Back to Journals » Clinical Epidemiology » Volume 3 » Issue 1

Letter to the editor

Authors Zühlke L, Engel ME 

Published 18 May 2011 Volume 2011:3(1) Pages 171—173


LJ Zühlke¹, ME Engel²
¹Western Cape Paediatric Cardiac Services, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; ²Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

We would like to applaud the authors of the article "The worldwide epidemiology of acute rheumatic fever (ARF) and rheumatic heart disease (RHD)"¹ for highlighting this important disease which continues needlessly to kill people living in poverty while being largely ignored by the developed world.² We would however like to address some key issues.

The authors state that: the evidence of serologic infection is based on one of "a pharyngeal swab culture positive for GABHS, positive rapid GABHS antigen test or rising serologic antibody titers". Very few countries in highly affected regions of the world utilize routine rapid antigen or microbiological testing due to the cost involved. Furthermore, the delay involved in repeat serological testing before a diagnosis can be made, will result in missed diagnoses and tragic consequences. We recommend therefore that elevated serological markers of previous GABHS infection, together with major and minor criteria, are sufficient for a diagnosis of ARF.

Creative Commons License © 2011 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.