Determining risk of acute rheumatic fever in patients with impetigo

Assessment of patient’s risk of acute rheumatic fever is an important consideration when treating impetigoRHDAustralia (ARF/RHD writing group), 2020.

An individual is at high risk of developing acute rheumatic fever if they are younger than 40 years and any one of the followingRHDAustralia (ARF/RHD writing group), 2020:

  • an Aboriginal and/or Torres Strait Islander person living in a rural or remote area
  • an Aboriginal and/or Torres Strait Islander person, or a Māori and/or Pacific person, living in a household affected by overcrowding or experiencing socioeconomic disadvantage
  • a person with a history of acute rheumatic fever or rheumatic heart disease
  • part of a family or household in which a member has a recent history of acute rheumatic fever or rheumatic heart disease.

For individuals younger than 40 years, but particularly between 5 and 20 years, other factors that could put them at high risk of developing acute rheumatic fever includeRHDAustralia (ARF/RHD writing group), 2020:

  • living in a household affected by overcrowding and experiencing socioeconomic disadvantage
  • current or prior residence in, or frequent or recent travel to, an Australian setting with a high rate of acute rheumatic fever1
  • current or prior residence in, or frequent or recent travel to, an international setting with a high rate of acute rheumatic fever (eg refugees, migrants)2.

Assessing risk of acute rheumatic fever should include the clinician’s knowledge of the patient (including travel history), understanding of their communities, and local epidemiology.

Health outcomes are significantly impacted by geographical, historical, socioeconomic, spiritual, emotional and cultural determinants. In Aboriginal and Torres Strait Islander peoples, the incidence of infection and increased risk of poor health outcomes can be linked to complex socioeconomic factors, including poverty, reduced access to health services, incarceration, discrimination and intergenerational trauma. A shared strengths–based approach to healthcare that recognises each patient's unique cultural determinants and circumstances is essential.

1 In Australia, acute rheumatic fever is generally considered to be endemic in Far North Queensland and North Queensland, the Northern Territory, and the Pilbara and Kimberley regions of Western Australia; acute rheumatic fever rates may also be high in other remote areas of Australia.Katzenellenbogen, 2020Return
2 Internationally, high rates of acute rheumatic fever occur in low- to middle-income countries.RHDAustralia (ARF/RHD writing group), 2020Return