Progress in detecting rheumatic fever
Rheumatic fever is triggered by infection with Group A Streptococcus. In Australia, large disparities in rates exist, with Aboriginal children most affected. Rheumatic fever causes diverse symptoms that can be mild to life threatening, ranging from arthritis through to cardiac involvement or neurological symptoms.
Given these differing manifestations, health practitioners often fail to get the diagnosis right. Even if they suspect rheumatic fever, there is no diagnostic test. All health practitioners can use is clinical judgement guided by a set of diagnostic criteria. Getting the diagnosis right is critically important, so preventive strategies and antibiotics can be prescribed to prevent further attacks which cause rheumatic heart disease.
ASID member Professor Anna Ralph and the team from the Menzies School of Health Research and Royal Darwin Hospital have developed a smartphone app which condenses the national clinical guidelines on rheumatic fever and rheumatic heart disease.
The app includes a diagnosis calculator which takes some of the challenge out of diagnosing rheumatic fever. It has ‘possible’ and ‘probable’ diagnostic categories for when there is uncertainty; and provides management pathways for these in the national guidelines.
Recent data shows that these categories are being applied appropriately. People with ‘possible’ rheumatic fever and no initial signs of heart involvement are least likely to ever develop rheumatic heart disease (around 2% did during 5.5 years of follow up), followed by ‘probable’ (6%) and ‘definite’ (10%).
An important next step is to work towards developing a diagnostic test. This is being undertaken by an international collaboration of clinicians and laboratory scientists.
This program of work is one of many aiming to contribute to the elimination of rheumatic heart disease as a public health problem.
This work was funded via the National Health and Medical Research Council and Australian Government Department of Health.
Professor Ralph is the director of Global and Tropical Health at Menzies School of Health Research in Darwin. She is a National Health and Medical Research Council Career Development Fellow, and is the Clinical Director of Rheumatic Heart Disease Australia, as well as being a practicing medical specialist in general medicine and infectious diseases at Royal Darwin Hospital.
She showcased this work at the ASID ASM in Adelaide in April 2023.
Key information from The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition) can be accessed from an iPhone, iPad and Android phone for free.