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Rheumatic Fever Follow-Up Study (RhFFUS) protocol: a cohort study investigating the significance of minor echocardiographic abnormalities in Aboriginal Australian and Torres Strait Islander children.
[acute rheumatic fever]
In
Australia
,
rheumatic
heart
disease
(
RHD
)
is
almost
exclusively
restricted
to
Aboriginal
Australian
and
Torres
Strait
Islander
people
with
children
being
at
highest
risk
.
International
criteria
for
echocardiographic
diagnosis
of
RHD
have
been
developed
but
the
significance
of
minor
heart
valve
abnormalities
which
do
not
reach
these
criteria
remains
unclear
.
The
Rheumatic
Fever
Follow-
Up
Study
(
RhFFUS
)
aims
to
clarify
this
question
in
children
and
adolescents
at
high
risk
of
RHD
.
RhFFUS
is
a
cohort
study
of
Aboriginal
and
/
or
Torres
Strait
Islander
children
and
adolescents
aged
8
-
17
years
residing
in
32
remote
Australian
communities
.
Cases
are
people
with
non-
specific
heart
valve
abnormalities
detected
on
prior
screening
echocardiography
.
Controls
(
two
per
case
)
are
age
,
gender
,
community
and
ethnicity-matched
to
cases
and
had
a
prior
normal
screening
echocardiogram
.
Participants
will
have
echocardiography
about
3
years
after
initial
screening
echocardiogram
and
enhanced
surveillance
for
any
history
suggestive
of
acute
rheumatic
fever
(
ARF
)
.
It
will
then
be
determined
if
cases
are
at
higher
risk
of
(
1
)
ARF
or
(
2
)
developing
progressive
echocardiography-detected
valve
changes
consistent
with
RHD
.
T
he
occurrence
and
timing
of
episodes
of
ARF
will
be
assessed
retrospectively
for
5
years
from
the
time
of
the
RhFFUS
echocardiogram
.
Episodes
of
ARF
will
be
identified
through
regional
surveillance
and
notification
databases
,
carer
/
subject
interviews
,
primary
healthcare
history
reviews
,
and
hospital
separation
diagnoses
.
Progression
of
valvular
abnormalities
will
be
assessed
prospectively
using
transthoracic
echocardiography
and
standardized
operating
and
reporting
procedures
.
Progression
of
valve
lesions
will
be
determined
by
specialist
cardiologist
readers
who
will
assess
the
initial
screening
and
subsequent
RhFFUS
screening
echocardiogram
for
each
participant
.
The
readers
will
be
blinded
to
the
initial
assessment
and
temporal
order
of
the
two
echocardiograms
.
RhFFUS
will
determine
if
subtle
changes
on
echocardiography
represent
the
earliest
changes
of
RHD
or
mere
variations
of
normal
heart
anatomy
.
In
turn
it
will
inform
criteria
to
be
used
in
determining
whether
secondary
antibiotic
prophylaxis
should
be
utilized
in
individuals
with
no
clear
history
of
ARF
and
minor
abnormalities
on
echocardiography
.
RhFFUS
will
also
inform
the
ongoing
debate
regarding
the
potential
role
of
screening
echocardiography
for
the
detection
of
RHD
in
this
setting
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated