Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren

Abstract

Screening is a useful method for detecting asymptomatic RHD in regions of high prevalence and we report a high echocardiographically confirmed prevalence. The most appropriate screening strategy remains to be confirmed, however, and implementation will depend on the availability of echocardiography and trained staff.

The challenge of screening for asymptomatic rheumatic heart disease in South Africa

“…(8,11) If clinical diagnosis had been relied upon in the Mozambique study, approximately 90% of echocardiographically detected cases would have been missed. (8,10) In the Mozambican study, clinical examination underdiagnosed rheumatic heart disease more than 10 fold, whereas in the Tongan study, the opposite held in that junior auscultators overestimated rheumatic heart disease.…”

“…(14,15) Clinical and echocardiographic screening studies indicate that the overwhelming majority of cases (over 85%) with defi nite rheumatic heart disease are asymptomatic. (1,8,11,12) These observations indicate that the disease has a pre-symptomatic stage that can be detected by portable echocardiography and penicillin prophylaxis is available to prevent recurrent attacks of rheumatic fever and potentially ameliorate the development of chronic rheumatic heart disease. There is therefore a strong case to be made for the screening of the general population for rheumatic heart disease in South Africa and other countries where the disease remains endemic.…”

“…(10)(11)(12) These echocardiographic screening studies have major implications for clinical and public health practice in South Africa. These data raise questions on whether screening for asymptomatic rheumatic heart disease is required, how it should be conducted, what diagnostic criteria should be used, and the cost-effectiveness of screening for asymptomatic rheumatic heart disease.…”

Rhumatisme articulaire aigu

“…Le nombre de lésions valvulaires était 3 à 10 fois supérieur à celui détecté par le stéthoscope selon les critères utilisés [18,19]. Ces données ont ensuite été confirmées par d'autres équipes [20]. Cependant, la distinction entre une situation variante de la normale et une atteinte rhumatismale minime est parfois subtile.…”

Screening for asymptomatic rheumatic heart disease: Understanding the mechanisms key to the diagnostic criteria

“…This strategy relies entirely on case detection and echocardiography has been identified as a superior modality (compared to clinical screening with auscultation) to deliver these cases. (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) However, this strategy has its problems. This focused review will critically evaluate the shortcomings of the current criteria used for the screening of asymptomatic RHD.…”