Keywords:
Diagnostic tests and procedures; Epidemiology; Group A Streptococcus
Abstract:
Strep A POCT is a critical element in preventing acute rheumatic fever and will contribute to the elimination of rheumatic heart disease in Australia
Group A β-haemolytic Streptococcus pyogenes (Strep A) most commonly causes superficial infections of the throat (pharyngitis) and skin (impetigo). In Australia, one-third of primary school aged children have an episode of pharyngitis each year, with Strep A identified in about 20% of children with symptomatic pharyngitis and 10% of asymptomatic children. Superficial Strep A infections are the sole precursor of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), with risk likely to be driven by both pharyngitis and impetigo. These autoimmune sequelae are a major cause of morbidity and mortality in developing countries and among Indigenous people living in high income countries. The burden of ARF and RHD in remote Australian communities is high and disproportionately affects Aboriginal and Torres Strait Islander people. The reported mortality rates of RHD in Aboriginal populations are among the highest worldwide (28.4 per 100 000 population; 95% CI, 24.1–32.7). This is despite ARF and RHD being preventable through the early treatment of Strep A pharyngitis and impetigo. In this article, we focus on the use of molecular point-of-care testing (POCT) in the diagnosis of pharyngitis, which is the dominant superficial infection leading to ARF.