BA, Brazil
| | - Maria Carmo Pereira Nunes
- Departamento de Clinica Medica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.R.N.); (L.P.A.d.S.); (B.F.G.); (L.S.C.); (V.R.S.); (M.C.P.N.)
- Servico de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaude, Hospital das Clinicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, 1st Floor, Belo Horizonte 30130-100, MG, Brazil
| | - Andrea Zawacki Beaton
- School of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA; (S.d.L.); (A.Z.B.)
- Cincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, OH 45229, USA
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Wegener A, Holm AE, Gomes LC, Lima KO, Kaagaard MD, Matos LO, Vieira IVM, de Souza RM, Marinho CRF, Nascimento BR, Biering-Sørensen T, Silvestre OM, Brainin P. Prevalence of rheumatic heart disease in adults from the Brazilian Amazon Basin. Int J Cardiol 2022; 352:115-122. [PMID: 35065154 DOI: 10.1016/j.ijcard.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/04/2022] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) continues to be a burden in low- and middle-income countries and prevalence estimates are lacking from South America. We aimed to determine the prevalence of RHD in the Brazilian Amazon Basin. METHODS We examined a random sample of adults (≥18 years) from the general population, who underwent echocardiographic image acquisition by a medical doctor. All images were analyzed according to (i) the 2012 World Heart Federation criteria and (ii) a simplified algorithm for RHD from a previously validated risk score (categories: low-, medium-, high-risk) which involved assessment of the mitral valve (leaflet thickening and excessive motion, regurgitation jet length) and aortic valve (thickening and any regurgitation). RESULTS A total of 488 adults were screened (mean age 40 ± 15 years, 38% men). The prevalence of RHD was 39/1000 adults (n = 17 definite and n = 2 borderline). Fourteen (74%) had pathological mitral regurgitation, four (21%) mitral stenosis, 0 (0%) pathological aortic regurgitation and six (32%) both mitral and aortic valve disease. None had a prior diagnosis of RHD, 10 (53%) had positive cardiac auscultation and two (11%) reported a history of rheumatic fever. The simplified algorithm identified four (21%) adults as low-risk, six (32%) as intermediate, and nine (47%) as high-risk. CONCLUSIONS The prevalence of RHD was 39/1000 in adults from the Brazilian Amazon Basin, indicating the need for screening programs in remote areas. A simplified model was only able to categorize every second case of RHD as high-risk. External validation of simplified screening models to increase feasibility in clinical practice are encouraged.
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Affiliation(s)
- Alma Wegener
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Anna Engell Holm
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Laura C Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Molly D Kaagaard
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Bruno R Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Departamento de Clínica Médica Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark; Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
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20
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Zahari N, Yeoh SL, Muniandy SR, Mat Bah MN. Pediatric Rheumatic Heart Disease in a Middle-Income Country: A Population-Based Study. J Trop Pediatr 2022; 68:6515782. [PMID: 35084036 DOI: 10.1093/tropej/fmac005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Rheumatic heart disease (RHD), a debilitating complication from rheumatic fever, remains a problem in low- and middle-income countries. This study describes the incidence, prevalence, modifiable risk factors for severe RHD and immediate outcome of pediatric RHD. METHODS This population-based and observational cohort study reviewed pediatric RHD patients (0-18 years) from the Sabah Pediatric Rheumatic Heart Registry from 2015 till 2018. RESULTS A total of 188 RHD were reviewed with 120 new cases. The incidence of RHD is 2.19 [95% confidence interval (CI): 1.83-2.61] per 100 000 population, with a rising trend over time. Meanwhile, the prevalence of RHD was 13.78 (95% CI: 11.92-15.86) per 100 000 pediatric population. The majority of patients were from indigenous groups (59.0%), male (56.4%) with a mean age of 14.3 (3.31) years. About 77.9% had the lowest household income, and a significant proportion lived in overcrowded conditions. At diagnosis, 59% were diagnosed with severe RHD. There is heightened risk but no statistical significance between modifiable factors (low weight and height percentile at diagnosis, lowest income group, renting a house, overcrowding and healthcare access of more than 5 km) with severe RHD. Severe RHD is significantly associated with risk for intervention (p = 0.016). Sixteen (13.8%) patients required surgical intervention. About 97.6% of patients were on intramuscular benzathine penicillin G with 84.5% compliance. CONCLUSION The rising prevalence and incidence of pediatric RHD in Sabah, with the most being severe RHD at diagnosis, necessitates the development of an echocardiographic screening and a comprehensive national disease program.
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Affiliation(s)
- Norazah Zahari
- Department of Pediatrics, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia
| | - Si Ling Yeoh
- Department of Pediatrics, Hospital Queen Elizabeth II, 88300 Kota Kinabalu, Malaysia
| | - Siva Rao Muniandy
- Department of Pediatrics, Hospital Queen Elizabeth II, 88300 Kota Kinabalu, Malaysia
| | - Mohd Nizam Mat Bah
- Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, 80000 Johor Bahru, Malaysia
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21
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Whitcombe AL, McGregor R, Bennett J, Gurney JK, Williamson DA, Baker MG, Moreland NJ. OUP accepted manuscript. J Infect Dis 2022; 226:167-176. [PMID: 35134931 PMCID: PMC9373162 DOI: 10.1093/infdis/jiac043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Group A Streptococcus (GAS) causes superficial pharyngitis and skin infections as well as serious autoimmune sequelae such as acute rheumatic fever (ARF) and subsequent rheumatic heart disease. ARF pathogenesis remains poorly understood. Immune priming by repeated GAS infections is thought to trigger ARF, and there is growing evidence for the role of skin infections in this process. Methods We utilized our recently developed 8-plex immunoassay, comprising antigens used in clinical serology for diagnosis of ARF (SLO, DNase B, SpnA), and 5 conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD, Group A carbohydrate), to characterize antibody responses in sera from New Zealand children with a range of clinically diagnosed GAS disease: ARF (n = 79), GAS-positive pharyngitis (n = 94), GAS-positive skin infection (n = 51), and matched healthy controls (n = 90). Results The magnitude and breadth of antibodies in ARF was very high, giving rise to a distinct serological profile. An average of 6.5 antigen-specific reactivities per individual was observed in ARF, compared to 4.2 in skin infections and 3.3 in pharyngitis. Conclusions ARF patients have a unique serological profile, which may be the result of repeated precursor pharyngitis and skin infections that progressively boost antibody breadth and magnitude.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah A Williamson
- University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- Correspondence: Nicole J. Moreland, BSc, PhD, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand ()
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22
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Lorenz N, Ho TKC, McGregor R, Davies MR, Williamson DA, Gurney JK, Smeesters PR, Baker MG, Moreland NJ. Serological Profiling of Group A Streptococcus Infections in Acute Rheumatic Fever. Clin Infect Dis 2021; 73:2322-2325. [PMID: 33639619 DOI: 10.1093/cid/ciab180] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/28/2023] Open
Abstract
Rheumatic fever is a serious post-infectious sequela of group A Streptococcus (GAS). Prior GAS exposures were mapped in sera using a large panel of M-type specific peptides. Rheumatic fever patients had serological evidence of significantly more GAS exposures than matched controls suggesting immune priming by repeat infections contributes to pathogenesis.
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Affiliation(s)
- Natalie Lorenz
- School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
| | - Timothy K C Ho
- School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
| | - Mark R Davies
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael G Baker
- Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand.,Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
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23
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Brusco NK, Oliver J, McMinn A, Steer A, Crawford N. The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia. BMC Health Serv Res 2021; 21:1340. [PMID: 34906126 PMCID: PMC8670128 DOI: 10.1186/s12913-021-07265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/27/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. AIM To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective. METHODS A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children's Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed. RESULTS Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0-4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11-2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0-4 years (62%). CONCLUSION As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted. TRIAL REGISTRATION The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.
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Affiliation(s)
- Natasha K Brusco
- Alpha Crucis Group, Health Economics, Langwarrin, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, Frankston, Australia
- College of Science Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Jane Oliver
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Alissa McMinn
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Andrew Steer
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Crawford
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
- Murdoch Children's Research Institute and Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
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Oliver J, Bennett J, Thomas S, Zhang J, Pierse N, Moreland NJ, Williamson DA, Jack S, Baker M. Preceding group A streptococcus skin and throat infections are individually associated with acute rheumatic fever: evidence from New Zealand. BMJ Glob Health 2021; 6:bmjgh-2021-007038. [PMID: 34887304 PMCID: PMC8663084 DOI: 10.1136/bmjgh-2021-007038] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Acute rheumatic fever (ARF) is usually considered a consequence of group A streptococcus (GAS) pharyngitis, with GAS skin infections not considered a major trigger. The aim was to quantify the risk of ARF following a GAS-positive skin or throat swab. Methods This retrospective analysis used pre-existing administrative data. Throat and skin swab data (1 866 981 swabs) from the Auckland region, New Zealand and antibiotic dispensing data were used (2010–2017). Incident ARF cases were identified using hospitalisation data (2010–2018). The risk ratio (RR) of ARF following swab collection was estimated across selected features and timeframes. Antibiotic dispensing data were linked to investigate whether this altered ARF risk following GAS detection. Results ARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8–90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1). Conclusions A GAS-positive throat or skin swab is strongly associated with subsequent ARF, particularly for Māori and Pacific Peoples. This study provides the first population-level evidence that GAS skin infection can trigger ARF.
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Affiliation(s)
- Jane Oliver
- The Peter Doherty Institute for Infection and Immunity, Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Bennett
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Sally Thomas
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jane Zhang
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nicole J Moreland
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Deborah A Williamson
- The Peter Doherty Institute for Infection and Immunity, Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Jack
- Southern District Health Board, Dunedin, Otago, New Zealand
| | - Michael Baker
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Almadhi AA, Alshammri MR, Altamimi NO, Hadal SA, Al Madhi AA, Salahie MS. Rheumatic Fever and Rheumatic Heart Disease-Related Knowledge, Attitude, and Practice in Saudi Arabia. Cureus 2021; 13:e19997. [PMID: 34987891 PMCID: PMC8716120 DOI: 10.7759/cureus.19997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives Rheumatic fever (RF) is an inflammatory disorder caused by group A streptococcal pharyngitis infections that can progress to rheumatic heart disease (RHD). Public awareness and knowledge of this condition are crucial for its prevention. This study aimed to assess the knowledge and attitudes regarding these disorders to identify the factors influencing the level of knowledge and to determine how to increase awareness and knowledge of rheumatic fever and rheumatic heart disease. Methods An observational, cross-sectional study was conducted using a self-administered questionnaire distributed to 1211 participants throughout Saudi Arabia using an online platform. The questionnaire collected data on sociodemographic characteristics, levels of awareness, knowledge of rheumatic fever along with rheumatic heart disease, and attitudes toward these diseases. Results A total of 1121 participants met the criteria for the study and completed the questionnaire (77.5% female vs. 22.5% male). The most common age group was 18 to 30 years old (30.5%). The lack of knowledge was most common among the younger age group (≤ 40 years) and males. Knowledge of rheumatic fever was assessed as poor, fair, and good among 80.2%, 16.2%, and 3.6% of participants, respectively. A good knowledge level was more common among the older age group (> 40 years) and those who had four to seven children. Poor, fair, and good attitude levels were expressed by 41.7%, 32.6%, and 25.8% of participants, respectively. Poor attitudes toward rheumatic fever and rheumatic heart disease were more common among those living in the Central region. Conclusion While the attitudes toward rheumatic fever and rheumatic heart disease seem adequate, significant deficiencies in the knowledge and awareness of these disorders were observed in the study population. Insufficient knowledge was primarily seen among young male participants.
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Abstract
PURPOSE OF REVIEW Rheumatic heart disease (RHD) is a neglected disease of poverty, which presents challenges for patients, communities, and health systems. These effects are magnified in low resource countries, which bear the highest disease burden. When considering the impact of RHD, it is imperative that we widen our lens in order to better understand how RHD impacts the over 40 million people currently living with this preventable condition and their communities. We aimed to perform an updated literature review on the global impact of RHD, examining a broad range of aspects from disease burden to impact on healthcare system to socioeconomic implications. RECENT FINDINGS RHD accounts for 1.6% of all cardiovascular deaths, resulting in 306,000 deaths yearly, with a much higher contribution in low- and middle-income countries, where 82% of the deaths occurred in 2015. RHD can result in severe health adverse outcomes, markedly heart failure, arrhythmias, stroke and embolisms, and ultimately premature death. Thus, preventive, diagnostic and therapeutic interventions are required, although insufficiently available in undersourced settings. As examples, anticoagulation management is poor in endemic regions - and novel oral anticoagulants cannot be recommended - and less than 15% of those in need have access to interventional procedures and valve replacement in Africa. RHD global impact remains high and unequally distributed, with a marked impact on lower resourced populations. This preventable disease negatively affects not only patients, but also the societies and health systems within which they live, presenting broad challenges and high costs along the pathway of prevention, diagnosis, and management.
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de Loizaga SR, Beaton AZ, Nascimento BR, Macedo FVB, Spolaor BCM, de Pádua LB, Ribeiro TFS, Oliveira GCF, Oliveira LR, de Almeida LFR, Moura TD, de Barros TT, Sable C, Nunes MCP. Diagnosing rheumatic heart disease: where are we now and what are the challenges? Expert Rev Cardiovasc Ther 2021; 19:777-786. [PMID: 34424119 DOI: 10.1080/14779072.2021.1970531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), affects 40.5 million people worldwide. The burden of disease disproportionately falls on low- and middle-income countries (LMIC) and sub-populations within high-income countries (HIC). Advances have been made in earlier detection of RHD, though several barriers to ideal management persist. AREAS COVERED This article reviews the current burden of RHD, highlighting the disparate impact of disease. It also reviews the clinical and echocardiographic presentation of RHD, as some may present in late stages of disease with associated complications. Finally, we review the advances which have been made in echocardiographic screening to detect latent RHD, highlighting the challenges which remain regarding secondary prophylaxis management and uncertainty of best practices for treatment of latent RHD. EXPERT OPINION Advances in technology and validation of portable echocardiography have made screening and identifying latent RHD feasible in the most burdened regions. However, uncertainty remains around best management of those with latent RHD and best methods to ensure ideal secondary prophylaxis for RHD. Research regarding latent RHD management, as well as continued work on innovative solutions (such as group A streptococcal vaccine), are promising as efforts to improve outcomes of this preventable disease persist.
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Affiliation(s)
- Sarah R de Loizaga
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrea Z Beaton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,University of Cincinnati School of Medicine, Cincinnati, Oh, United States
| | - Bruno R Nascimento
- Hospital das Clínicas da Ufmg, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Mg, Brazil
| | | | | | - Lucas Bretas de Pádua
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Lucas Rocha Oliveira
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Craig Sable
- Children's National Hospital, Washington, DC, USA
| | - Maria Carmo Pereira Nunes
- Hospital das Clínicas da Ufmg, Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Mg, Brazil
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de Loizaga SR, Arthur L, Arya B, Beckman B, Belay W, Brokamp C, Hyun Choi N, Connolly S, Dasgupta S, Dibert T, Dryer MM, Gokanapudy Hahn LR, Greene EA, Kernizan D, Khalid O, Klein J, Kobayashi R, Lahiri S, Lorenzoni RP, Otero Luna A, Marshall J, Millette T, Moore L, Muhamed B, Murali M, Parikh K, Sanyahumbi A, Shakti D, Stein E, Shah S, Wilkins H, Windom M, Wirth S, Zimmerman M, Beck AF, Ollberding N, Sable C, Beaton A. Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review. J Am Heart Assoc 2021; 10:e020992. [PMID: 34348475 PMCID: PMC8475057 DOI: 10.1161/jaha.120.020992] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty‐two US pediatric institutions participated in a 10‐year review (2008–2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract‐based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non‐White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline‐based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.
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Affiliation(s)
| | - Lindsay Arthur
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | - Bhawna Arya
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Wubishet Belay
- Monroe Carell Jr Children's Hospital at Vanderbilt Nashville TN
| | - Cole Brokamp
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nak Hyun Choi
- Morgan Stanley Children's Hospital of New York PresbyterianColumbia University Medical Center New York NY
| | - Sean Connolly
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Soham Dasgupta
- Children's Healthcare of AtlantaEmory University Atlanta GA
| | - Tavenner Dibert
- University of Florida Health, Shands Children's Hospital Gainesville FL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elizabeth Stein
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Hannah Wilkins
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | | | - Scott Wirth
- Cincinnati Children's Hospital Medical Center Cincinnati OH
| | | | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nicholas Ollberding
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | | | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
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McGregor R, Tay ML, Carlton LH, Hanson-Manful P, Raynes JM, Forsyth WO, Brewster DT, Middleditch MJ, Bennett J, Martin WJ, Wilson N, Atatoa Carr P, Baker MG, Moreland NJ. Mapping Autoantibodies in Children With Acute Rheumatic Fever. Front Immunol 2021; 12:702877. [PMID: 34335616 PMCID: PMC8320770 DOI: 10.3389/fimmu.2021.702877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/02/2021] [Indexed: 01/16/2023] Open
Abstract
Background Acute rheumatic fever (ARF) is a serious sequela of Group A Streptococcus (GAS) infection associated with significant global mortality. Pathogenesis remains poorly understood, with the current prevailing hypothesis based on molecular mimicry and the notion that antibodies generated in response to GAS infection cross-react with cardiac proteins such as myosin. Contemporary investigations of the broader autoantibody response in ARF are needed to both inform pathogenesis models and identify new biomarkers for the disease. Methods This study has utilised a multi-platform approach to profile circulating autoantibodies in ARF. Sera from patients with ARF, matched healthy controls and patients with uncomplicated GAS pharyngitis were initially analysed for autoreactivity using high content protein arrays (Protoarray, 9000 autoantigens), and further explored using a second protein array platform (HuProt Array, 16,000 autoantigens) and 2-D gel electrophoresis of heart tissue combined with mass spectrometry. Selected autoantigens were orthogonally validated using conventional immunoassays with sera from an ARF case-control study (n=79 cases and n=89 matched healthy controls) and a related study of GAS pharyngitis (n=39) conducted in New Zealand. Results Global analysis of the protein array data showed an increase in total autoantigen reactivity in ARF patients compared with controls, as well as marked heterogeneity in the autoantibody profiles between ARF patients. Autoantigens previously implicated in ARF pathogenesis, such as myosin and collagens were detected, as were novel candidates. Disease pathway analysis revealed several autoantigens within pathways linked to arthritic and myocardial disease. Orthogonal validation of three novel autoantigens (PTPN2, DMD and ANXA6) showed significant elevation of serum antibodies in ARF (p < 0.05), and further highlighted heterogeneity with patients reactive to different combinations of the three antigens. Conclusions The broad yet heterogenous elevation of autoantibodies observed suggests epitope spreading, and an expansion of the autoantibody repertoire, likely plays a key role in ARF pathogenesis and disease progression. Multiple autoantigens may be needed as diagnostic biomarkers to capture this heterogeneity.
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Affiliation(s)
- Reuben McGregor
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Mei Lin Tay
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Lauren H. Carlton
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Jeremy M. Raynes
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Wasan O. Forsyth
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | | | | | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - William John Martin
- Science for Technological Innovation Science Challenge, Callaghan Innovation, Wellington, New Zealand
| | - Nigel Wilson
- Starship Children’s Hospital, Auckland, New Zealand
| | - Polly Atatoa Carr
- Waikato District Health Board and Waikato University, Hamilton, New Zealand
| | - Michael G. Baker
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J. Moreland
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
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Oliver J, Robertson O, Zhang J, Marsters BL, Sika-Paotonu D, Jack S, Bennett J, Williamson DA, Wilson N, Pierse N, Baker MG. Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989-2015. Emerg Infect Dis 2021; 27. [PMID: 34153221 PMCID: PMC8237904 DOI: 10.3201/eid2707.203045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated outcomes for patients born after 1983 and hospitalized with initial acute rheumatic fever (ARF) in New Zealand during 1989-2012. We linked ARF progression outcome data (recurrent hospitalization for ARF, hospitalization for rheumatic heart disease [RHD], and death from circulatory causes) for 1989-2015. Retrospective analysis identified initial RHD patients <40 years of age who were hospitalized during 2010-2015 and previously hospitalized for ARF. Most (86.4%) of the 2,182 initial ARF patients did not experience disease progression by the end of 2015. Progression probability after 26.8 years of theoretical follow-up was 24.0%; probability of death, 1.0%. Progression was more rapid and ≈2 times more likely for indigenous Māori or Pacific Islander patients. Of 435 initial RHD patients, 82.2% had not been previously hospitalized for ARF. This young cohort demonstrated low mortality rates but considerable illness, especially among underserved populations. A national patient register could help monitor, prevent, and reduce ARF progression.
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31
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Pilapitiya DH, Harris PWR, Hanson-Manful P, McGregor R, Kowalczyk R, Raynes JM, Carlton LH, Dobson RCJ, Baker MG, Brimble M, Lukomski S, Moreland NJ. Antibody responses to collagen peptides and streptococcal collagen-like 1 proteins in acute rheumatic fever patients. Pathog Dis 2021; 79:6311134. [PMID: 34185083 DOI: 10.1093/femspd/ftab033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/26/2021] [Indexed: 11/13/2022] Open
Abstract
Acute rheumatic fever (ARF) is a serious post-infectious immune sequelae of Group A streptococcus (GAS). Pathogenesis remains poorly understood, including the events associated with collagen autoantibody generation. GAS express streptococcal collagen-like proteins (Scl) that contain a collagenous domain resembling human collagen. Here, the relationship between antibody reactivity to GAS Scl proteins and human collagen in ARF was investigated. Serum IgG specific for a representative Scl protein (Scl1.1) together with collagen-I and collagen-IV mimetic peptides were quantified in ARF patients (n = 36) and healthy matched controls (n = 36). Reactivity to Scl1.1 was significantly elevated in ARF compared to controls (P < 0.0001) and this was mapped to the collagen-like region of the protein, rather than the N-terminal non-collagenous region. Reactivity to collagen-1 and collagen-IV peptides was also significantly elevated in ARF cases (P < 0.001). However, there was no correlation between Scl1.1 and collagen peptide antibody binding, and hierarchical clustering of ARF cases by IgG reactivity showed two distinct clusters, with Scl1.1 antigens in one and collagen peptides in the other, demonstrating that collagen autoantibodies are not immunologically related to those targeting Scl1.1. Thus, anti-collagen antibodies in ARF appear to be generated as part of the autoreactivity process, independent of any mimicry with GAS collagen-like proteins.
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Affiliation(s)
- Devaki H Pilapitiya
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Paul W R Harris
- School of Chemical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand.,School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Paulina Hanson-Manful
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Renata Kowalczyk
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Jeremy M Raynes
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Lauren H Carlton
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Renwick C J Dobson
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand.,Biomolecular Interaction Centre and School of Biological Sciences, University of Canterbury, Christchurch, New Zealand.,Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Michael G Baker
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand.,Department of Public Health, University of Otago, Wellington, New Zealand
| | - Margaret Brimble
- School of Chemical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Slawomir Lukomski
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
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32
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Oliver J, Upton A, Jack SJ, Pierse N, Williamson DA, Baker MG. Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010-2016. Emerg Infect Dis 2021; 26:1113-1121. [PMID: 32441618 PMCID: PMC7258449 DOI: 10.3201/eid2606.181462] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Group A Streptococcus (GAS) pharyngitis is a key initiator of acute rheumatic fever (ARF). In New Zealand, ARF cases occur more frequently among persons of certain ethnic and socioeconomic groups. We compared GAS pharyngitis estimates (1,257,058 throat swab samples) with ARF incidence (792 hospitalizations) in Auckland during 2010–2016. Among children 5–14 years of age in primary healthcare clinics, GAS pharyngitis was detected in similar proportions across ethnic groups (≈19%). Relative risk for GAS pharyngitis was moderately elevated among children of Pacific Islander and Māori ethnicities compared with those of European/other ethnicities, but risk for ARF was highly elevated for children of Pacific Islander and Māori ethnicity compared with those of European/other ethnicity. That ethnic disparities are much higher among children with ARF than among those with GAS pharyngitis implies that ARF is driven by factors other than rate of GAS pharyngitis alone.
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33
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Wyber R, Wade V, Anderson A, Schreiber Y, Saginur R, Brown A, Carapetis J. Rheumatic heart disease in Indigenous young peoples. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:437-446. [PMID: 33705693 DOI: 10.1016/s2352-4642(20)30308-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 01/17/2023]
Abstract
Indigenous children and young peoples live with an inequitable burden of acute rheumatic fever and rheumatic heart disease. In this Review, we focus on the epidemiological burden and lived experience of these conditions for Indigenous young peoples in Australia, New Zealand, and Canada. We outline the direct and indirect drivers of rheumatic heart disease risk and their mitigation. Specifically, we identify the opportunities and limitations of predominantly biomedical approaches to the primary, secondary, and tertiary prevention of disease among Indigenous peoples. We explain why these biomedical approaches must be coupled with decolonising approaches to address the underlying cause of disease. Initiatives underway to reduce acute rheumatic fever and rheumatic heart disease in Australia, New Zealand, and Canada are reviewed to identify how an Indigenous rights-based approach could contribute to elimination of rheumatic heart disease and global disease control goals.
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Affiliation(s)
- Rosemary Wyber
- The George Institute for Global Health, Newtown, NSW, Australia.
| | - Vicki Wade
- RHDAustralia, Menzies School of Health Research, Darwin, NT, Australia
| | - Anneka Anderson
- Tomaiora Research Group, University of Auckland, Auckland, New Zealand
| | - Yoko Schreiber
- Section of Infectious Diseases, University of Manitoba, Clinical Sciences Division, Northern Ontario School of Medicine, ON, Canada
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, University of Adelaide, SA, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Perth, WA, Australia
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Abstract
During the 1920s, acute rheumatic fever (ARF) was the leading cause of mortality in children in the United States. By the 1980s, many felt ARF had all but disappeared from the US. However, although ARF and rheumatic heart disease (RHD) rates remain low in the US today, disease burden is unequal and tracks along other disparities of cardiovascular health. It is estimated that 1% to 3% of patients with untreated group A streptococcus (GAS) infection, most typically GAS pharyngitis, will develop ARF, and of these, up to 60% of cases will result in chronic RHD. This article reviews the epidemiology, pathogenesis, diagnosis, and management of ARF/RHD to increase awareness of ARF/RHD for clinicians based in the US. [Pediatr Ann. 2021;50(3):e98-e104.].
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Avire NJ, Whiley H, Ross K. A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control. Pathogens 2021; 10:248. [PMID: 33671684 PMCID: PMC7926438 DOI: 10.3390/pathogens10020248] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 01/10/2023] Open
Abstract
Streptococcus pyogenes, (colloquially named "group A streptococcus" (GAS)), is a pathogen of public health significance, infecting 18.1 million people worldwide and resulting in 500,000 deaths each year. This review identified published articles on the risk factors and public health prevention and control strategies for mitigating GAS diseases. The pathogen causing GAS diseases is commonly transmitted via respiratory droplets, touching skin sores caused by GAS or through contact with contaminated material or equipment. Foodborne transmission is also possible, although there is need for further research to quantify this route of infection. It was found that GAS diseases are highly prevalent in developing countries, and among indigenous populations and low socioeconomic areas in developed countries. Children, the immunocompromised and the elderly are at the greatest risk of S. pyogenes infections and the associated sequelae, with transmission rates being higher in schools, kindergartens, hospitals and residential care homes. This was attributed to overcrowding and the higher level of social contact in these settings. Prevention and control measures should target the improvement of living conditions, and personal and hand hygiene. Adherence to infection prevention and control practices should be emphasized in high-risk settings. Resource distribution by governments, especially in developed countries, should also be considered.
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Affiliation(s)
| | | | - Kirstin Ross
- Environmental Health, College of Science and Engineering, Flinders University, Adelaide 5001, Australia; (N.J.A.); (H.W.)
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36
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Robertson O, Nathan K, Howden-Chapman P, Baker MG, Atatoa Carr P, Pierse N. Residential mobility for a national cohort of New Zealand-born children by area socioeconomic deprivation level and ethnic group. BMJ Open 2021; 11:e039706. [PMID: 33419901 PMCID: PMC7799129 DOI: 10.1136/bmjopen-2020-039706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aims of this study are to describe area deprivation levels and changes that occur during residential moves involving New Zealand children from birth to their fourth birthday, and to assess whether these changes vary by ethnicity. DESIGN Longitudinal administrative data. SETTING Children born in New Zealand from 2004 to 2018. PARTICIPANTS All (565 689) children born in New Zealand with at least one recorded residential move. OUTCOME MEASURES A longitudinal data set was created containing lifetime address histories for our cohort. This was linked to the New Zealand Deprivation Index, a measure of small area deprivation. Counts of moves from each deprivation level to each other deprivation level were used to construct transition matrices. RESULTS Children most commonly moved to an area with the same level of deprivation. This was especially pronounced in the most and least deprived areas. The number of moves observed also increased with deprivation. Māori and Pasifika children were less likely to move to, or remain in low-deprivation areas, and more likely to move to high-deprivation areas. They also had disproportionately high numbers of moves. CONCLUSION While there was evidence of mobility between deprivation levels, the most common outcome of a move was no change in area deprivation. The most deprived areas had the highest number of moves. Māori and Pasifika children were over-represented in high-deprivation areas and under-represented in low-deprivation areas. They also moved more frequently than the overall population of 0 to 3 year olds.
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Affiliation(s)
- Oliver Robertson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Kim Nathan
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | | | - Polly Atatoa Carr
- National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
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37
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Bennett J, Zhang J, Leung W, Jack S, Oliver J, Webb R, Wilson N, Sika-Paotonu D, Harwood M, Baker MG. Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000-2018. Emerg Infect Dis 2021; 27. [PMID: 33350929 PMCID: PMC7774562 DOI: 10.3201/eid2701.191791] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000-2018 and RHD mortality rates during 2000-2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0-14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9-27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9-3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2-5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3-14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1-13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities.
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38
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Dooley LM, Ahmad TB, Pandey M, Good MF, Kotiw M. Rheumatic heart disease: A review of the current status of global research activity. Autoimmun Rev 2020; 20:102740. [PMID: 33333234 DOI: 10.1016/j.autrev.2020.102740] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 01/17/2023]
Abstract
Rheumatic heart disease (RHD) is a serious and long-term consequence of acute rheumatic fever (ARF), an autoimmune sequela of a mucosal infection by Streptococcus pyogenes (Group A Streptococcus, Strep A). The pathogenesis of ARF and RHD is complex and not fully understood but involves host and bacterial factors, molecular mimicry, and aberrant host innate and adaptive immune responses that result in loss of self-tolerance and subsequent cross-reactivity with host tissues. RHD is entirely preventable yet claims an estimated 320 000 lives annually. The major burden of disease is carried by developing nations and Indigenous populations within developed nations, including Australia. This review will focus on the epidemiology, pathogenesis and treatment of ARF and RHD in Australia, where: streptococcal pyoderma, rather than streptococcal pharyngitis, and Group C and Group G Streptococcus, have been implicated as antecedents to ARF; the rates of RHD in remote Indigenous communities are persistently among the highest in the world; government register-based programs coordinate disease screening and delivery of prophylaxis with variable success; and researchers are making significant progress in the development of a broad-spectrum vaccine against Strep A.
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Affiliation(s)
- Leanne M Dooley
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Tarek B Ahmad
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Michael Kotiw
- School of Health and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia; Institute for Life Sciences and the Environment, University of Southern Queensland, Toowoomba, Queensland, Australia.
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39
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Shah S, Danda D, Kavadichanda C, Das S, Adarsh MB, Negi VS. Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS-CoV-2 infection and its treatment. Rheumatol Int 2020; 40:1539-1554. [PMID: 32666137 PMCID: PMC7360125 DOI: 10.1007/s00296-020-04639-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic is likely to pose new challenges to the rheumatology community in the near and distant future. Some of the challenges, like the severity of COVID-19 among patients on immunosuppressive agents, are predictable and are being evaluated with great care and effort across the globe. A few others, such as atypical manifestations of COVID-19 mimicking rheumatic musculoskeletal diseases (RMDs) are being reported. Like in many other viral infections, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can potentially lead to an array of rheumatological and autoimmune manifestations by molecular mimicry (cross-reacting epitope between the virus and the host), bystander killing (virus-specific CD8 + T cells migrating to the target tissues and exerting cytotoxicity), epitope spreading, viral persistence (polyclonal activation due to the constant presence of viral antigens driving immune-mediated injury) and formation of neutrophil extracellular traps. In addition, the myriad of antiviral drugs presently being tried in the treatment of COVID-19 can result in several rheumatic musculoskeletal adverse effects. In this review, we have addressed the possible spectrum and mechanisms of various autoimmune and rheumatic musculoskeletal manifestations that can be precipitated by COVID-19 infection, its therapy, and the preventive strategies to contain the infection.
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Affiliation(s)
- Sanket Shah
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Saibal Das
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - M. B. Adarsh
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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40
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Buonsenso D, Riitano F, Valentini P. Pediatric Inflammatory Multisystem Syndrome Temporally Related With SARS-CoV-2: Immunological Similarities With Acute Rheumatic Fever and Toxic Shock Syndrome. Front Pediatr 2020; 8:574. [PMID: 33042918 PMCID: PMC7516715 DOI: 10.3389/fped.2020.00574] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022] Open
Abstract
Several studies demonstrated that COVID-19 in children is a relatively mild disease. However, recently a more serious condition characterized by systemic inflammation with clinical or microbiological evidence of exposure to SARS-CoV-2 has been described. This syndrome is now known as either "Pediatric Inflammatory Multisystem Syndrome temporally related with COVID-19" (PIMS-TS) (1), or Multisystem Inflammatory Syndrome in Children (MIS-C) (2) and is currently considered a rare post-COVID-19 complication which, in a minority of cases, can lead to death. The signs and symptoms of PIMS-TS are largely overlapping with the for Kawasaki disease (KD) and toxic shock syndrome (TSS) and are characterized, by fever, systemic inflammation, abdominal pain and cardiac involvement. In this study, we describe clinical and immunological characteristics shared by PIMS-TS, acute rheumatic fever and TSS, in order to provide hypotheses to direct future clinical and basic research studies.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Riitano
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
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Development and Evaluation of a New Triplex Immunoassay That Detects Group A Streptococcus Antibodies for the Diagnosis of Rheumatic Fever. J Clin Microbiol 2020; 58:JCM.00300-20. [PMID: 32461283 DOI: 10.1128/jcm.00300-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/20/2020] [Indexed: 02/04/2023] Open
Abstract
Streptococcal serology is a cornerstone in the diagnosis of acute rheumatic fever (ARF), a postinfectious sequela associated with group A Streptococcus infection. Current tests that measure anti-streptolysin O (ASO) and anti-DNaseB (ADB) titers require parallel processing, with their predictive value limited by the low rate of decay in antibody response. Accordingly, our objective was to develop and assess the diagnostic potential of a triplex bead-based assay, which simultaneously quantifies ASO and ADB together with titers for a third antigen, SpnA. Our previous cytometric bead assay was transferred to the clinically appropriate Luminex platform by coupling streptolysin O, DNaseB, and SpnA to spectrally unique magnetic beads. Sera from more than 350 subjects, including 97 ARF patients, were used to validate the assay and explore immunokinetics. Operating parameters demonstrate that the triplex assay produces accurate and reproducible antibody titers which, for ASO and ADB, are highly correlative with existing assay methodology. When ARF patients were stratified by time (days following hospital admission), there was no difference in ASO and ADB between <28 and 28+ day groups. However, for anti-SpnA, there was a significant decrease (P < 0.05) in the 28+ day group, indicative of faster anti-SpnA antibody decay. Anti-SpnA immunokinetics support very recent group A Streptococcus infection and may assist in diagnostic classification of ARF. Further, bead-based assays enable streptococcal serology to be performed efficiently in a high-throughput manner.
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Ghamrawy A, Ibrahim NN, Abd El-Wahab EW. How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018). PLoS Negl Trop Dis 2020; 14:e0008558. [PMID: 32804953 PMCID: PMC7451991 DOI: 10.1371/journal.pntd.0008558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/27/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023] Open
Abstract
Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.
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Affiliation(s)
- Alaa Ghamrawy
- Department of Non-Communicable Diseases, Ministry of Health and Population, Cairo, Egypt
| | - Nermeen N. Ibrahim
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W. Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- * E-mail:
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