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Diagnosing Rheumatic Heart Disease in Developing Countries

Echocardiographic screening detected about 10 times as many children with RHD as did use of clinical evidence with echocardiographic confirmation.

Rheumatic heart disease (RHD) causes considerable morbidity and mortality in developing nations, where it is typically a clinical diagnosis confirmed by echocardiography. How often does clinically inapparent RHD occur, detected only by echocardiography? To find out, investigators evaluated randomly selected 6- to 17-year-old children in Cambodia and Mozambique for RHD by both clinical and echocardiographic criteria.

Clinical evidence of RHD was found in 8 of 3677 Cambodian children (prevalence, 2.2 cases per 1000 children) and 5 of 2170 Mozambican children (2.3 cases per 1000). These rates were similar to rates seen in other published population-based surveys. Echocardiography revealed RHD in 79 of the Cambodian and 66 of the Mozambican children (21.5 cases and 30.4 cases per 1000). The ratios of echocardiographic to clinical detection of RHD were 9.8 and 13.2 in the Cambodian and Mozambican children, respectively.

Comment: In Cambodia and Mozambique, clinically silent RHD, detected by echocardiography, is about 10 times as common as RHD diagnosed by clinical examination. This striking finding has important implications for planning health-service delivery and targeting affected children for benzathine penicillin G injections to prevent recurrent group A streptococcal infections. Charitable foundations should very seriously consider funding ultrasound equipment in developing nations.

— Neil R. Blacklow, MD

Published in Journal Watch Infectious Diseases August 1, 2007

Citation(s):

Marijon E et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007 Aug 2; 357:470-6.

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