Poster Presentation 20th Lancefield International Symposium on Streptococci and Streptococcal Diseases 2017

The natural & unnatural history of acute rheumatic fever in the modern era. (#228)

Abigail North 1 , Walston Martis 1 , Joanne Wordley 2 , Briar Peat 1 , Diana Lennon 1 2 3 , Vigna Vignakumar 3 , Tim Sutton 3 , Ross Nicholson 3
  1. University Of Auckland, Auckland, New Zealand
  2. Auckland District Health Board, Auckland, New Zealand
  3. Counties Manukau Health, Auckland, New Zealand

Outcome following acute rheumatic fever (ARF) is determined by the presence, severity and progression of rheumatic heart disease (RHD). The focus of our study was the long-term outcome of mitral (MV) and aortic (AV) valves, and left ventricular size and function. 144 children and adults were admitted to Middlemore Hospital 1998-2002 with their first known episode of ARF. 86 of the patients had a follow up echocardiogram completed 10 or more years after diagnosis. The mean age at diagnosis was 12.8 years. 69% were Pacific, 26% Maori, 5% other.


After a first episode of ARF only 1 in 8 children & young people develop severe mitral or aortic regurgitation. Half of these undergo valve repair or replacement. The left ventricle is not dilated at diagnosis unless there is at least one valve with severe regurgitation. 2/3 of children requiring valve surgery have a good outcome 10 or more years from diagnosis and intervention. Aortic and mitral valves that escape surgery improve in the majority if adherent to benzathine penicillin prophylaxis.

The BMI of the cohort increased markedly during follow up with 8/10 being obese at end of the study. By the end of the study, patients with a markedly increased BMI were developing structural cardiac disease attributable to obesity rather than RHD which was mostly mild. This has potential implications to the longer term cardiovascular well being of young people who have been successfully treated for their index episode of rheumatic fever.