Contemporary Issues in Rheumatic Fever and Chronic Rheumatic Heart Disease

During the early part of the 20th century, rheumatic fever (RF) and rheumatic heart disease were considered the “most deadly enemy of youth.”1 Although RF has almost disappeared in developed countries, it remains rampant in regions of the world characterized by poverty, overcrowding, and lack of adequate health care.Progress in the field of rheumatic heart disease (RHD) has been slow, in part, because the disease has largely been eradicated from the developed world, but more importantly, because human immunodeficiency virus (HIV) and tuberculosis (TB) now occupy the center stage of disease in the developing world. Although the global annual mortality for HIV is 1.5 million2 and the global annual mortality for TB is 1.3 million,3 that for RHD is not insignificant at an estimated 233 000.4 The fact is that, at a fraction of the cost of treating HIV/TB, but with concerted effort, we have the potential to all but eliminate the burden of RHD.Although there are many unresolved questions around RF and chronic RHD, we have chosen to address those that we believe are germane to promoting a better understanding of the changing epidemiology, diagnostic methods, prevention, and treatment of the disease.There has been a profound decline in RF in Europe and North America beginning around the middle of the last century. Until recently, the incidence of RF was so low that it was thought to have all but disappeared in the United States.5 The inappropriateness of a complacent approach was highlighted by a sharp rise in the incidence of RF in geographically distinct regions of the United States, starting in Utah in 1985.6 A surge in the incidence of RF has been noted elsewhere as well. With the collapse of the USSR, the incidence of RF has increased dramatically …