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Rheumatic heart disease: progress and challenges in India.
[acute rheumatic fever]
Rheumatic
heart
disease
,
a
neglected
disease
,
continues
to
be
a
burden
in
India
and
other
developing
countries
.
It
is
a
result
of
an
autoimmune
sequalae
in
response
to
group
A
beta
hemolytic
streptococcus
(
GAS
)
infection
of
the
pharynx
.
Acute
rheumatic
fever
(
RF
)
,
a
multisystem
inflammatory
disease
,
is
followed
by
rheumatic
heart
disease
(
RHD
)
and
has
manifestations
of
joints
,
skin
and
central
nervous
system
involvement
.
A
review
of
epidemiological
studies
indicates
unchanged
GAS
pharyngitis
and
carrier
rates
in
India
.
The
apparent
decline
in
RHD
rates
in
India
as
indicated
by
the
epidemiological
studies
has
to
be
taken
with
caution
as
methodological
differences
exist
among
studies
.
Use
of
echocardiography
increases
case
detection
rates
of
RHD
in
population
surveys
.
However
,
the
significance
of
echo
based
diagnosis
of
carditis
needs
further
evaluation
to
establish
the
significance
.
Research
in
this
area
through
prospective
follow
up
studies
will
have
to
be
undertaken
by
the
developing
countries
as
the
interest
of
developed
countries
in
the
disease
has
waned
due
the
declined
burden
in
their
populations
.
Prevention
of
RHD
is
possible
through
treatment
of
GAS
pharyngitis
(
primary
prophylaxis
)
and
continued
antibiotic
treatment
for
number
of
years
in
patients
with
history
of
RF
to
prevent
recurrences
(
secondary
prophylaxis
)
.
The
cost
effectiveness
and
practicality
of
secondary
prophylaxis
is
well
documented
.
The
challenge
to
any
secondary
prophylaxis
program
for
prevention
of
RF
in
India
will
be
the
availability
of
benzathine
penicillin
G
and
dissipation
of
fears
of
allergic
reactions
to
penicillin
among
practitioners
,
general
public
and
policy
makers
.
The
authors
review
here
the
progress
and
challenges
in
epidemiology
,
diagnosis
and
primary
and
secondary
prevention
of
RF
and
RHD
.
Diseases
Validation
Diseases presenting
"autoimmune sequalae in response"
symptom
acute rheumatic fever
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