Rheumatic heart disease: progress and challenges in India

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Rheumatic heart disease (RHD) is a neglected disease prevalent in India and other developing countries.
• It arises from an autoimmune response to group A beta hemolytic streptococcus (GAS) pharyngeal infections, leading to acute rheumatic fever (RF) and subsequent RHD.
• RF involves multisystem inflammation affecting joints, skin, and the central nervous system.

Purpose of the Study:

• To review the current progress and challenges in the epidemiology, diagnosis, and prevention of RF and RHD.
• To highlight the need for continued research in developing countries due to waning interest from developed nations.
• To discuss the feasibility and obstacles of implementing prophylaxis programs for RHD prevention.

Main Methods:

• Review of epidemiological studies on GAS pharyngitis and RHD rates in India.
• Evaluation of echocardiography's role in RHD case detection.
• Analysis of primary and secondary prophylaxis strategies for RF and RHD.

Main Results:

• Epidemiological data suggests unchanged GAS pharyngitis rates in India, but RHD rate declines require cautious interpretation due to methodological differences.
• Echocardiography enhances RHD detection, though the clinical significance of echo-diagnosed carditis needs further study.
• Primary prophylaxis (GAS pharyngitis treatment) and secondary prophylaxis (long-term antibiotics for RF patients) are effective prevention methods.

Conclusions:

• RHD prevention is achievable through timely treatment of GAS infections and robust secondary prophylaxis programs.
• Challenges to secondary prophylaxis in India include the availability of benzathine penicillin G and public/practitioner concerns regarding penicillin allergies.
• Prospective follow-up studies are essential for developing countries to advance RHD research and control efforts.