Prevention and Diagnosis of Rheumatic Fever and Rheumatic Heart Disease
Summary of Recommendations
Health education
Group A streptococcal pharyngitis
Skin and skin structure infections
Diagnosis of rheumatic fever
Echocardiography in the diagnosis of rheumatic fever and rheumatic heart disease
Antibiotic prophylaxis for the prevention of recurrent rheumatic fever
An oral penicillin test dose may be given prior to IM BPG administration for patients who have a history of mild penicillin allergy; that is, in patients without a prior history of anaphylaxis, angioedema, StevenJohnson’s syndrome or toxic epidermal necrolysis. (Conditional recommendation, low certainty evidence for immediate allergy and anaphylaxis; very low for delayed allergy)
(C, VL )Anti-inflammatory agents for the treatment of rheumatic fever
Recommendation Grading
Disclaimer
Overview
Title
Prevention and Diagnosis of Rheumatic Fever and Rheumatic Heart Disease
Authoring Organization
World Health Organization
Publication Month/Year
October 29, 2024
Last Updated Month/Year
October 29, 2024
Document Type
Guideline
Country of Publication
Global
Document Objectives
Rheumatic fever (RF) and Rheumatic heart disease (RHD) are a preventable public health problem in low- and middle-income countries and in marginalized communities in middle- and high-income countries. RF is an autoimmune inflammatory reaction to throat infections (pharyngitis) or possibly to superficial skin and skin structure infections caused by Streptococcus pyogenes, a group A beta‐haemolytic Streptococcus (GAS) bacterium. The first episode of RF is commonly seen in children aged 5 to 14 years. Recurrent episodes are most common within 1 year of the first episode but can occur throughout the life course. RHD is characterized by chronic structural and/or functional changes in the heart, most commonly in the valves, caused by one or more episodes of rheumatic fever (RF). RHD most commonly starts in childhood with a diagnostic peak in young adults aged 20 to 39 years. RHD can lead to death or lifelong disability, however, effective early intervention can prevent premature morbidity and mortality. The WHO guideline on the prevention and diagnosis of rheumatic fever (RF) and rheumatic heart disease (RHD) provides evidence-informed recommendations for the prevention and management of RF and RHD. It encompasses three areas; 1) primary prevention of rheumatic fever and rheumatic heart disease, specifically the identification and treatment of suspected group A (beta-haemolytic) Streptococcus (GAS) pharyngitis and skin infections; 2) secondary prevention of recurrent rheumatic fever and of rheumatic heart disease, specifically use of long-term antibiotic prophylaxis, interventions to increase adherence to antibiotic prophylaxis, and screening for early rheumatic heart disease; and 3) management of rheumatic fever, specifically the treatment with anti-inflammatory drugs.
Inclusion Criteria
Male, Female, Adolescent, Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D012213 - Rheumatic Fever, D012214 - Rheumatic Heart Disease
Keywords
rheumatic heart disease, rheumatic fever
Source Citation
WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.