Most Patients with Acute Rheumatic Fever in Remote Far North Queensland, Australia, Do Not Present to Healthcare Facilities with a Group A Streptococcus Infection Before Diagnosis

Abstract

Although acute rheumatic fever (ARF) is a preventable condition, it continues to be diagnosed in Far North Queensland, Australia. Enhanced primary prevention is necessary to reduce the local burden of ARF and rheumatic heart disease. In this retrospective clinical audit, all cases of definite ARF in the remote Torres Strait and Cape York region of Far North Queensland between January 2020 and December 2024 were examined. Clinical records were reviewed to identify and characterize any healthcare presentations of individuals during the 6 weeks preceding their ARF diagnosis. Of 67 individuals with definite ARF 65 (97%) identified as First Nations Australians; 43/67 (64%) did not present for any healthcare in the 6 weeks preceding their diagnosis; and a further 10/67 (15%) presented for healthcare that was unrelated to group A Streptococcus (Strep A) infection. Overall, a possible Strep A infection (skin infection or sore throat) was identified in 14/67 (21%) patients; 9/67 (13%) patients presented with skin infections, and 5/67 (7%) presented with sore throats. Of these, 5/14 (36%) received appropriate antibiotic treatment. Most individuals with definite ARF in this remote region of Australia do not present for healthcare before their diagnosis; however, there remain opportunities for the primary prevention of ARF among those who do. Culturally considered health promotion, opportunistic screening, and improved recognition and treatment of Strep A infection are critical for reducing ARF incidence in this region of Australia. It is also important to define the contribution of asymptomatic Strep A infections to the pathogenesis of ARF.