Rouhiainen Oliver, Gatti Jessica, Ramadani Seide, Stewart Jayden, Matthews Melanie, Fairhurst Helen, Remenyi Bo, Francis Joshua R, Yan Jennifer
Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
Mala'la Health Service Aboriginal Corporation, Maningrida, Australia.
J Paediatr Child Health. 2025 May;61(5):741-746. doi: 10.1111/jpc.16797. Epub 2025 Feb 23.
A cross-sectional echocardiographic screening study in a remote Aboriginal community in Australia identified hyperendemic levels of rheumatic heart disease (RHD). 20/613 screened were newly diagnosed with RHD, and 18/20 had no known history of acute rheumatic fever (ARF). Our aim was to explore the medical histories of those newly diagnosed with RHD for potential (1) missed opportunities for primary prevention of ARF through management of Group A Streptococcal (Strep A) infection, and (2) missed opportunities for diagnosis of ARF.
We assessed community clinic and tertiary hospital medical records of those children with new diagnoses of RHD (n = 20), and collected information regarding previous episodes of possible Strep A infection or its sequelae.
All 20 participants had previous documented possible or confirmed Strep A infections, predominantly in the form of impetigo or infected scabies (range 1-17 episodes per participant). At least 15/20 participants had potential Strep A infections where treatment that was documented may not have adequately covered Strep A. 11/20 participants had scabies diagnosed without documented scabies treatment. 2/20 participants had previously diagnosed ARF, however these were diagnosed within the month prior to the community-wide screening for RHD. 2/20 participants had undiagnosed, probable or possible ARF when classified retrospectively from review of their case documentation. 13/20 participants had non-specific presentations with joint complaints that may have represented an ARF episode but with inadequate workup to fulfil diagnostic criteria on retrospective assessment.
在澳大利亚一个偏远的原住民社区进行的一项横断面超声心动图筛查研究发现，风湿性心脏病（RHD）的地方性流行程度很高。在613名接受筛查的人中，有20人被新诊断为RHD，其中18人既往无急性风湿热（ARF）病史。我们的目的是探究那些新诊断为RHD的患者的病史，以寻找潜在的：（1）通过管理A组链球菌（A组链球菌）感染进行ARF一级预防的错失机会；（2）ARF诊断的错失机会。
我们评估了那些新诊断为RHD的儿童（n = 20）的社区诊所和三级医院病历，并收集了有关既往可能的A组链球菌感染或其后遗症发作的信息。
所有20名参与者既往均有记录的可能或确诊的A组链球菌感染，主要表现为脓疱病或疥疮感染（每位参与者1 - 17次发作）。至少15/20的参与者存在潜在的A组链球菌感染，其记录的治疗可能未充分覆盖A组链球菌。11/20的参与者被诊断为疥疮但无疥疮治疗记录。2/20的参与者既往被诊断为ARF，但这些诊断是在社区范围内进行RHD筛查前一个月内做出的。回顾其病例文档进行分类时，2/20的参与者存在未诊断的、可能或疑似的ARF。13/20的参与者有非特异性的关节症状，可能代表一次ARF发作，但回顾性评估时检查不充分，未达到诊断标准。
