Persisting burden and challenges of rheumatic heart disease.
Eloi MarijonAna MocumbiKumar NarayananXavier JouvenDavid S CelermajerPublished in: European heart journal (2021)
Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by an abnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved living conditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a disease of poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease. Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common infectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. This relative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years. Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improving social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria and appropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies.
Keyphrases
- rheumatoid arthritis
- public health
- pulmonary hypertension
- healthcare
- antiretroviral therapy
- aortic valve
- mental health
- atrial fibrillation
- left ventricular
- hiv aids
- oxidative stress
- mitral valve
- hiv infected
- randomized controlled trial
- human immunodeficiency virus
- magnetic resonance imaging
- mycobacterium tuberculosis
- hepatitis c virus
- magnetic resonance
- hiv positive
- emergency department
- working memory
- cardiovascular events
- computed tomography
- type diabetes
- drug induced
- body composition
- human health
- hiv testing
- young adults
- bioinformatics analysis
- electronic health record
- global health