Apparent Contrasting Rates of Pharyngitis and Pyoderma in Regions where Rheumatic Heart Disease is Highly Prevalent

McDonald, Malcolm; Brown, Alex; Edwards, Tahnia; Hope, Alex; Amu, Maryanne; Morey, Fran; Currie, Bart J.; Carapetis, Jonathan R.

doi:10.1016/j.hlc.2007.02.087

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Volume 16, Issue 4 , Pages 254-259, August 2007

Apparent Contrasting Rates of Pharyngitis and Pyoderma in Regions where Rheumatic Heart Disease is Highly Prevalent

Malcolm McDonald, MBBS
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Corresponding author at: Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia. Tel.: +61 8 89228196; fax: +61 8 89227876.
Alex Brown, MBBS
- Menzies School of Health Research, Alice Springs Campus, Charles Darwin University, Northern Territory, Australia
Tahnia Edwards, RN
- Centre for Remote Health, Alice Springs, Northern Territory, Australia
Alex Hope, MBBS
- The Ltyentye Apurte Health Centre, Ltyentye Apurte, Northern Territory, Australia
Maryanne Amu, RN
- The Ltyentye Apurte Health Centre, Ltyentye Apurte, Northern Territory, Australia
Fran Morey, MAppSci
- Medvet Science, Alice Springs, Northern Territory, Australia
Bart J. Currie, MBBS
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
Jonathan R. Carapetis, MBBS, PhD
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia

Received 23 October 2006; received in revised form 18 December 2006; accepted 7 February 2007.

Background

The aim of the study was to describe the epidemiology of pharyngitis and pyoderma in a Central Australian Aboriginal community with a high prevalence of rheumatic heart disease (RHD) and compare it to communities in the Top End of the Northern Territory.

Methods

Following ethics approval and community consultation, selected households were enrolled and visited over a 13-month period. People were asked if they had a sore throat and/or skin sores and asked about current or recent use of antibiotics; all throats and any pyoderma lesions were swabbed for bacterial culture. Beta-haemolytic streptococci (BHS), including group A streptococcus (GAS), were identified in the central laboratory using standard methods. Household crowding was also assessed. Results were then compared to those from the Top End study.

Results

Sore throat was relatively common (480 episodes per 100 person years), although there was only one case of GAS pharyngitis in 326 consultations. Only 5.5% of children <15 years had pyoderma during the course of the study. This is the opposite picture to that reported in the Top End where symptomatic pharyngitis is rare and pyoderma is common.

Conclusions

Although the data are limited, the epidemiology of pharyngitis and pyoderma in this Central Australian Aboriginal community appears to be more akin to that seen in temperate climates rather than tropical Top End communities. In this community, RHD preventative measure should continue to include aggressive treatment of pharyngitis according to recommendations.

Keywords: Rheumatic fever, Rheumatic heart disease, Beta-haemolytic streptococcus, Pharyngitis, Pyoderma, Aboriginal, Central Australia