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  • Title: Acute rheumatic fever in Africa.
    Author: Olubodun JO.
    Journal: Afr Health; 1994 Jul; 16(5):32-3. PubMed ID: 12318891.
    Abstract:
    Acute rheumatic fever (RF) is a common health problem in Africa, Asia, and South America. This article gives a description of the clinical diagnosis, management, and prevention of RF. The seriousness of the problem is reflected in the fact that almost 13.3% of the population in the developing world may be throat carriers of RF, and almost 40% of infected persons may suffer from the tragic complication, rheumatic heart disease (RHD). Incidence of RHD in Africa is estimated at 17-43% of all cardiovascular disease. RF is the result of complications from group A hemolytic streptococcal infection of the upper respiratory tract. Severity of RF infection is determined by the severity of the streptococcal infection, length of time the organism survived in the throat, degree of antistreptolysin response, early age of onset, and frequent undiagnosed recurrences. RF is prevalent among children aged 5-10 years, and males are more affected. Acute RF occurs within two weeks of acute streptococcal infections. Predisposing factors are identified as low socioeconomic status, poor sanitation, and genetic propensity. The modified Jones criteria is useful in diagnosing RF, either with two major criteria or one major and two minor criteria. Obstacles to early detection of RF are stated as late medical assessment when symptoms are no longer present, little medical history of sore throats, frequent indiscriminate use of antibiotics and salicylates, and mild attacks not included in the Jones criteria. Diagnosis is dependent upon a high index of suspicion and good clinical judgment. Treatment of acute RF involves complete bed rest and administration of 50 mg/kg daily of acetyl salicylate for children unless signs of rheumatic activity reappear. Caution is urged in prescribing large doses. Corticosteroids may be administered in carditis cases. Penicillin may be given in the acute stage, but this does not prevent RHD. Premature administration of drugs may obscure RHD. Diuretics may be used for cardiac failure. Primary prevention involves avoidance of contact with persons with colds and upper respiratory tract infections, prevention of infection, prompt treatment of streptococcal sore throat, improved standards of housing, and possibly immunization. Prevention of reoccurrences may include administration of benzathine penicillin (0.6-1.2 mu monthly) or penicillin V (125-250 mg, twice daily) until the age of 25 years is reached. Serious complications are permanent heart damage and economic costs.
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