Preceding group A streptococcus skin and throat infections are individually associated with acute rheumatic fever

Evidence from New Zealand

Bibliographic Data

ID21880908
AuthorsJane Oliver (0000-0001-5548-7512, The University of Melbourne), Julie Bennett (0000-0002-3461-7223, University of Otago, corresponding author), Sally Thomas (0000-0001-9337-9168, University of Otago), Jane Zhang (0000-0003-2725-1259, University of Otago), Nevil Pierse (0000-0002-2726-8141, University of Otago), Nicole J Moreland (0000-0001-6548-637X, University of Auckland), Deborah A Williamson (0000-0001-7363-6665, The University of Melbourne), Susan Jack (0000-0001-9459-6455, Southern District Health Board), Michael G Baker (0000-0002-1865-1536, University of Otago), Michael Baker (0000-0003-2507-3436, Department of Public Health, University of Otago Wellington, Wellington, New Zealand)
Year2021
Volume6
Issue12
Pagese007038
Publication date2021-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-007038
PMID34887304
OpenAlexW4200476183
LanguageEN
Citations received4
References cited16

INTRODUCTION: Acute rheumatic fever (ARF) is usually considered a consequence of group A streptococcus (GAS) pharyngitis, with GAS skin infections not considered a major trigger. The aim was to quantify the risk of ARF following a GAS-positive skin or throat swab. METHODS: This retrospective analysis used pre-existing administrative data. Throat and skin swab data (1 866 981 swabs) from the Auckland region, New Zealand and antibiotic dispensing data were used (2010-2017). Incident ARF cases were identified using hospitalisation data (2010-2018). The risk ratio (RR) of ARF following swab collection was estimated across selected features and timeframes. Antibiotic dispensing data were linked to investigate whether this altered ARF risk following GAS detection. RESULTS: ARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8-90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1). CONCLUSIONS: A GAS-positive throat or skin swab is strongly associated with subsequent ARF, particularly for Māori and Pacific Peoples. This study provides the first population-level evidence that GAS skin infection can trigger ARF

Antibiotics · Biology · Confidence interval · Pharyngitis · Relative risk · Skin infection · Staphylococcus aureus · Streptococcus · Throat · Antimicrobial Resistance in Staphylococcus · Infective Endocarditis Diagnosis and Management · Medicine · Streptococcal Infections and Treatments · Internal Medicine · Microbiology · Surgery

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