Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand

Abstract

Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), have largely disappeared from high-income countries. However, in New Zealand (NZ), rates remain unacceptably high in indigenous Māori and Pacific populations. The goal of this study is to identify potentially modifiable risk factors for ARF to support effective disease prevention policies and programmes. A case-control design is used. Cases are those meeting the standard NZ case-definition for ARF, recruited within four weeks of hospitalisation for a first episode of ARF, aged less than 20 years, and residing in the North Island of NZ. This study aims to recruit at least 120 cases and 360 controls matched by age, ethnicity, gender, deprivation, district, and time period. For data collection, a comprehensive pre-tested questionnaire focussed on exposures during the four weeks prior to illness or interview will be used. Linked data include previous hospitalisations, dental records, and school characteristics. Specimen collection includes a throat swab (Group A Streptococcus), a nasal swab (Staphylococcus aureus), blood (vitamin D, ferritin, DNA for genetic testing, immune-profiling), and head hair (nicotine). A major strength of this study is its comprehensive focus covering organism, host and environmental factors. Having closely matched controls enables the examination of a wide range of specific environmental risk factors.

Autoimmune and rheumatic musculoskeletal diseases as a consequence of SARS-CoV-2 infection and its treatment

“…This may reduce the occurrence of subsequent effects of influenza infection on RMDs. Diseases like acute rheumatic fever, where overcrowding plays an essential role in familial predisposition may also reduce with these hygienic measures [85]. At the negative spectrum of these hygienic measures, an increase in autoimmune disease should be born in mind as proposed by the proponents of the hygiene hypothesis.…”

Pediatric Inflammatory Multisystem Syndrome Temporally Related With SARS-CoV-2: Immunological Similarities With Acute Rheumatic Fever and Toxic Shock Syndrome

“…It is an immune-mediated consequence of group A beta-hemolytic streptococcal (GAS) infection which causes pharingotonsillitis, or even a paucy or asymptomatic first infection (10). Several exposures to GAS are thought to be necessary for priming of the immune responses and the later development of ARF (11). Importantly, evidence of exposure to GAS is the prerequisites for ARF diagnosis (12).…”

How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018)

“…In most populations, ARF is equally common in males and females, although an increased risk of RHD in females has been found in almost all populations [3,4,31,33,34], particularly in adolescents and adults rather than in children [26,33]. Conversely, male sex predominance of valvular disease in ARF was previously reported in Nepali children [35].…”

“…We identified ARF in people older than 30 years. Although we could not correctly delineate whether these were initial or recurrent episodes, literature would suggest these cases are almost entirely recurrences [1,4]. RHD is caused by accumulated heart valve damage from recurrent ARF episodes.…”

“…Recurrent episodes of ARF and its associated cardiac inflammation ultimately lead to permanent valvular damage and rheumatic heart disease (RHD) [2]. Molecular mimicry between the GABHS and heart or brain structures underlays the immune responses in ARF, where cross-reactive antibodies and T-cells that react with self-antigens are the effectors of valve or brain tissue damage [1,3,4]. The risk of ARF recurrences increases following the initial episode, although it can be largely prevented by secondary prophylaxis with injectable long-acting penicillin [benzathine penicillin G (BPG] every 3-4 weeks [5,6].…”