Download prevalence of early rheumatic heart disease in rural guyanese

1497, poster, cat: 49
PREVALENCE OF EARLY RHEUMATIC HEART DISEASE IN RURAL
GUYANESE AMERINDIAN CHILDREN AS DETECTED BY
ECHOCARDIOGRAPHIC SCREENING
S.N.L. Roth1,2, L. Aronson5, L. Craw1,4, F. Fernandes1,4, E. Koelink1,4, J. Longtin6,
N. Musewe7, B. Ortuoste2, N.R. Saunders1,4, M. Silverman3
1
University of Toronto, Toronto, ON, Canada, 2The Scarborough Hospital, Toronto,
ON, Canada, 3Lakeridge Health Centre, Oshawa, ON, Canada, 4Hospital for Sick
Children, Toronto, ON, Canada, 5North York General Hospital, 6Ontario Agency for
Health Protection and Promotion, Toronto, ON, Canada, 7Markham Stouffville
Hospital, Markham, ON, Canada
Background: Cardiac auscultation has low sensitivity for diagnosing rheumatic heart
disease (RHD) in children. No previous prevalence studies using echo Doppler (ED)
to screen for RHD in children in the tropical Western Hemisphere exist.
Objective: To determine the prevalence of early changes by ED in asymptomatic
children compatible with RHD in the Amerindian population of rural Guyana.
Methods: A Canadian medical team visited ten remote Amerindian villages in eastern
and southern Guyana. Randomly selected healthy children underwent clinical
examination and ED study using portable equipment. Two cardiologists using prespecified criteria reviewed all ED studies. If RHD findings were noted, a long-term
penicillin supply for secondary prophylaxis was provided. A small subgroup of
identified RHD cases (7) and ED negative age and sex matched controls (15)
underwent throat swabs for PCR for Streptococcus pyogenes and Streptococcal
serology (ASOT).
Results: 228 children between the ages of 8 and 17 years were reviewed: Thirteen
children had definite echo evidence for RHD (5.9%). Sixty-seven percent had
evidence of recent streptococcal infection. The relative risk of cases versus controls of
being PCR positive for Streptococcus pyogenes was 3.6 (p<0.05). Incidental findings
included one case each of patent ductus arteriosus, bicuspid aortic valve, ventricular
and atrial septal defect.
Conclusions: Although sample size is small, this study suggests the highest
prevalence of subclinical RHD worldwide and evidence of extremely high prevalence
of streptococcal infection. Approaches to the local diagnosis and management of
streptococcal pharyngitis need to be reassessed and appropriate treatment algorithms
formulated to reduce RHD prevalence.