Management of Rheumatic Heart Disease among the children in regional areas of northern Australia
Mr Andrew Jeyaruban, Faculty of Medicine, James Cook University, Australia*
Acute Rheumatic Fever (ARF) may cause chronic progressive damage to the heart valves. Disease prevalence in Australia is highly correlated with low socioeconomic status. Although ARF is rare in Australia, the incidence among the indigenous children in regional areas of northern Australia is much higher than recently reported rates in other countries. The major factor involved with the occurrence of ARF is a high load of Group_A Streptococcus (GAS) infections. The infection with this bacterium occurs much more often where there are poor sanitation, overcrowding, and other factors usually associated with economic and social disadvantage. Genetic, environmental and immune system responses to GAS infection are the foundations on which ARF develops. ARF can subsequently lead to Rheumatic Heart Disease (RHD).
The RHD is a chronic condition, which leads to heart valve stenosis, with various levels of regurgitation, atrial dilation and arrhythmias. It is caused by long term damage to heart muscle and valve as a result of RF. The RHD could be controlled by proper management procedures such as quick diagnosis and treatment. These management procedures vary with time and duration of their application, to treat and to prevent recurrence attack.
In management of ARF, a single dose of intramuscular benzathine penicillin G or 10 days oral penicillin is proven to be effective in treating patients with one major manifestation such as arthritis or subcutaneous nodules and two other minor manifestations such as fever, arthralgia with a preceding GAS infection. In order to prevent recurrent infection, antibiotics administration at four week intervals and regular monitoring of the heart, especially the severity of the valve lesions, are recommended. The increased research into these issues and the implementation of effective strategies could reduce the prevalence and incidence of RHD among the indigenous children in regional areas of northern Australia.
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