Abstract:
Group A Streptococcus (GAS) causes superficial and invasive infections and immune
mediated post-infectious sequalae (including acute rheumatic fever/rheumatic heart disease). Acute
rheumatic fever (ARF) and rheumatic heart disease (RHD) are important determinants of global
cardiovascular morbidity and mortality. ARF is a multiorgan inflammatory disease that is trig-
gered by GAS infection that activates the innate immune system. In susceptible hosts the response
against GAS elicits autoimmune reactions targeting the heart, joints, brain, skin, and subcutaneous
tissue. Repeated episodes of ARF—undetected, subclinical, or diagnosed—may progressively lead
to RHD, unless prevented by periodic administration of penicillin. The recently modified Duckett
Jones criteria with stratification by population risk remains relevant for the diagnosis of ARF and
includes subclinical carditis detected by echocardiography as a major criterion. Chronic RHD is
defined by valve regurgitation and/or stenosis that presents with complications such as arrhythmias,
systemic embolism, infective endocarditis, pulmonary hypertension, heart failure, and death. RHD
predominantly affects children, adolescents, and young adults in LMICs. National programs with
compulsory notification of ARF/RHD are needed to highlight the role of GAS in the global burden
of cardiovascular disease and to allow prioritisation of these diseases aimed at reducing health
inequalities and to achieve universal health coverage.
